Teamwork

In your coursework at Rollins, you will often be asked to complete group work either in the form of larger projects or smaller discussion groups. After Rollins, being able to enhance the work of a team will be an invaluable skillset in the professional setting. Public health is a field that needs to communicate effectively with other science fields, policy makers and the public to gain support for recommendations. Collaborative relationships are necessary for success and in public health, success means saving lives and increasing quality of life.

When I think of teamwork, I think of the African Proverb:

“If you want to go quickly, go alone.  If you want to go far, go together.”

While group assignments are not always met with excitement, they are a great way to practice teamwork and flex skills that help everyone succeed. Teamwork is everyone’s responsibility and will be an important skill in your career. Some important traits that I seek out in good team members include accountability, commitment, flexibility and optimism.

Accountability and commitment

Every individual on a team has an enormous effect on a team’s dynamic and its performance. While a leader might seem like the person who can solely guide a team to success, I believe each member plays a significant role in deciding how the team will function. It does not take many team members to lead a talented group towards dysfunction. Individuals are ultimately responsible for deciding whether the team will be stymied by this dysfunction or will hold each other and themselves accountable to being functional and high performing.

This commitment to high standards can be coached, but a team is so much more effective if this comes from each individual in a team. You want team members who are committed to the goal and to each other. This commitment includes supporting each other. When others need help, every team member should be aware of those needs and willing to provide their support. This commitment to each other is an essential ingredient in successful teams.

Flexibility and optimism

Team members also need to be flexible. When talented individuals with different approaches, ideas, and skills are brought together on a team, some conflict will be inevitable. The most effective teams have members who actively seek out and include others in making key decisions and solving problems creatively. They understand that having a diversity of opinions leads to optimal solutions and that you need to listen to these ideas and experiences of others because they will stretch you, challenge you, and call on you to empathize. In that context, disagreement is a blessing, not a curse. If you truly value the opinions and input of others, your team will benefit as a whole, and each member will grow.

I also believe successful teams approach the team’s goals and the future optimistically. Optimism tends to lead to more energy about a project and is an approach that feeds connection and commitment. It is much easier to be committed to a team that is forward thinking, flexible in opinion, and filled with the expectation of good work together.

Teamwork in action

It is certainly true that teamwork is not always easier than working alone, but the benefits of a connected and hardworking team can be immense. The next time you are part of a team, consider how you engage to support teammates and the goals of the team. Practice being the teammate you want to have. Connect, support, listen, encourage and motivate each other. These skills will serve you well both in school and in your career. 

Lessons in Resilience – Be like the weeble

“Do not judge me by my success, judge me by how many times I fell down and got back up again.” 

― Nelson Mandela 

After a recent meeting, a debriefing conversation sidelined to discussing the general sense of angst we were all (students, staff, faculty, children..) experiencing, and the phrase “lessons in resilience” was spoken*..  which got me wondering – what is resilience? why is it so important? can it be learned at any time?

There is no denying that we are all feeling burned out, with no end in sight. How many times have you caught yourself questioning the actual date/day/time? It can be numbing how everything has blurred together, while being barraged with one crisis after another.

Along with COVID, we are experiencing a grief pandemic, “We’re dealing with disparities in health and socioeconomics, and we have blurred boundaries between our work and personal life. A new daily stressor happens before we learned to deal with the last one.” (Debra Kawhara)

“Note to self: every time you were convinced you couldn’t go on, you did.”

― Unknown

How can we grow and become stronger, and resilient through all of this?

Seeking Help

First, what are some myths regarding resilience? It is NOT in fact a badge of honor to be struggling. It is okay to feel overwhelmed, despondent, numb – in these situations, please ask for help. Being able to reach out for support is critical. Rely on your social networks, and/or resources for assistance. “Resilience is when you have the ability to break and get back together.” Caveat here – you will not be bouncing back, but rather bouncing forward. Each time you work through any adversities you build new skills and incorporate new ways of coping and are better able to deal with future challenges.

Leaning In

Resilience CAN be learned. My favorite quote on this comes from Josh Altman, “There is already a seed of resilience inside everyone,” he says. “Learning to lean into rather than avoiding difficult situations makes us stronger.”

This article by Paula Davis-Laack on her work with soldiers provides a helpful framework on cultivating resilience:

1. Practice the skills associated with resilience to cultivate crucial faculties: self-awareness, nimble thinking, high-quality relationships, stress awareness. “Resilience isn’t about toughening up people – it’s about empowering them.”
   
   
2. It’s okay to feel positive during a crisis: I have had numerous conversations with students, colleagues, and friends/family about this. Don’t feel guilty for laughing, enjoying yourself, finding joy and humor in the midst of the crisis we all find ourselves. It is what will get you through this time, and future challenges in your life.
   
   
3. Relationships matter: Perhaps one of the greatest lessons we have all learned during social distancing and quarantining is how much we value and need social interactions. Who are you counting on, who counts on you? Cultivate, build and strengthen your relationships. They give life meaning, and make you stronger.
   
   
4. It’s okay to be vulnerable: Brené Brown’s work in this area has been groundbreaking, “Vulnerability is not winning or losing; it’s having the courage to show up and be seen when we have no control over the outcome. Vulnerability is not weakness; it’s our greatest measure of courage.” We grow from struggle and adversity.

Try doing this self-assessment: The Resilience Advantage Questionnaire, and then access the toolkit.

Good Enough is Good Enough

Finally, if you can find 16 minutes, watch this TED talk, Sh*t happens: 8 Lessons in resilience. Spoiler alert: here are the major takeaways: no person is an island (reach out for social support), mentalizing (thinking about thinking, taking time to process your emotions), practice, practice, practice on where to focus your attention, be like the weeble – “weebles wobble but they won’t fall down,” name the thing that we are most challenged by to avoid the risk of the “nameless dread” coined by psychoanalyst Bion, and the best –  good enough is good enough.

“Wobbling” is essential for those times when we can’t function at our best, and nor should we expect ourselves to. We cannot be 100% all the time, there are challenges that are often out of our control, this is when we must be compassionate with ourselves.

“I can be changed by what happens to me. But I refuse to be reduced by it.”

― Maya Angelou

References:

1. https://www.winona.edu/resilience/common-myths.asp
2. https://www.fastcompany.com/90547087/these-5-myths-about-resilience-might-be-hurting-your-ability-to-cope

Compartmentalizing

The Fall 2020 semester has already brought new challenges and new successes. Students, staff, and faculty have implemented and improved new modes of learning and communication, all without the respite of a fall break or holiday, and all without the usual means of interpersonal social support. There is room to do better, and we are all working towards that, but it’s worth taking a moment to appreciate how well we have done overall.

Planning for the home stretch

The last part of the Fall 2020 semester overlaps with the US election season, and we ought to plan accordingly. Our department community is engaged in the voting season, and we are especially grateful to student leadership to promote civic engagement. The voting season ends November 3, but that may not be the end of the election season. November may bring longer than normal waits for election results, and then these results may be contested in courts and legislatures. This waiting will likely stoke anxieties and distract us from the classroom, at exactly the time that we are all working to finish a difficult semester. Each of us needs to have a plan.

What’s your strategy?

Your plan may profit from the strategy called compartmentalization. Compartmentalization is a defense mechanism used to prevent mental discomfort and anxiety caused by having conflicting values, cognitions, emotions, beliefs, and demands. Compartmentalization is not about being in denial; it’s about putting things where they belong and not letting them get in the way of the rest of your life. As described in today’s reading,

“Compartmentalizing is one of the most important strategies for setting healthy boundaries. It allows us to establish mental barriers between one priority and another so that we can direct all of our energy into what’s right in front of us.”

In this week’s article, the author outlines five steps to become better at compartmentalizing. TL;DR, the main points are to:

1. recognize the conflicting emotional and structural demands on your mental energy, and
2. give all of them their own individual space in your day.
   
   

Compartmentalization in practice

There is a 24/7 news cycle these days, but election news is unlikely to change much minute to minute. Schedule the times that you will check in on the news, and then work on the semester at other times. You may choose to exercise your right to peaceful protest (while taking care to protect yourself by following pandemic protocols). Schedule the preparation and protest time as a compartment, and keep that time separate from the time you spend following the news and the time you spend on finishing the semester.

The Road Ahead

We are all hoping for a just and swift election result. If there is uncertainty, the period of uncertainty will overlap with the end of our semester. Spend some time in October planning for how you will react and how you will assure that all of the demands on your mental energy and time will be met, and your mental and physical wellbeing will be preserved.

The Fall 2020 semester is unlikely to be the last time that the sum of your personal, social, and professional lives demand more attention than you can deliver. Honing the skills needed to meet these challenges will serve you well later.

Personal Branding

Who am I?

Blending Personal and Professional

Risk vs. Reward

[Insert Specialty Here]

“I am an HIV researcher” 

Until recently, it was unlikely someone you met, or your family at Thanksgiving dinner, would know what epidemiology was and what we do. But even now, it’s still unlikely people will know the breadth of work done by epidemiologists – everything from cardiovascular damage due to pervasive stress, to cancer research, sleep, maternal health, and a wide variety of infectious diseases.

Throughout my career, I have often taken the shortcut of saying, “I am an HIV researcher” although that commonly has to be followed by explanations of not doing bench science. Lately, as I spend much of my time doing COVID-19 work, I am described, and describing myself, more as an infectious disease epidemiologist which harkens back to my first research jobs in graduate school. So, even today, you could say my “specialty” in epidemiology continues to evolve – representing a combination of my personal experiences, my interests, and the context of the world at present. For students and early career epidemiologists, there are a seemingly infinite number of directions to go with your skillset, and deciding which of these avenues fits you best is often more of a journey than a choice. 

So, how do we all find our area of interest?

Some students come to Rollins with very targeted goals; I was not one of them. I did not come to graduate school determined to do HIV work, although I was drawn to infectious diseases. Some students come to try out different areas of research and I fall into this category. I took electives in other disease specialties until I could honestly say ID was my thing, and I learned with every one of these courses both new information and methods, and what I did or did not see myself doing my entire career. While you consider which electives to take, make sure to review the Department’s Areas of EPI document on Canvas, which provides some helpful background on many of the common subspecialties within epidemiology and which courses fall into those categories. 

When I think about how I decided to specialize in HIV epidemiology, there are really two reasons and two influential people involved in this story. The reasons are timing and opportunity and the people are my uncle and my mentor.

Timing and my uncle – the personal connection:

Going into public health in the 1990s, it felt cliché to be interested in HIV/AIDS and this alone made me not want to pursue this topic. Yet, it was a deeply personal area and one that has informed much of my thoughts about public health since. Students who have taken HIV Epidemiology with me have heard me speak about my Uncle Bill.

I was in high school when he called my mom, his sister, to let her know that his longtime roommate had been diagnosed with AIDS. It was a call that not only told our family that he was sick but also one that told us his roommate was his partner, a relationship that had not been clearly understood in our family for decades. As a kid, I recall watching my family learn to love all of who my uncle was. There was never any doubt that my family loved him, but I still look at that time as a sad realization that he had not been able to share all of who he was with us for so very long. We were fortunate to have more than four years left with him before he, too, died of HIV.

We all have experiences that shape us and even though I was not consciously pursuing the field of HIV epidemiology because of Uncle Bill, the impact his life has had on my career is deep.

Opportunity and my mentor:

When I arrived at Emory for my masters, I began work at the Atlanta VA Medical Center on several infectious disease studies in the Emerging Infectious Disease Program with CDC. I learned a tremendous amount about writing questionnaires, problems with skip patterns, and the willingness of hospitalized patients to participate in studies. I also learned that it can take over 680 cold calls to find a control for a case of Group B Strep and that food borne illnesses are interesting but were not my passion.

Every study I worked on taught me something and brought me in contact with interesting, dedicated, and very smart researchers. One of these investigators, Dr. David Rimland, became my thesis advisor. I still recall the first day I met David although I had no way of knowing the opportunities he would provide for me and the truly remarkable ways he would influence my career. When given the chance to do my thesis work using the HIV cohort he had followed since 1982 at the Atlanta VA, I jumped at the opportunity. 

It is important to note that I did take a 13-month detour to work at the American Cancer Society but missed work in the HIV world the entire time I was gone. I still remember making the phone call to David asking if he had a position to work with him again, but this time specifically in HIV research. Thankfully, he said yes and I returned home. To me, home had become the quirky VA hospital, people I admired, a rich set of data, HIV research, and working with my mentor. In the 17 years I worked in the VA HIV clinic, we fought every day to improve lives of those we served in our clinic and all people living with HIV. There is no doubt that the way I approach research and my love for the work I do has been heavily influenced by working with David. I learned, I made mistakes, and I grew all under his supportive mentorship.  

I admire our students who come to graduate school with a true vision for their work. I encourage each of you to explore other fields just for a class or two, or even for a guest lecture. There is so much to learn and so many ways to connect specialty fields. And for those who are searching for your passion, it is out there. Speak to faculty about how we found our field of work. Most have a story to share about their journey and how their lens on the world has influenced their work. Most of these stories are about connection; connection to diseases, specialty areas, or important mentors who both guide us and offer their connections to us as we pursue our careers.

Looking back, it seems obvious that losing my uncle to HIV, and watching him combat stigma that was so deeply pervasive during the first years of the epidemic, is why my career took the path that it did. But my journey also needed the influence of a great HIV researcher and mentor to find its true course. As the adage goes: hindsight is 20/20, and the arc of your own story is unlikely to be clear from the outset. However, if you commit to exploring new avenues, seek out mentors, and connect your past experiences to your curiosity, your path in epidemiology will reveal itself. 

Managing Up

These PROspective columns are meant to help RSPH EPI students to be more influential public health practitioners, especially after they graduate and join the public health workforce. Our department works hard to assure that students’ learning experiences prepare them with the knowledge, skills, and philosophy to be influential, but career skills are often as important in determining influence and success once graduated. This week’s PROspective takes on the difficult topic of how to succeed when your workplace supervisor stands in the way.

Supervising in Epidemiology

Poor supervisory skills can emanate from many sources, as described in this article from Harvard Business Review. One possibility, especially in some pubic health workplaces, is that the supervisors have never had any help preparing to manage. They may have risen to their position because of the skills in epidemiology, which typically provide little foundation for managing others well.

So how do you cope in this circumstance? I have written in a previous PROspective column about how to disagree, and many of those same skills may apply here. But beyond disagreeing about work products or workplace priorities, poor supervision often emanates from failure on the supervisor’s part to set clear expectations.

Setting Expectations

Expectations are the sets of goals and standards that your supervisor expects you to achieve, with some understanding of which are most important and should receive most of our effort. Failure to set and enforce standards and expectations is one of the most common management failures. If you are working without a clear understanding of what is expected, then it will be difficult for you to feel satisfied with your work.

Fortunately, failure of your supervisor to set expectations is something that you can help to address. If your supervisor has not set the expectations, you can take the initiative and suggest them. You can write out short and long-term goals and deadlines and ask for your supervisor’s feedback. Be sure that these pertain to the organization’s goals and priorities, and not to your own career aspirations. It’s a good idea to write these down also, and maybe to share them with your supervisor, but that’s a separate task. Hopefully the two will align.

Soliciting Feedback

Failure to provide constructive feedback is a second common failure associated with poor management. Again, it is something that you can help to address. When you reach a milestone, or complete one of the short or long-term goals on the list described in the previous paragraph, you can ask for feedback. Be sure to ask more than “Was my report okay?” You will probably only get back “Yes, it was good.” That’s not feedback that will help you to improve. Ask a question that requires a longer answer, such as “How can I do this task differently next time so that it will be even better?” Importantly, do not tie these requests for feedback to requests for additional compensation or leave time.

Zooming Out

Last, if your workplace dissatisfaction continues, it might be worth a self-check about whether your values align with the values of your supervisor or organization. If your values differ from theirs, it will be hard to ever feel satisfied with your work; a change may be needed.

Goal Setting

From Dr. Lauren McCullough, Assistant Professor, Department of Epidemiology

I love the start of a new semester. As a kid, it meant new school supplies. In college, it was a fresh beginning. Now, it represents an opportunity to reflect on what is important to me. How much progress do I want to make on that research paper? What new skills do I want to learn? A new semester brings a fresh set of goals.

Goal setting is a helpful way to establish a marker for success and measure your progress. Yet, your journey may be inefficient or ill-conceived if your goal setting strategy is missing some crucial steps. Over the years, I have refined my strategy for developing and achieving my professional goals. (1) Who are you? (2) What do you want? (3) What is your plan? Below, I outline some goal setting techniques that are easy to implement and may be useful in your own journey towards success.

Who are you?

The goals and aspirations of your colleagues may be different than your own. Think about what brought you to public health and imagine your future self. This will serve as a guiding light. What are your passions, interests, and values? What skills do you have or want to gain? Staying keenly aware of who you are will allow you to forge a path that is uniquely yours while maximizing the opportunities Rollins and Emory have to offer.

What do you want?

See the long-term goal (the BIG picture) and develop specific short-term goals to get you there. For many of you, this may be a time to figure out the big picture, and that’s ok! During my MSPH, I spent a whole semester conducting informational interviews with professionals I respected and admired to better understand their path, perceived opportunities, and challenges. Guided by my passions, interests, and values, I ultimately figured out what I wanted… to improve cancer outcomes among African-Americans through research. That’s a HUGE goal, and I’m still working at it! So along the way, you should set some short-term SMART goals (Specific, Measurable, Attainable, Relevant, and Time-based) that will get you there. For me, that meant getting research experience—taking an unpaid internship with an epidemiologist at a major cancer center—and finding ways to connect with affected communities. Importantly, think in chapters. You can’t possibly do everything now. Maximize your current environment or opportunity to its fullest potential and know that some things will have to wait until the next chapter.

What is your plan?

The best goals are inconsequential if they can’t be executed, so I consider this last section the most important. Let me start by saying that strategic planning is a SKILL! It requires intentionality, practice, and repetition. Once you have a short-term goal in mind (i.e., reviewing the literature for a thesis project), the planning process can be accomplished in 4 easy stages.

1. Map the steps—these are the specific tasks that are necessary to achieve the short term goal.
2. Integrate into your calendar—allocate specific time to work on these tasks. Literally, put it on your calendar like you would a meeting!
3. Create accountability—check-in with yourself or an accountability partner. Did you accomplish the task? If not, why? If so, find a way to celebrate!
4. Refine and repeat.

Finally, for additional inspiration, take a look at this article from Inc.com on SMART goal setting.

Dr. Lauren E. McCullough is Rollins Assistant Professor in the Department of Epidemiology at the Rollins School of Public Health. Her overarching research interests are in the life-course epidemiology of cancer (breast cancer and lymphoma), specifically the contributions of obesity and physical inactivity to the tumor epigenome and microenvironment, as well as disparities in cancer outcomes. 

Imposter Syndrome

I love the beginning of the semester. As a faculty member, there is so much planning to prepare for the journey and yet I still feel that same excitement I had as a student beginning new classes. As a student, I remember excitedly looking at a syllabus for a new class; the roadmap for the trip a class will take during the semester with highlights and instructions listed. With new colored pens, sticky notes, and new notebooks, I would feel sure this was the semester I would stay organized, keep artfully exquisite notes, and never question my purpose in taking a class.

I also fully recall the feeling when moments of doubt trickle in. That first lecture when concepts no longer click, when your homework answers do not reflect your understanding (or perhaps they fully reflect your lack of understanding), and the dread of the first exam where you will find out how well you have been doing and rank your results against your peers. That dread can also speak to another fear: do I belong here and when will someone realize I don’t – the Imposter Syndrome.

Silent but Pervasive

Imposter syndrome is a common phrase these days and a prevalent feeling in graduate school. Imposter Syndrome is defined as feelings of inadequacy that persist despite evident success. ‘Imposters’ suffer from chronic self-doubt and a sense of intellectual fraudulence regardless of external proof of their competence and, often, their mastery. Ironically, this is more common among high achieving, highly successful people. And to be clear, this is not the same as low self-esteem or a lack of self-confidence. In fact, some researchers have linked it with perfectionism, especially in women and among academics.

At least 30% of millennials currently experience some feelings of imposter syndrome and as much as 70% of people will experience it at least once in their lives. 

Recently, you may have seen celebrities normalizing imposter syndrome and sharing that they too suffer from feelings of inadequacy despite their earned position. Michelle Obama discussed still feeling like an imposter in 2018 while sitting on the stage at the Royal Festival Hall in London. That’s right, a lawyer who graduated from Princeton and Harvard Law School, the author of a #1 New York Times bestseller that sold out in a few days, a woman who went on a book tour across the world, and the former first lady doubts her abilities and shares her surprise that people want to listen to her. If you have ever had these feelings of “being found out,” you are in some very good company.

Many studies agree that up to one third of millennials are affected by the phenomenon and some have estimated that 70% of people will experience at least one episode of Impostor Syndrome in their lives (Gravois, 2007), where they doubt their abilities and accomplishments, regardless of how successful they are and despite evidence to the contrary. 

“Do I belong here and when will someone realize I don’t?”

Seeking an antidote

So what can you do to mitigate the negative effects of Imposter Syndrome?

First, you need to recognize these feelings for being the undermining forces that they are (several researchers in the UK call them gremlins, and I admit that I love that visual. If you think about the movie, gremlins are small and annoying but not altogether as awful). 

Accept that you are not supposed to know everything, especially at the beginning of a semester or graduate program. I have been working in HIV research for two decades and I do not know everything and I never will. No one does. How liberating is that?

Put your feelings in context. Most people have moments where they don’t feel confident and self-doubt can be a normal reaction. Graduate school is a prime opportunity for this. But take a look around you, as you sit in your classrooms, virtually or literally, and settle into the beginning of a semester. If you feel a trickle of doubt about being in the right place or being “found out,” odds are that one of the people on either side of you (socially distance and 6 feet away), is feeling the same. When the doubt hits you, talk to people you are close with and get support. Opening up to someone about being unsure of your abilities in graduate school is good for your mental health and you will almost surely find that you are not alone.

Lastly, be kind to yourself. Self-doubt tears down our confidence and lets those inner (gremlin) voices get loud. Graduate school is hard. Moving to a new city is hard. Being a first generation student is hard. Living through a pandemic is hard and is making all of the other hard things harder. And living at a time in our country where we are confronting racial justice issues brings up insecurities and decades or demeaning messaging. So be kind to yourself and acknowledge this: you are in one of the premier schools of public health in this country at a time when we could not need well-trained, justice-minded epidemiologists more. You are not here by accident. We read your application. We read your recommendations. We picked you and we want you here. We are here to support you, learn with you and from you, and to cheer you on.

You belong here.

Flexibility, Empathy, & Patience

Whether you are brand new to Rollins (Welcome Class of 2022!) or returning for your 2nd year after a summer applied practice experience, you’re probably asking yourself, “What does success look like for the Fall 2020 semester?”

Excellent question. No one has ever done this before, so the truth is—no one knows how to make a success of it. We will all be learning, adapting, and improving as we go. That process will accrue benefits most rapidly if we recognize and practice flexibility, empathy, and patience in all of our endeavors and interactions. Humans are remarkably adaptable and resilient, much more so than we sometimes realize, especially when we can recognize common goals, reorient quickly when necessary, and maintain composure in the face of hardship. 

With that in mind, I want to take this opportunity to share a few pandemic-adapted suggestions that, in the past, have helped students to make the most of their Fall semester at Rollins. 

Stronger Together

One of the great strengths of the science of epidemiology is that those who study it come from widely different personal and professional backgrounds. We embrace the diversity of perspectives as a strength. In our previous educational experiences, some of us studied public health, while others studied biology, mathematics, economics, psychology, languages, or arts, among others. What you already know will help you with your curriculum this semester, so let it shine through. Bring your unique perspectives to your classrooms and share it with others, and listen to the unique perspectives that others will share with you. Realize, also, that because of the differences in earlier education and experiences, some parts of the curriculum will come easier to you and some will be more difficult. This too will be an individualized experience. There is no point in comparing your academic progress with your peers; you will only steal your own joy by making such comparisons. 

Commit to growing your network

This semester’s hybrid learning experience will make it more difficult to develop a professional network. We humans are pack animals and having six feet or a computer screen between us is an unnatural way to socialize. It is critical, though, that we adhere to these public health requirements during this pandemic – to protect our own health and the health of our entire community. Finding solutions and strategies for how to develop a social and professional network despite the barriers starts with realizing that it is a problem, and you will have to invest more than the normal effort to solve it. Get to know your peers in the program through the shared experience, even if virtual. Imagine how nice it will be to one day greet them in person, with a smile not hidden behind a face covering. The department’s Canvas site provides guidance on how to network with faculty. The guidance suggests that your initial contact with faculty include a specific request. My friendly amendment is to keep the bar low for that ask. For example, many faculty members hold regular meetings with their research groups. Rather than asking to join their groups, ask to listen in on one of their (now Zoom enabled) research group meetings. That is not difficult to arrange and provides a point of entrée to the group’s network.

Don’t forget career skills

The department’s overriding educational goal is to prepare students to be influential public health practitioners. The knowledge, skills, and philosophies that you will learn in the classrooms will be instrumental in achieving this goal. Important, too, will be the career skills that, despite often being complex and nuanced, are seldom part of the classroom learning experience. This column has often addressed these skills, so I encourage you to read the archives and begin work on honing these professional competencies. Once again, the lack of usual social interactions will make it more difficult to practice these skills during the pandemic. Recognize the problem, and plan to solve it. Realizing the importance of career skills and learning how to practice them will be instrumental in your success while at Rollins and for many years thereafter.

We can do it!

Welcome to the department and thank you for your faith in us to provide an excellent learning experience this semester. The faculty and staff have worked hard to prepare, and are ready to change and improve as the semester progresses. We look forward to working with you to make it a success.

Sleep Epidemiology: Contributions of Social Determinants

from Assistant Professor, Dr. Dayna A. Johnson, PhD, MPH, MSW, MS:

The practice of epidemiology applies to many health outcomes (e.g., cardiovascular disease) and types of risk factors (e.g., social) that form the specific areas within epidemiology (e.g., social, environmental, genetic, etc.). In my research, I employ epidemiologic methods to study determinants and consequences of adverse sleep health and sleep disorders; therefore, I identify as a sleep epidemiologist. As defined in the book, The Social Epidemiology of Sleep, sleep epidemiology is “the study of the distribution and determinants of sleep, sleep-related symptoms, and sleep disorders and the application of this study to improve sleep health and sleep-health related conditions, including studies of how sleep influences health and disease”.¹

Sleep involves a dynamic set of neurophysiological and behavioral states. What I find most interesting about sleep, is that it is a physiologic activity that is necessary for health and well-being – everyone must sleep. Healthy sleep is multidimensional involving adequate sleep duration, continuity or efficiency, appropriate and consistent sleep timing, alertness during wakefulness, and individual satisfaction.²  Sleep and sleep patterns are adapted to individual, social, and environmental demands. Similarly, our sleep is shaped by many factors including social, environmental, and genetic. In my research, I primarily study social and environmental determinants of adverse sleep health.

Racism and Sleep

The current climate in the world is truly affecting how we sleep. Individuals around the world have witnessed the heinous killings of George Floyd, Breonna Taylor, Ahmaud Arbery (which occurred in our home of Georgia) as well as many others. Witnessing such injustices, which are the result of racism – a fundamental cause of health inequities, can cause a state of vigilance, which is particularly salient for racial minorities. These brutal acts can be even more traumatic for the individuals who resemble the victims, which can cause one to ruminate over how that could have been them or their spouse, father, brother, sister, friend, etc. These are vicarious experiences of racism or discrimination, which are known to affect health, and sleep. These experiences can lead to stress, anxiety or depression, which can directly affect sleep and/or indirectly through rumination where someone repetitively go overs thoughts or problems, which can inhibit sleep onset or disturb sleep.

Location and Environment

Racism, discrimination, and stress are just a few of the contributing social factors to the high prevalence of sleep deficiencies among racial and sexual minorities as well as individuals of lower socioeconomic status (SES). Another important social factor to consider is where we live. Our household and neighborhood environments contain features such as light, noise, safety, density, cohesion that are associated with sleep health.³ Residential segregation based on race, immigration status, SES has largely determined the resources within neighborhoods. Historical discriminatory policies, such as redlining, unwarrantedly denied racial minorities (mainly Black/African American or Latinx) in urban areas mortgages to purchase a home or loans to renovate homes. Housing discrimination is considered one of the largest contributors to the wealth gap and these effects have lasted across generations. Additionally, these under-resourced environments often house manufacturing companies that emit pollution into the air as well as traffic which promotes noise and pollution. Air pollution is directly related to a common sleep disorder, sleep apnea.⁴ And, noise and light pollution are associated with less sleep and sleep difficulties.⁵ Emerging data suggests that the neighborhood environment partially explains racial disparities in sleep. It is also important to note, that there is evidence suggesting that racial disparities in sleep are minimized when Black and White individuals – for example live in similar environments; thus, underscoring the effect of place as opposed to race.

Sleep can be considered a privilege.

It is important to consider the person that works multiple jobs due to low wages, or lives in a neighborhood with noise, violence and/or a household with interpersonal violence… how will they sleep? Children exposed to high levels of screen time or those without a regular bedtime routine are placed on a trajectory of sleep deficiencies in adulthood, which is related to poor health outcomes such as obesity, diabetes, cancer, cardiovascular disease, cognitive decline and mortality. School start times are another factor that can affect sleep, particularly for the student who must take the bus across town to school who, therefore, has less opportunity for sleep. As seen during COVID-19, racial minorities and individuals of lower SES are more likely to be low wage essential workers without worker protection such as sick leave, thus leading to fear and anxiety and consequently sleep deficiencies. This is important because sleep is necessary for healing. In general, those of higher SES have better sleep health. However, higher SES racial minorities such as Black or African Americans tend to have worse sleep compared to their lower SES counterparts. It is hypothesized that stress may explain this unexpected gradient, but more research is needed to fully understand this association.

Sleep Equity

The social factors referenced above-racism, discrimination, stress, mood, household and neighborhood environment are all understudied determinants of sleep deficiencies. Sleep is socially patterned, therefore exploring and addressing these factors can help decrease the burden of adverse sleep health and sleep disorders as well as reduce health disparities. Targeting sleep may improve overall health, decrease accidents (occupational and motor vehicle), and improve performance (athletic and academic).

Sleep is critical and everyone deserves it! Therefore, as epidemiologists we can shed light on the social factors that are contributing to sleep disparities and inform the policies and interventions that may improve sleep for all individuals.

Sleep well!

References

1. Duncan DT, Kawachi I and Redline S. The Social Epidemiology of Sleep: Oxford University Press; 2019.
2. Buysse DJ. Sleep health: can we define it? Does it matter? Sleep. 2014;37:9-17.
3. Johnson DA, Billings ME and Hale L. Environmental Determinants of Insufficient Sleep and Sleep Disorders: Implications for Population Health. Curr Epidemiol Rep. 2018;5:61-69.
4. Billings ME, Hale L and Johnson DA. Physical and Social Environment Relationship With Sleep Health and Disorders. Chest. 2020;157:1304-1312.
5. Billings ME, Gold D, Szpiro A, Aaron CP, Jorgensen N, Gassett A, Leary PJ, Kaufman JD and Redline SR. The Association of Ambient Air Pollution with Sleep Apnea: The Multi-Ethnic Study of Atherosclerosis. Ann Am Thorac Soc. 2018.

Dr. Dayna A. Johnson, PhD, MPH, MSW, MS is an Assistant Professor in the Department of Epidemiology. Her research is aimed at understanding the root causes of sleep health disparities and their impact on cardiovascular disease by 1) addressing the social and environmental determinants of sleep disorders and insufficient sleep; and 2) investigating the influence of modifiable factors such as sleep disorders and disturbances on disparities in cardiovascular outcomes.