Heightened psychosocial stress coupled with maladaptive coping may be associated with greater sexual risk engagement. This study examined the association between stress levels and coping strategy use as predictors of sexual risk behavior engagement over 24 months among African-American adolescent females (N = 701; M = 17.6 years) enrolled in an STI/HIV risk-reduction intervention program. Participants completed audio computer assisted self-interview (ACASI) measures of global stress, interpersonal stress, coping strategy use, and sexual behaviors prior to intervention participation. Follow-up ACASI assessments were conducted at 6, 12, 18, and 24 months post-intervention. Generalized estimated equation models examined associations between baseline stress levels and coping strategy use as predictors of condom use (past 90 days, last sex) and multiple partners during follow-up. Global stress and individual coping strategy usage were not associated with differences in condom use. Higher interpersonal stress was associated with lower proportion condom use (p = .018), inconsistent condom use (p = .011), and not using a condom at last sex (p = .002). There were no significant associations between stress levels, coping strategy use, and multiple partners. Future research should explore mechanisms that may underlie the association between elevated interpersonal stress and decreased condom use among this population.

Recommended citation: Erin N. Hulland, Jennifer L. Brown, Andrea L. Swartzendruber, Jessica M. Sales, Eve S. Rose & Ralph J. DiClemente (2015) The association between stress, coping, and sexual risk behaviors over 24 months among African-American female adolescents, Psychology, Health & Medicine, 20:4, 443-456, DOI: 10.1080/13548506.2014.951369 https://www.tandfonline.com/doi/abs/10.1080/13548506.2014.951369

Parameters associated with design effect of child anthropometry indicators in small-scale field surveys

Published in Emerging Themes in Epidemiology, 2016

Cluster surveys provide rapid but representative estimates of key nutrition indicators in humanitarian crises. For these surveys, an accurate estimate of the design effect is critical to calculate a sample size that achieves adequate precision with the minimum number of sampling units. This paper describes the variability in design effect for three key nutrition indicators measured in small-scale surveys and models the association of design effect with parameters hypothesized to explain this variability.

Recommended citation: Hulland, E.N., Blanton, C.J., Leidman, E.Z. et al. Parameters associated with design effect of child anthropometry indicators in small-scale field surveys. Emerg Themes Epidemiol 13, 13 (2016). https://doi.org/10.1186/s12982-016-0054-y https://ete-online.biomedcentral.com/articles/10.1186/s12982-016-0054-y#citeas

Travel time to health facilities in areas of outbreak potential: maps for guiding local preparedness and response

Published in BMC Medicine, 2019

Repeated outbreaks of emerging pathogens underscore the need for preparedness plans to prevent, detect, and respond. As countries develop and improve National Action Plans for Health Security, addressing subnational variation in preparedness is increasingly important. One facet of preparedness and mitigating disease transmission is health facility accessibility, linking infected persons with health systems and vice versa. Where potential patients can access care, local facilities must ensure they can appropriately diagnose, treat, and contain disease spread to prevent secondary transmission; where patients cannot readily access facilities, alternate plans must be developed. Here, we use travel time to link facilities and populations at risk of viral hemorrhagic fevers (VHFs) and identify spatial variation in these respective preparedness demands.

Recommended citation: Hulland, E.N., Wiens, K.E., Shirude, S. et al. Travel time to health facilities in areas of outbreak potential: maps for guiding local preparedness and response. BMC Med 17, 232 (2019). https://doi.org/10.1186/s12916-019-1459-6 https://link.springer.com/article/10.1186/s12916-019-1459-6

Patterns of posttraumatic stress symptoms among international humanitarian aid workers

Published in Traumatology, 2020

Most studies of mental health in humanitarian aid workers have found low levels of posttraumatic stress disorder, making it hard to disaggregate and look at differences between subgroups. This study sought to identify the risk and protective factors associated with resistant, resilient, and nonresilient trajectories of stress response over time that could be used to inform more targeted training and organizational support programs for aid workers. Aid workers from 19 qualifying humanitarian organizations who aged =18 years and were to deploy for 3 to 12 months completed questionnaires at 3 time points (pre, post, and follow-up). We identified 3 unique groups (nonresilient, resistant, and resilient) using latent class growth analysis and identified predictors of subgroup classification using multivariate logistic regression. Single individuals were less likely to be in the resilient group than in the resistant group compared to coupled individuals. Individuals with one prior deployment were three times more likely to be nonresilient than resistant compared to individuals with no previous deployments. There was no significant difference in resistant, resilient, and nonresilient classification for individuals with >2 deployments. Findings suggest a need for supplemental training and psychosocial support post the first deployment as well as resources focused on potential this should be cumulative rather than accumulative effects of stress and trauma exposure for more seasoned deployers.

Recommended citation: Greene-Cramer, B. J., Hulland, E. N., Russell, S. P., Eriksson, C. B., & Lopes-Cardozo, B. (2021). Patterns of posttraumatic stress symptoms among international humanitarian aid workers. Traumatology, 27(2), 177 https://doi.org/10.1037/trm0000286

Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021

Published in The Lancet, 2022

National rates of COVID-19 infection and fatality have varied dramatically since the onset of the pandemic. Understanding the conditions associated with this cross-country variation is essential to guiding investment in more effective preparedness and response for future pandemics.

Recommended citation: Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021. Bollyky, Thomas J and Hulland, Erin N. et al. The Lancet, Volume 399, Issue 10334, 1489 - 1512 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00172-6/fulltext

talks

The Association between stress, coping, and sexual risk behaviors over 24 months among African-American female adolescents

Published: April 26, 2014

Presentation on work from our manuscript assessing association between stress levels and coping strategy use as predictors of sexual risk behavior engagement over 24 months among African-American adolescent females enrolled in an STI/HIV risk-reduction intervention program

Parameters associated with design effect of child anthropometry indicators in small-scale field surveys

Published: July 28, 2016

Presentation on work from our manuscript considering factors related to small-scale surveys of anthropometry indicators in refugee settings.

Precision Public Health and Pandemic Preparedness: Quantifying travel time to health care from locations at risk for pathogen transmission

Published: November 21, 2019

Presentation on work from our manuscript investigating the travel time to health care facilities in locations with Viral Hemmorhagic Fever transmission risk to understand barriers to timely detection and response.

Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021

Published: November 17, 2021

Presentation on work from our manuscript investigating the drivers of differential COVID-19 outcomes across 177 countries.

Estimating time-varying cholera transmission and oral cholera vaccine effectiveness in Haiti and Cameroon, 2021-2023

Published: June 19, 2024

Presentation on work from our research using EpiEstim and the extension VaxEstim to model cholera transmission and one-dose oral cholera vaccine effectiveness in Cameroon and Haiti between 2021 and 2023.Preprint