Faculty Profile: Rachel Shelton

Describe some of your primary research Interests/methods 

My research focuses on understanding how social context and social inequality shape health behaviors and outcomes associated with cancer and obesity. The goal of this work is to inform interventions and policies that seek to address racial/ethnic and socioeconomic health disparities. In recent research I have collected data using surveys and in-depth interviews to describe patterns in social networks, sociocultural norms, social support, and social capital among low-income African American and Latino populations, and have examined how these factors influence physical activity, dietary behaviors, uptake of HPV vaccination, and engagement in breast, cervical, and colorectal cancer screening. I have conducted research using similar methods to examine social and structural stressors like experiences of discrimination and racism, medical mistrust, and financial hardship, and how these factors shape obesity and cancer risk among medically underserved populations.  Other research interests relate to implementation science. Specifically, I am developing a new program of research that focuses on factors that influence the implementation and long-term sustainability of lay health advisor programs in community settings.

HOW DOES YOUR RESEARCH ON CANCER PREVENTION FIT INTO PUBLIC HEALTH RESEARCH, AND MORE SPECIFICALLY INTO SOCIOMEDICAL SCIENCES? WHAT ARE YOU WORKING ON NOW IN THAT AREA?

I have a very diverse background and training, with an undergraduate degree in Anthropology, MPH in Health Promotion, doctoral degree in Social Epidemiology and Community Interventions, and a post-doctoral fellowship in interdisciplinary cancer prevention and control. Given the diversity of social science perspectives in SMS, this department is a perfect academic home for me. From a social justice perspective, my research focuses on health issues where racial/ethnic and socioeconomic disparities have been striking and persistent, including breast and colorectal cancer, as well as obesity. Consistent with the mission and vision of SMS, my research on social and structural resources and stressors (e.g. social networks, discrimination) seeks to deepen conceptual understanding of how social context and social determinants of health shape inequalities related to cancer and obesity. Across studies, my research has highlighted that having large, close social networks and high levels of social capital promotes physical activity and cancer screening among racially diverse low-income populations. This work has also identified ‘who’ within social networks is particularly important in influencing behavior, with family norms and support being particularly critical in shaping dietary behaviors and physical activity among Hispanic populations.  Medical mistrust rooted in experiences of discrimination has repeatedly emerged as a critical determinant of cancer screening and other preventive health behaviors among African American populations in my research, and I recently validated a theoretically-grounded medical mistrust measure that can be used in public health research among urban black men. Taken together this research indicates that cancer and obesity prevention behaviors need to be understood in context, and that the social environment is an important aspect of context that should be understood and addressed to support behavior change.

While much of my work in this area has focused on cancer prevention and screening behaviors, a Mentored Research Scholar Grant through the American Cancer Society is allowing me to explore these factors in the context of treatment decisions for cancer, along with other important factors like cultural norms and social influence of providers and family members. Through collaborations built through my involvement with the school-wide Obesity Prevention Initiative, I have plans to expand this work to obesity, and will be examining how social and structural resources and stressors, in combination with neighborhood factors, shape trajectories of BMI and obesity patterns from early childhood to adolescence. 

TELL ME ABOUT SOME OF YOUR OTHER MAJOR PROJECTS THAT YOU’RE CURRENTLY WORKING ON OR IDEAS YOU HAVE FOR FUTURE RESEARCH?

One area of research that I have been most excited about has been a research collaboration with a national group of African American lay health advisors called The National Witness Project that conducts outreach, education and system navigation related to cancer screening. This program was developed twenty five years ago by African American cancer survivors (in partnership with Anthropologist Deborah Erwin) to help address cancer disparities and issues of medical mistrust and fatalism for African American women in a culturally appropriate way. The program has been recognized by the National Cancer Institute as an evidence-based program for increasing breast and cervical cancer screening among African American women. The program has now been disseminated and replicated nationally in over 40 sites, reaching over 15,000 women annually. With nearly 900 lay health advisors, one of their biggest challenges is documenting the broader contributions of this program and sustaining the program with limited resources. I recently completed an R03 grant from the NCI using mixed methods to better understand the personal, social, and community impact of being a lay health advisor in this program, and the contribution the program makes to building community capacity in African American communities. Recent publications have documented the characteristics, capacity, and contribution of African American lay health advisors in their communities and factors that facilitate their sustained involvement in the program. Building off of this work, I have submitted a large NIH grant to understand the organizational and contextual factors that contribute to the sustainability of the National Witness Project program in community settings at a national level. This project would be part of my research program I am building in the area of dissemination and implementation research, an area that focuses on reducing the gap between ‘what we know’ through research/science and ‘what we do’ in practice. I am also thrilled to be teaching a course on Dissemination and Implementation Science for the third year in a row, one of the first classes offered on this subject at a School of Public Health nationally. Data collection is also underway for my American Cancer Society grant on treatment decisions for colon cancer patients (for stage II, where there is not a clear clinical recommendation to inform treatment decisions), so I am eager to begin analyses of patient and provider data from this study in upcoming years and identify next steps for research.

WHAT IS YOUR FAVORITE THING ABOUT TEACHING OR MENTORING?

I love the enthusiasm of students who are just discovering public health. Seeing them begin to make the connection between broader social, economic, political and cultural factors and health is always exciting to me. I benefitted tremendously from the excellent mentorship I received during my MPH and doctoral studies, and I recognize how critical teaching and mentoring is in fostering student development and scholarship. I try and pay back the time and investment others have made in me with my own students, and think it is important to establish a strong personal connection with students. Given that I’m not too far removed from some of the decision-making that goes along with establishing a public health or academic career, I try to be very open about my own experience and share what I have learned that has worked well and what I might have done differently.  Something I recommend to all of my students is that they identify an area of public health that gets them excited and that they feel committed to. When students find an issue that they are passionate about, I think creativity, innovation, and success are more likely to follow.

DO YOU HAVE ANY HOBBIES? OR FAVORITE BOOKS?

I have two young children—my daughter Violet is 4 and my son Hendrix is 2, so almost all of my free time is spent with them dancing, singing, playing with trains, and reading. Right now my daughter is really into art and performing, so I spend hours doing craft projects with her and being the back-up singer for her favorite songs.  One of my favorite children’s books to read with them right now is ‘Rosie Revere, Engineer’ (about a brilliant inventor of gadgets who dreams of becoming a great engineer). My commute from Brooklyn is over an hour on the subway, so I have been using some of that time to read Alondra Nelson’s wonderful book ‘Body and Soul: The Black Panther Party and the Fight against Medical Discrimination’. Before I had kids I was a long distance and marathon runner, and I dream of one day getting back into running. My husband and I both love the outdoors, and we spend a lot of time with our kids hiking and having adventures in Prospect Park in Brooklyn and in the Catskill Mountains in upstate New York.