Dr. Theresa Chappel talks applied epidemiology and how the birth of her child shapes her research, as well as riding giraffes, bad reality tv, Philly cheese steaks, and more!
Dr. Theresa Chappel talks applied epidemiology and how the birth of her child shapes her research, as well as riding giraffes, bad reality tv, Philly cheese steaks, and more!
Essence:
Hi.
Theresa Chapple:
Hello.
Lisa Bodnar:
Hi. What is your name?
Essence:
Essence.
Lisa Bodnar:
How old are you?
Essence:
Eight. Bye.
Lisa Bodnar:
Goodbye. I think we knew that we weren't going to get through this without someone's little voice coming in. Oh, her eyes are still right there.
Theresa Chapple:
I'm surprised we made it almost 25 minutes before interruption.
Lisa Bodnar:
Hi, everyone. Welcome to Shiny Epi People. I'm Lisa Bodnar. I'm an epidemiologist at the University of Pittsburgh. So I say that this podcast is one where we talk to epidemiologists about anything but epi, but today's going to be a little bit different. I talk with Theresa Chapple, who received her PhD in epidemiology from the University of Illinois at Chicago. Theresa has worked in public health for 11 years in applied epi. Now between you and me, I didn't really know what it means to be an applied epidemiologist. And so that's why I asked her to come on the show. Like a lot of other academics, I don't know much about jobs for doctorally trained epidemiologist, aside from staying in academia.
Lisa Bodnar:
So we do talk some work stuff. If you aren't an epi person and you want to skip to the personal stuff, it starts around minute 11. One quick note, there is some weird audio stuff with this episode where it goes between mono and stereo sound, can make it a little weird. I was going to poke my eyes out if I had to look at audio wave forms any longer. So mess with your volume if you need to. I hope you enjoy this chat.
Lisa Bodnar:
Oh gosh, I'm so happy to see your face.
Theresa Chapple:
Yay. Same here.
Lisa Bodnar:
All I've seen are still photos of you, very professional. So it's nice to see your smile and your animation. Exactly the energy I would have imagined. Theresa and I are both in our closets. We both have three children. These things are not unrelated.
Theresa Chapple:
Exactly. This is where the best conversations happen, in our closet.
Lisa Bodnar:
And I have a nice view of your shoes, which I love. I'd rather look your shoes than bookshelf. So I have so many things that I want to talk to you about. So let's just jump in. I think that people who follow you on Twitter at least know you for how passionate you are about applied epi. How did you make that decision to work outside of academia?
Theresa Chapple:
It was actually a decision that was made for me. I accepted it and grew to love it. When I went to my doctoral program, it was clear the doctoral program said it was a applied MCH epi program. At the time, I had no idea what that meant, but I was excited for something different. Immediately, it was clear that applied epi meant we were going to really work closely with our health departments. We were going to make sure that we had great research and critical thinking skills and analytic skills to apply it to the work of health departments so that we can take their work to a different level. We had to do our dissertations with the health department. It had to be approved by a health department as something that would be helpful to them and the work that they're doing, and that just really kind of set me up to using health department data, knowing how it works, knowing how they think, knowing what's impactful for the community. And as I graduated, it was just clear that that's where I would go.
Lisa Bodnar:
That seems like such a unique lens for a PhD program in epi. I really have never heard of that before.
Theresa Chapple:
It was really quite different. We had a training grant from HRSA for all of our MCH students and when I talked to my friends who stayed at UNC, also on the similar training grant, they were like, "We're not interpreting our work that way." So it was definitely a different lens and I am completely thankful for it.
Lisa Bodnar:
Are there ever moments where you sort of feel like you have to explain yourself? Do those feelings come up for you?
Theresa Chapple:
The question I get is, "Why didn't you get a DrPH instead?" The answer is that my PhD in epi is more intense than just the regular PhD that they offer to epi students. So my PhD is in maternal and child health epidemiology. And so there were different tracks and for an MCH epi track, you had to actually take an additional year of courses. I have all of the same coursework that the regular epis, the infectious disease, chronic disease epis. I have all the same course work that they took, plus an extra year to become applied. So it's not that I took an easier route to this. It's not at all anywhere like the DrPH program, which was really focused on practice. My program was focused on how well can you learn these methods so that you can apply it to the life of people that you're actually going to see and interact with?
Lisa Bodnar:
You are taking our basic core training and then elevating it.
Theresa Chapple:
An extremely heavy course load for a doctoral program. I had to take 122 credits of classes in my doctoral program. I had to take 17 stats and epi courses. This was really a intense program that I went through and then learned the applied work on top of it. There was a conversation that actually brought me into Twitter about the definition of epi and it used gorgeous definition of epi. And the question was, is the second part, the part that says and apply it to the work, or... I'm not going to get it right, right now, just because I need too.
Theresa Chapple:
But the second part of the definition talks about application. And the question was, is this really epidemiology or is this public health? And for me, I learned that we're going to embrace the whole definition of epidemiology. We're going to learn about the distribution and determinants of diseases, but we're also going to learn the skills necessary to apply it to our populations that we care about. It was really interesting to me last year when that conversation was happening on Twitter, that everybody didn't see it that way and then I realized, "Oh yeah, I took that extra year of course work."
Lisa Bodnar:
Could you give me a couple of examples of projects that you work on that illustrate what applied epi really is?
Theresa Chapple:
My favorite project of all times would be a infant mortality project I worked on. The question was asked to me was, help us figure out infant mortality in Georgia through a different lens, a way that we've never thought about it before so that we can approach it and address it differently so that our numbers can start to go down, because if we keep doing the same thing, nothing's going to happen. So what's the different approach? What are we missing? So I look at Georgia's infant mortality data and notice that what had been done is really kind of the basic stuff that people do, look at administrative boundaries, talk about what's happening within those administrative boundaries, and then try to apply a program. Instead, I thought, "Wouldn't it be interesting if infant mortality crosses administrative boundaries? What if infant mortality doesn't care anything about zip codes or county lines or things like that?"
Theresa Chapple:
So instead, let me look at infant mortality at a block by block level. And I did a spatial analysis where I look at infant mortality at the block level to see, are there clusters of infant deaths that might cross normal boundaries like zip codes and county lines? And I was able to find six clusters of infant deaths across the state of Georgia, outside of the typical boundaries that we're used to that weren't identified other ways, because if you looked within the regular boundaries that didn't rise the clustered level. I then did analysis to see what were the factors that put babies at risk of dying within the first year of life. And so I did a regression analysis to determine what those factors were. From there, I did a perinatal periods of risk to look at excess death within those clusters and see what I could attribute the excess death to.
Theresa Chapple:
And then once I did that, I was able to go to those clusters with some really great information. Your cluster of infant death includes those people who live six blocks over into this county as well. And what we need to do is include both county resources in order to address infant death that's happening here, because women are moving back and forth on and on, whatever the other reasons are that would include these two counties needing to work together. And this was work that had never been done before. No counties have been working together to address a health issue in Georgia. From there, I was able to say, "Here's the risk factors that matters to this cluster. What can we do? What type of program can we create?" Then I was able to sit down and work with program creators to design an intervention that would address infant mortality in this cluster.
Theresa Chapple:
From there I said, "Okay, I'm going to leave you guys to your work. I'm not an implementer. What I can do is keep track of your data. I can keep sending you data dashboards and letting you know where you are and if you're on track and what things need to be changed. I can help you through plan, do, study, act cycles to make sure that you are still on track and doing the work that needs to be done."
Theresa Chapple:
Within two years, my six clusters of infant death in Georgia were reduced to four clusters. This is kind of the type of work that I always imagined I would do where my research would actually be transmitted into action and I would see the benefits of that action. The biggest piece that I wasn't trained to do in all of my training was to deal with the political aspects of health, and I think that that's a majorly important thing if we're going to send people out into the world to be applied epidemiologist, we need to teach them how to speak to politicians. We need to teach them how to translate our data into policy, and that's something I had to learn on the job. And even better than seeing my work turned into interventions is seeing my work turned into policy.
Lisa Bodnar:
Can you give me an example from the one you just spoke about with reducing infant mortality, where you had to incorporate that kind of political side to things?
Theresa Chapple:
So getting these counties to work across county line, you had to include county leadership and political representation or else it was never going to work. You needed buy in from all levels. So I had one county official tell me that the reason babies die in their community is because of teen pregnancy. That was not true. There's a lot of work around the weathering hypothesis that says that younger Black mothers have better birth outcomes and older Black mothers. So actually in this community, that was the case. Younger Black mothers had better birth outcomes and our issues were the older Black population. But getting this politician to understand that was really something that I had to try multiple different approaches in order to do this.
Theresa Chapple:
I tell this part of my story often, because I think it's important. My husband is a conservative Republican and I am a liberal Democrat.
Lisa Bodnar:
That must be fun at home.
Theresa Chapple:
I like challenges all around apparently.
Lisa Bodnar:
And then you have three children.
Theresa Chapple:
So what I have learned from my personal home life is how to switch my message quickly, how to get what I want with still being able to give as much of the correct information as possible, but have other people on opposite party sides listen to the points that I'm making. That was one of the things I had to learn how to do both at home and working in conservative states like Georgia and Tennessee, where it was really clear that you just can't say certain things. I could not say the word abortion. I couldn't talk about teen pregnancy as if it had any positive impacts on population health at all. I had to be able to frame the conversation in a way they wanted to hear in order for them to join on and do the work. That was one life lesson I've taken with me. And one day when I run for president, I'll be able to-
Lisa Bodnar:
I endorsed you. Right now. Theresa 2032 or wherever we are. Can you also give me an example of how you do that at home?
Theresa Chapple:
At home, I'm a little less pragmatic. At home, I'm more, "I'm right and you're wrong." What's more fun is that I've included in my will that if I die before my husband, that my children have to be raised to be Democrats.
Lisa Bodnar:
And who's going to raise them Democrats?
Theresa Chapple:
Everyone else.
Theresa Chapple:
One of the biggest things I've seen with our master's prepared students coming out and trying to get a job, trying to get jobs in applied epidemiology is that they've never seen a dirty dataset before. They know how to analyze [inaudible 00:13:03] datasets. They know how to analyze anything that's nice and pretty, set up for classroom, but when I'm giving them a birth certificate file and asking them to clean it, this is something that way over what they have been taught. My plea to academics for that, give them dirty datasets. There's a major skill to be learned in how to clean a dataset. If you only know how to analyze and not clean data, then you're not that useful in the real world because you have to do both. A lot of students don't know how to present their data. They don't know what's the takeaway.
Theresa Chapple:
What do you want people to know? What do you want people to remember about your work? That's really a hard thing for me to get students to even articulate in an interview when I'm trying to ask them about their own thesis or project that they're most proud of. How would they take that work and see it through to make change? What would change look like as a result of the research that they did? Those are questions that trick students all the time, and I'm not trying to trick anyone. I'm just trying to see, can I get you to take the research skills that you've learned and apply it to a population that would make sense?
Theresa Chapple:
Another thing that I've learned is that the majority of people don't have an idea of what type of datasets health departments have. And so I get asked what I call unprepared questions about what data do you have? I'm like, "Health departments house tons of data and some of the data that you should be using for population health research." But it's just the idea that all we do are STD screenings. People really don't have a good sense of what we do and how to apply their skills to our work.
Lisa Bodnar:
How can we change epidemiology curriculum?
Theresa Chapple:
I think one thing that's really important and that is missing from a lot of our schools of public health are having people that have an applied background at all. And if they're there as adjunct, that's fine. If they're there on dissertation committees, if they serve as capstone reviewers, those are great opportunities to bring applied people in. I think what happens a lot or that we give our students the 10 week applied session. So what we need to do is bring in people that have this type of training or that have this type of experience in applied work to work with our students and just give them a introduction. I would love if every school had one class on applied epidemiology.
Lisa Bodnar:
Switching gears a bit, Theresa, you've been speaking publicly about your own traumatic outcome following the birth of your third kiddo. Now that motivates some of your work in public health, would you feel comfortable sharing any of that?
Theresa Chapple:
Sure. While in labor, the baby, she turned and hit up against three spinal nerves and damaged three spinal nerves. While in labor, my whole body went numb and I couldn't feel anything. I was able to push the baby out. About a hour later I said, "I still can't feel my leg." And they said, "Oh, it's the epidural you had." I said, "I didn't have an epidural." "Well, that's interesting." About seven hours out, I decided that people weren't going to take me seriously. So I just started screaming to the top of my lungs, "I can't feel my legs." Over and over again. People started rushing in. My care team decided that this was something that they never heard of before. And so they said, "Well, just stay in the hospital until Tuesday when physical therapy comes in."
Theresa Chapple:
Physical therapy gives me a wheelchair, never do they try and get to the underlying factor of why I can't feel my leg. Being in the hospital, freshly having a new baby, completely immobilized from the waist down, six days postpartum I finally saw a neurologist who said, "This is just a part of sciatica. You'll recover in about three weeks." And after about three weeks, I started feeling more movement in my leg. So I hear the baby crying downstairs and I decided to get up and go help. I make it to the top step and I fall down [crosstalk 00:17:03]. Inpatient physical therapy, where I stayed about three months, found out that it was actually a spinal nerve damage to three nerves, two of which will recover, but one will never recover because of delay in care. It was a really tough time. I had to kind of relearn how to walk. I wasn't able to pick up anything because the damage was to my lower spine, so I couldn't hold my baby until she was about 10 months old was the first time I was able to pick her up unassisted.
Theresa Chapple:
I went on to having outpatient physical therapy for about a year. I walked with a walker and then a cane. I still need to use my cane if I'm going to do hikes, which I love to do. I used to be a Double Dutch champion.
Lisa Bodnar:
Oh I love it. That is so cool.
Theresa Chapple:
But now my dreams of teaching my children to jump Double Dutch have really... It's not something I can do anymore. So I often questioned why I didn't catch these things and how come I didn't think through what could have been happening to me at the time, but being a new mom is big enough. So just the level of life changing long-term sequelae that I have to deal with is something that is really hard for me. So this was a major fail of my care team to one, listen to Black women. It was a major fail to send me home without a care plan.
Theresa Chapple:
What I think about often is that my birth injury is not represented in anyone's dataset. If we only capture those births that end in death or near misses, how do you know about the rest of those births? We have no surveillance mechanism that will even tell us what to look for in the postpartum period that could be tied back to having adverse outcomes at delivery. So if I can walk away in 10 years and there be a surveillance system around postpartum outcomes, then that's what I really want the story to be told about what Theresa did in her career.
Lisa Bodnar:
You've got three kiddos. What's it like for them to have a mom who's in reproductive health?
Theresa Chapple:
I remember this fun story of my daughter when she was seven. My boss came out and introduced herself and my daughter goes, "So you're pregnant." And my boss goes, "I have a baby in my belly." And my daughter goes, we get back to my office and she says, "I need to write your boss a note." So I give her some paper and she says, "Fetuses are carried in your uterus."
Lisa Bodnar:
I taught my kids when they were young names of their anatomy. And now that they're a bit older, 12, 15, like, " Oh, do you have to say labia?" I'm like, "I do have to say labia. I'm sorry. That's what it is."
Theresa Chapple:
Yes.
Lisa Bodnar:
So Theresa, which of your three kids is your favorite? Just kidding. I'm just kidding. Although, you and I both know there always is a favorite.
Theresa Chapple:
And it changes every day.
Lisa Bodnar:
Do you have a food memory from your childhood?
Theresa Chapple:
Yes. So I am from Philadelphia and our food of choice are either hoagies or cheese steaks, and so to me that is what is necessary to make life complete.
Lisa Bodnar:
Theresa, what's something you're embarrassed to admit that you like?
Theresa Chapple:
Married at First Sight. That is my favorite TV show and I often-
Lisa Bodnar:
I don't know it. What is it?
Theresa Chapple:
It's on TLC and it is-
Lisa Bodnar:
Oh, it's one of those. Okay. Yeah, that's embarrassing.
Theresa Chapple:
It's a reality TV show where people get married to someone that's picked by matchmakers and they get married to them at first sight at the altar.
Lisa Bodnar:
Would you rather fight one horse-sized duck or 100 duck-sized horses?
Theresa Chapple:
I'm going to go with 100 duck-sized horses.
Lisa Bodnar:
Because?
Theresa Chapple:
I feel like if I step on three, the others might run away.
Lisa Bodnar:
Okay. Favorite pizza topping?
Theresa Chapple:
Pepperoni.
Lisa Bodnar:
Favorite smell?
Theresa Chapple:
Newborn babies.
Lisa Bodnar:
Oh, that's such a good one. Oh, their heads. I love the small of a newborn baby's head. That's amazing. If you had to choose one, which would you prefer to be your only mode of transportation, a donkey or a giraffe?
Theresa Chapple:
Was not expecting that. I'm going to say a giraffe because I am very short, and so the idea of actually being able to see things sounds amazing.
Lisa Bodnar:
How would you park it, though?
Theresa Chapple:
I don't even know how I would get off of it, so.
Lisa Bodnar:
Theresa, it's a pleasure connecting with you personally. I'm so happy that you shared all of this. Thank you for being on.
Theresa Chapple:
Thank you so much.
Lisa Bodnar:
Your conservative husband is checking in on what you're saying.
Theresa Chapple:
Somebody definitely is.
Lisa Bodnar:
That door peeps open and I see someone's eyes.