Associate Professor of Behavioral and Social Sciences
Community is the thread that runs through the teaching, research, and policy work of Professor Dulin, a medical sociologist studying how ‘resilience,’ or the ability to flourish in spite of adversity, may lead to better HIV-related outcomes.
How did you first become interested in public health?
I initially wanted to be a lawyer, so my major was political science and I had a class I’ll never forget. It was juvenile justice, or kids in the court, and it was all about juvenile injustice. And I talked with the professor after, and he said, “You should really consider sociology.”
As I did more research, I thought sociology, criminal justice, or learning about the justice system were where it’s at. I transferred to the University of Alabama at Birmingham and pursued a medical sociology program, which is designed to understand social structures and factors contributing to health. I minored in criminal justice, but really, my heart was with understanding factors that contribute to health inequities.
You’re a Midwesterner, originally from Ohio, you went to the University of Alabama and now, you’re a New Englander. How do all those different perspectives inform your work?
It just reinforces that you can’t use a one-size-fits-all approach to health or intervention design and that you really need to take the time to understand the inner workings and processes of a specific culture or community where you’re going to be working.
Community is the thread that connects all of your work; not just studying the health of communities, but engaging with community members, being informed by their perspectives. Why is community engagement important and how does this approach inform your work?
So, one of the things that lured me into public health is the applied approach. I didn’t want to just observe people doing things and write 20-page articles that go in a journal that no one sees. I really wanted to get out into the community. Sometimes, the quantitative data only tells one part of the story, but engaging people in qualitative discussions tells another part.
“I didn’t want to just observe people doing things and write 20-page articles that go in a journal that no one sees. I really wanted to get out into the community.”
With any kind of research, when you’re studying a population who’s affected by something, there’s a knowledge base that already exists in the community. And why not start there to see what they think is important? I mean, they know themselves best. We help move the process along in a scientifically rigorous way, and we’re able to bring in best evidence and then tailor it to the communities of interest, but that only happens if you work with the community.
This kind of work comes with unique challenges.
It’s not as hard as people make it out to be. It’s a matter of learning how to talk to people and learning how to make connections with organizations who can help you along the way. It takes a team to do community engaged science. I don’t do it alone. I never have.
What is your advice for young, idealistic scholars interested in a community-engaged approach or applied public health?
Get training before you go out into communities. You don’t want to go out without a tool kit and then disappoint the community partners. Often, I think young students want to help but they don’t necessarily know how to sit back and listen and learn from the community before coming in and saying, “I want to implement X, Y, Z project, and it should look like this.” So a level of humility.
Also, before you reach out to communities, think about the feasibility of doing something in the short amount of time that you may have. Will you leave a project unfinished? Will that do more harm than good? Community organizations have competing interests, and they don’t necessarily align with what you want to do, so scale your expectations accordingly.
You bring this same approach to your teaching here at Brown.
For my class Place Matters: Exploring Community-Level Contexts on Health Behaviors, Outcomes and Disparities, students create policy briefs. It’s applied on-the-ground work without a lot of structure. I say, “Okay students, here’s your research question, now you all plan it from beginning to end, and I serve as your consultant.”
“With this study, we really wanted to move away from the deficit approach and recognize that even though some communities are at disproportionate risk for a wide array of poor health behaviors and outcomes, we know that assets still exist within the community.”
When students graduate and they’re out in the profession, no one’s telling them what to do from A to Z directly. They have to come up with things on their own, so this course is a great way to build the professionalization process and students’ self-confidence for going through the literature, identifying evidence-based measures, implementing training plans, team-building, teamwork, and then going out and doing evaluations, and distilling their results in a way that’s tangible to community organizations or community members.
At the end of the day, what we want to do is improve population health across an array of populations or conditions. And we’re not always talking to other scientists or researchers, so we need to find ways to translate our evidence into practical solutions and through policy.
Students seem to love it. I get a lot of positive feedback. It’s a lot of work, and I can’t stress enough to students how much work it is, probably more work than they’ve done in a class before, but they take on the challenge with enthusiasm, and the results that they deliver at the end of the semester have been amazing. I’ve been very impressed.
Brown students are special.
They rise to challenges, they embrace challenges, and they enjoy challenges. It allows me to be a lot more creative. I can do more ambitious things within a 13 week class than I’ve ever been able to do before. It’s been a lot of fun.
The policy training your students engage with is also an important part of your work. Tell us about your policy work with the Society of Behavioral Medicine.
I like applied research so I thought, how can I have more of an impact? How can I translate the evidence? There were opportunities to develop policy briefs with the Society of Behavioral Medicine, which I’m a member of. So I joined their Health Policy Committee and co-wrote a policy brief on sugar sweetened beverages taxation providing the evidence base.
Later, I led a policy brief on increasing fruit and vegetable production in the Farm Bill to make fruits and vegetables more accessible and more affordable, and what that should look like in that upcoming reauthorization. I was appointed chair of the Health Policy Committee in 2019 and I’m helping to shepherd through policy briefs by our professional membership and supporting them through the process.
I embed policy in both of my classes. Students have to find what the evidence is in support of a policy, describe the policy, and then also think strategically and critically about the intended and unintended consequences of a policy.
In addition to teaching, you are currently at work on a 5-year, $3 million dollar project testing how ‘resilience,’ may lead to better HIV-related outcomes. Tell us what you mean by resilience.
Resilience is positive psychological, behavioral, and/or social adaptation despite life’s adversities; so someone using their own capacity combined resources to overcome threats to development and health or to overcome adversities.
With this study, we really wanted to move away from the deficit approach and recognize that even though some communities are at disproportionate risk for a wide array of poor health behaviors and outcomes, we know that assets still exist within the community. So in spite of structural barriers that are real, that reinforce inequities and exacerbate them over time, what are disparity groups doing to overcome said barriers to engage in favorable health behaviors?
We’ve completed aim one of the study, which is to use a mixed methods approach to understand and identify resilience resources among African Americans in the South who are living with HIV. The second step is to take those items and test them and develop a measure formally. Aim three, our longitudinal aim, will examine risk and resilience on HIV outcomes like viral load, clinic attendance, and medication adherence.
Tell us what you mean by resilience resources.
At the individual level, often things like optimism, religiosity, or spirituality for example. At the interpersonal and neighborhood levels, things like social support, neighborhood measures of social capital or social cohesion.
With this study, we are looking at resilience from a multilevel perspective. The majority of resilience research is at the individual level, but if you focus only on the individual, you say, “Well, this person’s not resilient enough. Clearly, just work harder.” That’s unfair when people are coming against these very real barriers to health that are not just at the individual level—access to a clinic, neighborhood unsafety, socioeconomic barriers, or racism. So you can’t tell someone that they’re just not resilient enough. There also have to be structures, external to the individual, that help them to be resilient.