Profile: Nancy Brown, Ph.D.

A couple of constant themes run through the professional life of Nancy Brown, Ph.D. One is her passionate interest in adolescent health and development. The other is her strong belief in information and education as effective tools to help prevent disease.

"The thread that binds my work is that I'm trying to learn how to intervene to change people's behavior in ways that allow them to protect themselves from disease," she said. "In order to affect behavior and reduce the risk or consequences of disease, people need information at all levels and in ways that are appropriate to them and tailored to them."

Dr. Brown studied community medicine as an undergraduate at San Jose State University and later worked as a lay midwife, counselor and teacher. She earned a Master's degree in Child Development at the University of California at Santa Cruz, and a doctorate in Child and Adolescent Health at Stanford University. After conducting research studies on adolescent development, sexual decision-making and HIV/AIDS prevention at the American Institutes for Research in Palo Alto, she joined the staff of the Research Institute's Department of Health Services Research in November 1997.

Along with Department Chair Sandra R. Wilson, Ph.D., and their colleagues, Dr. Brown has focused on the prevention of sexually transmitted diseases (STDs) among specific patient populations. She is Principal Investigator of a project involving high-risk women who are injection drug users (IDUs) or the sexual partners of IDUs. The study is measuring the effectiveness of a small-group intervention conducted by several community-based organizations.

"As of June 2000, 42 percent of women in the United States with AIDS were infected through injection drug use, either their own or that of a sexual partner," Dr. Brown said. "The rate of heterosexual transmission to women has been rising. In many cases, the risk to the women is not through their own behavior, but through the behavior of their partners."

Dr. Brown is the evaluator for an HIV prevention program that the IDU project started in April 2000. Through the program several community agencies -- AIDS Resources Information Services (ARIS), Economic Service Opportunities (ESO) and Planned Parenthood -- offer a series of four workshops in conjunction with voluntary STD and HIV testing. The workshops cover several topics: injection drug use (including information on preventing overdoses); self-esteem and nutrition; an overview of STDs; and community health services.

"The goal of the workshops is to teach these women how to recognize their HIV risk, access available services, and initiate and sustain sexual and drug-related practices that prevent HIV infection," Dr. Brown said. "As the evaluators, we're working with the organizations to help them standardize the workshop content, so that there is a consistent product that can be evaluated and replicated."

To measure the impact of the workshops on the participants, up to 250 women will be recruited to participate in baseline and follow-up interviews over a one-year period.

"We're measuring all the traditional outcome variables," Dr. Brown said. "Are they using clean needles? Are they using condoms? Have they reduced their number of sexual partners? Are they getting tested? But we're also documenting their needs in terms of their overall health and well-being. We want to know if, over the course of the year, they access available community services. We want to see how many referrals they get from the workshops and whether they act on them or not.

"An important part of our effort is to document what has to happen in the chaotic lives of these women to bring HIV protection onto their priority list. These women have multiple service needs. The community-based organizations can't walk into their lives and ask them to make these behavioral changes without taking into account that their own priorities might include having a place to sleep tonight, finding a pair of shoes and feeding their children. So what we're trying to do in this evaluation is document where HIV prevention fits into their priorities -- if at all -- and what it takes to move them over the course of a year towards making it a priority."

The Department of Health Services Research is involved in two other studies whose goals are to understand how to prevent the spread of HIV. One focused on the sexual behavior of Latino couples and the factors that placed the female partner at risk for HIV. The other study, named "Psst!" for Practicing Safer Sex Today, is testing the effectiveness of an educational strategy directed at women recently diagnosed with an STD.

One common thread that runs through all three of these patient populations, according to Dr. Brown, is a serious health information gap.

"With all three groups of women, there's a strong need for information about their own health, the transmission of diseases, and how their behavior may be putting them at risk," she said. "Gender is an important issue. For all of the women in these studies, we've found that certain subjects are hard to bring up. They need information about how to communicate with their sexual partners and how to ask questions of a clinician."

"We've found that this information has to be addressed to their particular needs in a way they can access it. It's a constant challenge to try and figure out how to accept people for who they are, respect them, respect their culture, respect their beliefs and respect their need to feel they're in a safe relationship, but also help them protect their reproductive health."

In an effort to address that challenge earlier in peoples' lives, Dr. Brown teamed with PAMF pediatrician Tina McAdoo, Intranet Manager Ed Bierman, social workers Joyce Kart and Gina Earle, and Health Education Manager Becky Beacom to create an adolescent interest group and teen-health Web site, www.pamf.org/teen, in March 2001.

"We want to provide the information people need, but at younger ages, to teens who are just starting to develop sexual habits and make sexual decisions," she said.

"Hopefully, we can help them enact healthy behaviors and safe habits they won't have to break as adults."


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