October 4, 2016—Cassandra Okechukwu, associate professor of social and behavioral sciences, studies how different environments—such as our homes and our workplaces—shape our health.
How did you first become interested in academic public health?
I always knew I would become a professor—it is the family business! Nigerians, especially my tribe, the Igbos, have high regard for professors, and many family members are professors. After immigrating to the U.S. in 1993, I learned quickly that a successful academic career required not just intelligence but adequate funding, so I pursued an undergraduate degree in nursing because of the high hourly wage and flexible schedule. Nursing is a common occupational entry point for African immigrants in the D.C./Maryland area where I grew up.
My first exposure to public health was through occupational and environmental health courses that I took at Johns Hopkins. I became interested in the health effects of work environments on workers. As my own career trajectory was shaped by occupational segregation, noting these forces and their effects on workers’ opportunities for optimal health has continued to be a theme in my research. I loved the focus on creating social change in my occupational health courses so much that I ditched my original plan of pursuing a PhD in nursing after my MSN/MPH degree. Instead, I took a job as a project coordinator at the University of Maryland’s Center for Environmental and Occupational Health Justice. Working alongside nurses with doctoral degrees in public health inspired me to follow the same path. While I taught and supported the Center’s research, the part I enjoyed most was working in state legislatures, where we recruited and coached low-wage workers who testified at legislative hearings.
What research are you currently doing on how work and home environments shape health?
Through the Work, Family and Health Network (WFHN), I have conducted research highlighting how the health of nursing home workers, their partners, children, and bosses are interconnected with each other and with broader patterns of health disparities. In one group-randomized controlled trial, we found that making worksites more supportive of workers’ family needs led to increases in the quantity and quality of workers’ interactions with their children at home. My colleagues have shown that it also led to better sleep for workers as well as for their children.
I have also done research demonstrating that when workers receive work-family support, this may influence the quality of care they provide to nursing home patients. My work in nursing homes as a clinician and as an academic has also opened my eyes to important issues of health equity. Nursing home patients are among the most vulnerable people in our society, while a majority of the workers taking care of them are low-income single women—also vulnerable—often raising children at risk of obesity and other negative health outcomes.
I am currently investigating differences in the occupational consequences of marijuana use using national data, given current liberalization of marijuana laws. If we find that minorities and low-income workers are suffering greater or different consequences for their marijuana use, then states should develop laws that protect workers from such discrimination.
Next, I plan to investigate how policies geared towards patients may influence workers’ health outcomes. For example, 26 states have enacted, repealed, and sometimes readopted wage pass-through policies where states provide nursing homes with extra reimbursements that must be used for workers’ wages. Evaluations indicate the policies improve staffing levels, wages, and quality of care. I want to find out if they also impact the high levels of occupational injuries in nursing homes.
You have an interest in health behavior theories, could you explain what they are and why in some cases they come up short?
Using theory to ground my work and teaching a class on theory in public health helps me to stay humble and open to ideas from all disciplines. As a student, I felt that many health behavior theories focused too much on the individual without acknowledging how difficult our particular environments and circumstances can make it to change behavior in everyday life. Now as a teacher, I see my students struggle with the same criticisms. My interdisciplinary experiences in the Robert Wood Johnson Health and Society Scholars program at University of California, San Francisco and Berkeley taught me the value of not simply becoming an acolyte of your field’s main theories, but rather, to expand your repertoire and to be thoughtful and curious in giving and taking critiques of ideas and theories.