Scholars@Duke
Christine L Gray

Christine L Gray

Assistant Research Professor of Global Health
Duke Global Health Institute
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Selected Publications

Uncovering determinants of perceived feasibility of TF-CBT through coincidence analysis.

Journal Article Implementation research and practice · January 2024 IntroductionA mental health provider's perception of how well an intervention can be carried out in their context (i.e., feasibility) is an important implementation outcome. This article aims to identify determinants of feasibility of trauma-focus ... Full text Cite

Is gastroschisis associated with county-level socio-environmental quality during pregnancy?

Journal Article Birth defects research · November 2023 BackgroundGastroschisis prevalence more than doubled between 1995 and 2012. While there are individual-level risk factors (e.g., young maternal age, low body mass index), the impact of environmental exposures is not well understood.Methods Full text Cite

The association between urban greenspace and psychological health among young adults in Addis Ababa, Ethiopia.

Journal Article Environmental research · December 2022 IntroductionPsychological disorders are emerging as health priorities in Sub-Saharan Africa, specifically Ethiopia. Urban greenspace - parks, trees, and other vegetation integrated into urban form - may facilitate population psychological health, ... Full text Cite

Predictors of HIV Testing among Orphaned Youths in Three East African Countries.

Journal Article AIDS and behavior · April 2021 In parts of sub-Saharan Africa, where HIV prevalence is high, HIV is a leading cause of death among youths. Orphaned and separated youths are an especially vulnerable group, yet we know little about what influences their testing behavior. We conducted mult ... Full text Cite

Family Composition and Stability for Orphans: A Longitudinal Study of Well-Being in 5 Low- and Middle-Income Countries.

Journal Article Int J Public Health · 2021 Objectives: Many orphaned children in low- and middle-income countries live with family. Yet, their household composition and its stability are not well-characterized, nor is impact of stability on longer-term outcomes. Methods: We used the longitudinal, m ... Full text Link to item Cite

Advancing successful implementation of task-shifted mental health care in low-resource settings (BASIC): protocol for a stepped wedge cluster randomized trial.

Journal Article BMC Psychiatry · January 8, 2020 BACKGROUND: The mental health treatment gap-the difference between those with mental health need and those who receive treatment-is high in low- and middle-income countries. Task-shifting has been used to address the shortage of mental health professionals ... Full text Open Access Link to item Cite

Divergent trends in life expectancy across the rural-urban gradient and association with specific racial proportions in the contiguous USA 2000-2005.

Journal Article International journal of public health · December 2019 ObjectivesTo estimate county-level adult life expectancy for Whites, Black/African Americans (Black), American Indian/Alaska Native (AIAN) and Asian/Pacific Islander (Asian) populations and assess the difference across racial groups in the relatio ... Full text Cite

Factors affecting the psychosocial well-being of orphan and separated children in five low- and middle-income countries: Which is more important, quality of care or care setting?

Journal Article PloS one · January 2019 As millions of children continue to live without parental care in under-resourced societies in low- and middle-income countries (LMICs), it is important for policymakers and practitioners to understand the specific characteristics within different care set ... Full text Cite

Lay Counselor Perspectives of Providing a Child-Focused Mental Health Intervention for Children: Task-Shifting in the Education and Health Sectors in Kenya.

Journal Article Frontiers in psychiatry · January 2019 The global mental health treatment gap has increasingly been addressed using task-shifting; however, very little research has focused on lay counselors' perspectives on the acceptability, feasibility, and appropriateness of mental health interventions in s ... Full text Cite

Starting the Conversation: Are Campus Sexual Assault Policies Related to the Prevalence of Campus Sexual Assault?

Journal Article Journal of interpersonal violence · November 2018 One goal of university campus sexual assault (CSA) policies is to help prevent CSA. Federal guidance in the 2014 White House Task Force to Protect Students From Sexual Assault Checklist for Campus Sexual Misconduct Policies suggests 10 elements for inclusi ... Full text Cite

Associations between environmental quality and infant mortality in the United States, 2000-2005

Journal Article Archives of Public Health · October 15, 2018 Background: The United States (U.S.) suffers from high infant mortality (IM) rates and there are significant racial/ethnic differences in these rates. Prior studies on the environment and infant mortality are generally limited to singular exposures. We uti ... Full text Cite

Associations between environmental quality and adult asthma prevalence in medical claims data.

Journal Article Environmental research · October 2018 As of 2014, approximately 7.4% of U.S. adults had current asthma. The etiology of asthma is complex, involving genetics, behavior, and environmental factors. To explore the association between cumulative environmental quality and asthma prevalence in U.S. ... Full text Cite

The association between physical inactivity and obesity is modified by five domains of environmental quality in U.S. adults: A cross-sectional study.

Journal Article PloS one · January 2018 Physical inactivity is a primary contributor to the obesity epidemic, but may be promoted or hindered by environmental factors. To examine how cumulative environmental quality may modify the inactivity-obesity relationship, we conducted a cross-sectional s ... Full text Cite

County-level cumulative environmental quality associated with cancer incidence.

Journal Article Cancer · August 2017 BackgroundIndividual environmental exposures are associated with cancer development; however, environmental exposures occur simultaneously. The Environmental Quality Index (EQI) is a county-level measure of cumulative environmental exposures that ... Full text Cite

Associations between Environmental Quality and Mortality in the Contiguous United States, 2000-2005.

Journal Article Environmental health perspectives · March 2017 BackgroundAssessing cumulative effects of the multiple environmental factors influencing mortality remains a challenging task.ObjectivesThis study aimed to examine the associations between cumulative environmental quality and all-cause an ... Full text Cite

Additive interaction between heterogeneous environmental quality domains (Air, Water, Land, Sociodemographic, And Built Environment) on preterm birth

Journal Article Frontiers in Public Health · October 24, 2016 Background: Environmental exposures often occur in tandem; however, epidemiological research often focuses on singular exposures. Statistical interactions among broad, well-characterized environmental domains have not yet been evaluated in association with ... Full text Cite

Civic engagement among orphans and non-orphans in five low- and middle-income countries.

Journal Article Global Health · October 11, 2016 BACKGROUND: Communities and nations seeking to foster social responsibility in their youth are interested in understanding factors that predict and promote youth involvement in public activities. Orphans and separated children (OSC) are a vulnerable popula ... Full text Open Access Link to item Cite

An argument for renewed focus on epidemiology for public health.

Journal Article Annals of epidemiology · October 2016 PurposeAlthough epidemiology has an indispensable role in serving public health, the relative emphasis of applications of epidemiology often tend toward individual-level medicine over public health in terms of resources and impact.Methods ... Full text Cite

Potentially traumatic experiences and sexual health among orphaned and separated adolescents in five low- and middle-income countries.

Journal Article AIDS Care · July 2016 Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in sub-Saharan Africa and Asia. Over 153 million children worldwide have lost one or both parents, including 17 million orphaned by AIDS, and millio ... Full text Link to item Cite

Uncovering determinants of perceived feasibility of TF-CBT through coincidence analysis.

Journal Article Implementation research and practice · January 2024 IntroductionA mental health provider's perception of how well an intervention can be carried out in their context (i.e., feasibility) is an important implementation outcome. This article aims to identify determinants of feasibility of trauma-focus ... Full text Cite

Is gastroschisis associated with county-level socio-environmental quality during pregnancy?

Journal Article Birth defects research · November 2023 BackgroundGastroschisis prevalence more than doubled between 1995 and 2012. While there are individual-level risk factors (e.g., young maternal age, low body mass index), the impact of environmental exposures is not well understood.Methods Full text Cite

The association between urban greenspace and psychological health among young adults in Addis Ababa, Ethiopia.

Journal Article Environmental research · December 2022 IntroductionPsychological disorders are emerging as health priorities in Sub-Saharan Africa, specifically Ethiopia. Urban greenspace - parks, trees, and other vegetation integrated into urban form - may facilitate population psychological health, ... Full text Cite

Predictors of HIV Testing among Orphaned Youths in Three East African Countries.

Journal Article AIDS and behavior · April 2021 In parts of sub-Saharan Africa, where HIV prevalence is high, HIV is a leading cause of death among youths. Orphaned and separated youths are an especially vulnerable group, yet we know little about what influences their testing behavior. We conducted mult ... Full text Cite

Family Composition and Stability for Orphans: A Longitudinal Study of Well-Being in 5 Low- and Middle-Income Countries.

Journal Article Int J Public Health · 2021 Objectives: Many orphaned children in low- and middle-income countries live with family. Yet, their household composition and its stability are not well-characterized, nor is impact of stability on longer-term outcomes. Methods: We used the longitudinal, m ... Full text Link to item Cite

Advancing successful implementation of task-shifted mental health care in low-resource settings (BASIC): protocol for a stepped wedge cluster randomized trial.

Journal Article BMC Psychiatry · January 8, 2020 BACKGROUND: The mental health treatment gap-the difference between those with mental health need and those who receive treatment-is high in low- and middle-income countries. Task-shifting has been used to address the shortage of mental health professionals ... Full text Open Access Link to item Cite

Divergent trends in life expectancy across the rural-urban gradient and association with specific racial proportions in the contiguous USA 2000-2005.

Journal Article International journal of public health · December 2019 ObjectivesTo estimate county-level adult life expectancy for Whites, Black/African Americans (Black), American Indian/Alaska Native (AIAN) and Asian/Pacific Islander (Asian) populations and assess the difference across racial groups in the relatio ... Full text Cite

Factors affecting the psychosocial well-being of orphan and separated children in five low- and middle-income countries: Which is more important, quality of care or care setting?

Journal Article PloS one · January 2019 As millions of children continue to live without parental care in under-resourced societies in low- and middle-income countries (LMICs), it is important for policymakers and practitioners to understand the specific characteristics within different care set ... Full text Cite

Lay Counselor Perspectives of Providing a Child-Focused Mental Health Intervention for Children: Task-Shifting in the Education and Health Sectors in Kenya.

Journal Article Frontiers in psychiatry · January 2019 The global mental health treatment gap has increasingly been addressed using task-shifting; however, very little research has focused on lay counselors' perspectives on the acceptability, feasibility, and appropriateness of mental health interventions in s ... Full text Cite

Starting the Conversation: Are Campus Sexual Assault Policies Related to the Prevalence of Campus Sexual Assault?

Journal Article Journal of interpersonal violence · November 2018 One goal of university campus sexual assault (CSA) policies is to help prevent CSA. Federal guidance in the 2014 White House Task Force to Protect Students From Sexual Assault Checklist for Campus Sexual Misconduct Policies suggests 10 elements for inclusi ... Full text Cite

Associations between environmental quality and infant mortality in the United States, 2000-2005

Journal Article Archives of Public Health · October 15, 2018 Background: The United States (U.S.) suffers from high infant mortality (IM) rates and there are significant racial/ethnic differences in these rates. Prior studies on the environment and infant mortality are generally limited to singular exposures. We uti ... Full text Cite

Associations between environmental quality and adult asthma prevalence in medical claims data.

Journal Article Environmental research · October 2018 As of 2014, approximately 7.4% of U.S. adults had current asthma. The etiology of asthma is complex, involving genetics, behavior, and environmental factors. To explore the association between cumulative environmental quality and asthma prevalence in U.S. ... Full text Cite

The association between physical inactivity and obesity is modified by five domains of environmental quality in U.S. adults: A cross-sectional study.

Journal Article PloS one · January 2018 Physical inactivity is a primary contributor to the obesity epidemic, but may be promoted or hindered by environmental factors. To examine how cumulative environmental quality may modify the inactivity-obesity relationship, we conducted a cross-sectional s ... Full text Cite

County-level cumulative environmental quality associated with cancer incidence.

Journal Article Cancer · August 2017 BackgroundIndividual environmental exposures are associated with cancer development; however, environmental exposures occur simultaneously. The Environmental Quality Index (EQI) is a county-level measure of cumulative environmental exposures that ... Full text Cite

Associations between Environmental Quality and Mortality in the Contiguous United States, 2000-2005.

Journal Article Environmental health perspectives · March 2017 BackgroundAssessing cumulative effects of the multiple environmental factors influencing mortality remains a challenging task.ObjectivesThis study aimed to examine the associations between cumulative environmental quality and all-cause an ... Full text Cite

Additive interaction between heterogeneous environmental quality domains (Air, Water, Land, Sociodemographic, And Built Environment) on preterm birth

Journal Article Frontiers in Public Health · October 24, 2016 Background: Environmental exposures often occur in tandem; however, epidemiological research often focuses on singular exposures. Statistical interactions among broad, well-characterized environmental domains have not yet been evaluated in association with ... Full text Cite

Civic engagement among orphans and non-orphans in five low- and middle-income countries.

Journal Article Global Health · October 11, 2016 BACKGROUND: Communities and nations seeking to foster social responsibility in their youth are interested in understanding factors that predict and promote youth involvement in public activities. Orphans and separated children (OSC) are a vulnerable popula ... Full text Open Access Link to item Cite

An argument for renewed focus on epidemiology for public health.

Journal Article Annals of epidemiology · October 2016 PurposeAlthough epidemiology has an indispensable role in serving public health, the relative emphasis of applications of epidemiology often tend toward individual-level medicine over public health in terms of resources and impact.Methods ... Full text Cite

Potentially traumatic experiences and sexual health among orphaned and separated adolescents in five low- and middle-income countries.

Journal Article AIDS Care · July 2016 Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in sub-Saharan Africa and Asia. Over 153 million children worldwide have lost one or both parents, including 17 million orphaned by AIDS, and millio ... Full text Link to item Cite

Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study.

Journal Article Glob Health Sci Pract · August 25, 2015 BACKGROUND: Policy makers struggling to protect the 153 million orphaned and separated children (OSC) worldwide need evidence-based research on the burden of potentially traumatic events (PTEs) and the relative risk of PTEs across different types of care s ... Full text Link to item Cite

Data quality from a longitudinal study of adolescent health at schools near industrial livestock facilities.

Journal Article Annals of epidemiology · July 2015 PurposeLongitudinal designs enable examination of temporal relationships between exposures and health outcomes, but extended participation can cause study fatigue. We present an approach for analyzing data quality and study fatigue in a participat ... Full text Cite

The associations between environmental quality and preterm birth in the United States, 2000-2005: a cross-sectional analysis.

Journal Article Environmental health : a global access science source · June 2015 BackgroundMany environmental factors have been independently associated with preterm birth (PTB). However, exposure is not isolated to a single environmental factor, but rather to many positive and negative factors that co-occur. The environmental ... Full text Cite

Dipeptidyl-peptidase-4 inhibitors and pancreatic cancer: a cohort study.

Journal Article Diabetes, obesity & metabolism · December 2014 AimTo compare pancreatic cancer incidence and diagnostic evaluation among patients initiating dipeptidyl-peptidase-4 (DPP-4) inhibitor treatment with those initiating sulfonylureas (SU) and thiazolidinediones (TZD).MethodsMedicare claims ... Full text Cite

Use of combination antihypertensive therapy initiation in older Americans without prevalent cardiovascular disease.

Journal Article Journal of the American Geriatrics Society · September 2014 ObjectivesTo describe new users of antihypertensive medications and identify predictors of combination therapy initiation in older Americans.DesignRetrospective observational cohort study.SettingPopulation-based study using U.S. ... Full text Cite

Throwing out the baby with the bathwater?: Comparing 2 approaches to implausible values of change in body size.

Journal Article Epidemiology · July 2014 BACKGROUND: In childhood obesity research, the appearance of height loss, or "shrinkage," indicates measurement error. It is unclear whether a common response--excluding "shrinkers" from analysis--reduces bias. METHODS: Using data from the National Longitu ... Full text Link to item Cite

Mental health service utilization in the U.S. Army.

Journal Article Psychiatric services (Washington, D.C.) · April 2013 ObjectiveU.S. Army personnel experience significant burden from mental disorders, particularly during times of war and with multiple deployments. This study identified the rates and predictors of mental health service use by Army soldiers and exam ... Full text Cite

A systematic review of PTSD prevalence and trajectories in DSM-5 defined trauma exposed populations: intentional and non-intentional traumatic events.

Journal Article PloS one · January 2013 ObjectiveWe conducted a systematic review of the literature to explore the longitudinal course of PTSD in DSM-5-defined trauma exposed populations to identify the course of illness and recovery for individuals and populations experiencing PTSD. Full text Cite

The Epidemiology of Acute Stress Disorder and Other Early Responses to Trauma in Adults

Chapter · November 21, 2012 Acute stress disorder (ASD) is an anxiety disorder characterized by exposure to a traumatic event followed by symptoms of re-experiencing, avoidance, hyper-arousal, peritraumatic dissociation, and impairment in functioning. ASD's time-limited duration (two ... Full text Cite