Marie Stoner, PhD, MPH – Investigator, Women’s Global Health Imperative, RTI International

Interview Questions

[OnlineEducation.com] Your current title is Investigator at RTI International where you are part of the Women’s Global Health Imperative, correct?

[Dr. Stoner] Yes. Investigator is my title, but epidemiology is what I do.

[OnlineEducation.com] How would you situate that work within the broader context of public health?

[Dr. Stoner] At the Women’s Global Health Imperative at RTI, I work in two basic areas of research. The first involves behavioral studies within HIV prevention product clinical trials through the Microbicide Trials Network (MTN). In that group, we are looking at products that are being developed to prevent the spread of HIV infection. For example, there are now clinical trials being done to test a vaginal ring as an intervention to prevent the spread of HIV. The behavioral research my group does is aimed at gaining a better understanding of the acceptability of the product and the experiences of women using the product. Is this something that women find easy to use? Are they comfortable with it? What are their attitudes toward it? Those are the kinds of questions we are trying to answer. Right now we have several different studies in this area, with pregnant women, breast feeding women, and adolescent girls and young women, all in sub-Saharan African countries. We are also doing a study with couples looking at preferences around products that would prevent both pregnancy and HIV.

The second line of research I do is related more to social factors, like poverty, education, and family support, and how those factors influence adolescent sexual and reproductive health. I became particularly interested in this line of research when I thought back to my own experiences as a young woman and how sensitive you are at that time in life to influences from your peers and your family and the first partnerships that you have. That research is more about trying to create supportive interventions for young women to help them make informed decisions about sexual health.

As an epidemiologist, how do you approach that type of research?

We do a number of different studies in which we’re trying to get insights from women that will help us to develop interventions and then test those interventions in randomized trials. I’m also very involved in using quantitative methods in existing data sets to untangle the complexities around how one factor affects another factor in health. For example, I’ve done some work that looks at staying in school and how that seems to prevent HIV in young people. The indications there are that it has a lot to do with the networks of friends and types of partners that you are likely to have when you are in school.

So you’re looking at various correlations to see how they might lead to a particular outcome in a population group.

Yes. We’re trying to untangle these complex relationships and to better understand them using quantitative methods. Once we’ve done that, we can use the information to create better intervention strategies and develop programs that can improve the health of young people.

To backtrack, you got your undergraduate degree in neuroscience, which would seem to indicate that you were already thinking about a career in a scientific field. How did you find your way to epidemiology and what were some of the formative experiences that led you there?

Initially, my interest was in medicine and possibly a career in medicine. As an undergraduate, I was essentially a pre-med student. But I gravitated to neuroscience because I was particularly interested in the psychological aspects of health. As I learned more and more about public health and was exposed to the concepts and the thinking behind public health, it’s appeal grew for me because it felt like an interesting blend of medicine and the psychology of how people make decisions about health. I also like the more quantitative scientific part of it as well, which is probably why I chose epidemiology. Public health was interesting to me because it was complex and hard to disentangle. I think we’re seeing that now with the COVID-19 epidemic and how all these different factors come into play with wearing masks and the economic impacts. It’s complicated because it is difficult to identify all of the factors and connections that influence how people behave in a public health crisis.

Were you aware of epidemiology and public health as an undergraduate and did you see public health as a career option?

I actually was aware of public health. My mother was involved in maternal health work. She used to work for a nonprofit, but she is retired now. The work she did was in international maternal and child health. Through her, I was aware that public health was a career option, although I ended up doing a different type of work within public health than the work that she was involved in.

Were there points along the at which you found yourself noticing that there were unique hurdles or specific challenges that might hold women back from advancing in the field?

Yes. I think that you can see that specifically in epidemiology. Public health programs in general are predominantly women. In some areas of public health it may be as much as 90% women from what I have seen. And yet, a lot of the leaders are men and in the research methods classes you see that many of the most prominent role models are male. So, there is a definitely a gendered aspect in terms of representations in different specializations. Epidemiology has more men than some of the other fields and I think that has to do with the quantitative and statistical components of epidemiology.

As I’ve gotten older, something else I’ve seen with my friends and people I went to school with is that, within research and academic settings, public health and epidemiology can be a stressful job. There’s a lot of pressure to publish in academia, and there’s a lot of pressure to get funding for research and to support yourself. That pressure really starts mounting at around the same time that a lot of women are thinking about starting a family. That can create a challenging dynamic, a dynamic that leads some women in the field who are very good at what they do to wonder if it’s really worth it. That’s a factor that might influence women to choose a career in which they can have more balance in their life. It’s definitely something that I have seen come up.

That’s not something that is unique to public health or epidemiology. Public health is just one field in which the data indicates that women are quite well represented at the entry and middle levels. And yet there are still gender disparities as you move up the ladder. Is that something you noticed in your MPH program?

I did a little bit at the MPH level. But I think I noticed it more at the PhD level, which is when the classes are smaller and you’re in closer contact with the professors. In epidemiology, one of the things that you notice is that a lot of the people who are regarded as really great researchers and methods leaders are men. In fact, leaders in methods are almost all men.

In academic fields and research fields seniority is often key to advancement. In a field that was male dominated three or four decades ago, you might expect to find a larger number of men in senior positions today. But I’m not sure that dynamic accounts for all disparities in representation. Are the gender disparities in leadership and administrative roles that show up in studies of the field consistent with what you see anecdotally?

Yes. It is very consistent with what I’ve seen in the field in terms of leadership and senior faculty positions, although I do think one of the good things about the work that I do now at RTI is that I work on a team of women. Most of us are epidemiologists. It’s a really supportive environment and it’s been a great experience for me to be working with smart, successful women. We can brainstorm together, and I feel like I have some really good role models in them.

Do you think that the situation you’re describing is fairly unique or is it becoming more common?

I think it depends on the field and it also depends on the focus of the research. As I said, I do a lot of sexual and reproductive health work. That’s an area of research and policy in which you tend to find a lot of women. Overall, public health is a somewhat newer field, and, in the past, it was a predominantly male field that was dominated by medical doctors. Now, there are definitely more women in the field and instead of just medical doctors we have people getting PhDs in public health and PhDs in epidemiology, which changes the composition of the field. So that has opened up the field in a lot of ways.

How would you characterize that change or those changes?

Because there is a lot of pressure and stress when it comes to publishing and competing for grants, and because that pressure can pose difficult work-life balance issues for women who are thinking about starting a family, it makes a big difference when you have strong mentors and systems that can help women succeed. In my experience teaching when I was in my PhD program, I found that there were a lot of really smart women within epidemiology. But I also noticed a dynamic in which the men in my classes seemed to feel more confident speaking up and being aggressive about expressing their opinions, especially in quantitative methods classes. Having role models for women and mentors in the more quantitative areas of public health is an important counterbalance to that dynamic.

Did you encounter that along the way?

I was lucky in that regard. I had mentors who made me feel more confident especially in the methods areas. It helps to give you a sense that you can do this. There are situations where women are in a better position to understand the challenges that other women in the field are facing and to know the kinds of support that women might need. Even within my group at RTI there is an openness and willingness to talk about our personal experiences and how that may be affecting the work that we are doing, the time that we have, or just the ability to concentrate. That’s helpful. I know that it has helped me to feel supported. There’s also something about seeing women who have achieved leadership positions and who also have balanced lives that is inspiring and that has made me feel confident that I can also achieve that.

Reproductive health and maternal and child health are two public health issues that have probably received more attention as more women have entered the field. Sexual assault on college and university campuses is another such issue. You a co-author on a recent study that looks at sexual assault among college students. As an epidemiologist, are you looking to find a new way into looking at the problem?

Yes. We’re looking for new ways to address the problem. Just trying to get a better understanding of what we can do about the problem seemed important to me. I wanted to work on that paper and with that team in order to draw attention to the issue and to make it clear that we need to make changes. We need to understand the problem better and to continue driving home the message that more work needs to be done. I think one of the interesting things we found was about the reporting of sexual harassment. It seems that even for students who have reported sexual harassment – they’ve gone through the process of contacting people at their university – they still have negative views about the process and the university’s reaction. That would indicate that we should be thinking more about how schools are responding to reports about incidents and about how we make students feel more comfortable with the process.

You referred earlier to your teaching experiences as a PhD student and to the insights that gave you on some of the challenges for women in the field and on the importance of mentoring. With that in mind, what kinds of advice would you offer to women who are considering a career in public health or epidemiology?

That’s a good question. The first thing I would say is that it’s definitely worth pursuing. There’s a lot of work to be done in public health and a lot of need. We’ve certainly seen that during this coronavirus pandemic. But it is really important to have support, especially if you’re considering a PhD in epidemiology. Epidemiology is a challenging field and getting a PhD is a difficult process. So, it helps to be surrounded by supportive mentors and friends as you’re going through it, just to balance out the challenges. And I do think that having female mentors can be particularly helpful in terms of building confidence. So, finding a good mentor is an important piece of the puzzle.

Is there specific advice you would offer on how to go about that?

When I was at UNC, the women in the department started having discussions within the program about different topics related to women in the field of epidemiology. That was helpful. So, I think that more discussions like that should happen. I also think that for women going into public health networking is important and reaching out to people who are at an organization you might be interested in and to people who are doing the type of work you’re interested in. Networking, having conversations, and getting to know women in the field is definitely a good place to start.

I think it is also important to take into account that the field of public health is very broad and there are lots of different types of work you can do within it. There are people in the field who do health policy and think about larger level initiatives and programs that federal and state governments are putting into place. There are people in the field who do health economics and analyze the costs of different types of interventions. There are epidemiologists who focus on the quantitative analysis side of understanding disease within populations. And there are also specializations like maternal and child health. So there are a lot of options in public health. You can work in academia, at pharma companies that are testing drugs, at nonprofit organizations. Understanding that can be important.

One positive development is that it seems like there are more undergraduate programs that are offering intro courses in public health. So, I think between that and the increased public interest in public health, we’re at a good place for people in the field to reach out to college and even high school students, just to explain more about the field and the options in public health.