Megan Smith, PhD - Assistant Professor in the Department of Community and Environmental Health at Boise State University

Interview Questions

[OnlineEducation.com] Let’s start by putting your work into context. I think many of us have been introduced over the past year to the relevance of public health and some of its functions, from epidemiological and medical research, to policy planning and implementation, to communication and education. You have your PhD in Human Development and Family Studies.

[Dr. Smith] Yes.

[OnlineEducation.com] And at Boise State you’re positioned in the Department of Community and Environmental Health.

[Dr. Smith] Yes. Are you confused yet?

[OnlineEducation.com] Not yet. But I am curious. How do you characterize your work and how is it situated in the larger context of public health?

[Dr. Smith] I do what’s called social behavioral health within public health. Sometimes it is referred to as social behavioral health sciences. Essentially, I study the ways in which the environment and other contextual factors impact the health of people at the community level and within groups of individuals who have some connection. In public health we like to say we treat society just as medical doctors treat the patient. Specifically, I am working in areas related to adolescent health, at least that’s primarily what I do. I study substance use, mental health, and sexual risk behavior in adolescent populations, and I look at the factors in their environment that correlate with those behaviors: family factors; peer factors; school factors; and community factors, like neighborhood cohesion. These are all contextual and environmental factors that can impact the health trajectory of adolescents.

[OnlineEducation.com] So you’re looking for causal factors in health outcomes.

[Dr. Smith] Yes, and at how complex factors work together to impact health. So, we might find that young people who do not graduate from high school end up with less ideal mental or physical health outcomes. Instead of just looking at an individual characteristic – for example, how intelligent is that person – we want to examine the cascade of factors in that person’s experiences and that person’s environment that contribute to mental and physical outcomes in that population. So, social behavioral health looks at factors like race, neighborhood, peers, and parents, and at how all of these things work together in complex ways to influence health outcomes not just for one person but for an entire population of people, if that makes sense.

[OnlineEducation.com] It does. It was only a decade ago that you were teaching middle and high school students in California, correct?

[Dr. Smith] Yes. And that was part of my trajectory. As a young person and particularly as a young woman, I didn’t really know what careers were available to me. I think, given my experiences and where my family was situated, I was aware that women could be nurses and women could be teachers. I decided I wanted to be a teacher, mostly because I didn’t like blood and grossness. Teaching seemed fun. I liked getting up in front of people and I had a bunch of younger siblings, so it seemed like a good fit.

I went into teaching and I really loved it. I loved teaching at all levels, but my favorite level was seventh grade. At that age the kids are starting to be able to think deeply and critically and question their world and they are still hungry for knowledge. As kids get a little older, they tend to become more cynical and jaded about their love for learning.

I initially became an English and drama teacher, which now seems very different from where I ended up. But I had an opportunity early on in my teaching career to either teach high school English or middle school math and science. So, here I was in a newer teaching position in a small mountain town and they’re offering me the opportunity to teach at the middle school level, but the subject area was math and sciences. I thought to myself, “I could probably do that.” So, I added a math and science credential, and I went to work teaching life sciences and pre-algebra at the middle school.

Through that experience, I learned a couple of things. First, I saw firsthand how gender disparities manifest at that level. Many of the young women in my classes had already begun to internalize the idea that they were not well suited to become mathematicians or scientists. So, I was seeing a drop off for women who just didn’t seem to identify with being good at math or science.

The second important thing that I learned was that I had been super well prepared to create excellent lessons. In that general sense I could be a good teacher. My graduate work at Chico State had prepared me well to create a curriculum. What I was less prepared for were all the additional needs my students brought with them to class every day. In my first year of teaching, I had a student go missing for two days and I saw students who had issues with incarceration and other things that are so challenging for young people. So I had students bringing these things to my classroom and there I was trying to teach math.

[OnlineEducation.com] The math turned out to be the easy part.

[Dr. Smith] Exactly. There were so many things that these young people were wrestling with and that I was somewhat unprepared to deal with. That got me thinking about different ways we could improve the middle school experience for our students.

I ended up marrying my partner. We moved to West Virginia for his job. I wanted to continue teaching, but there were no teaching jobs in math, science, or English available at the time where we were in West Virginia. I had thought about going back to school to get my PhD and this seemed like a good opportunity to do that.

I wanted to study adolescents and how we could better prepare them and help them deal with the problems and challenges I had seen in the students that I had taught. Young people have all this potential and I knew that schools were not always able to give their students the right kinds of support. So, I went into Human Development and Family Studies, which was housed in the College of Education and Human Services at West Virginia University (WVU). That gave me the opportunity to blend my interest in helping young people through the study of adolescent development with what I knew and would learn about schools.

It was through the work I was doing in my PhD program that I realized that I was essentially looking at health outcomes. I had been concerned about the mental health of my students and about the behavioral choices they were making based on various contextual factors. As a result, my dissertation ended up being in the area of public health. In fact, a member of my dissertation committee was on the faculty at WVU’s School of Public Health. So, by the end of my PhD program I had realized that the work I was doing and the work I wanted to do was in the area of public health.

[OnlineEducation.com] What was the focus of your dissertation?

[Dr. Smith] I was looking at the different elements of school climate, which is one of those amorphous terms. But to make it less amorphous I was measuring specific factors, like how a school’s physical environment or student-teacher relationships or the socioeconomic composition of the student population impacts health outcomes. Specifically, I looked at substance abuse and sexual risk behavior. What we found is that there is a strong relationship or association between all these factors. So, again, I was looking at health outcomes in a social environmental context, which meant I was doing public health.

[OnlineEducation.com] That transition from teaching and education to public health appears to have been fairly seamless for you.

[Dr. Smith] Yes. Through my experience as a teacher and in education, I’d been viewing a lot of the issues that young people have through the lens of positive development. If you look at positive development literature, it maps really well onto healthy outcomes for young people. And, when you’re looking at health outcomes, you’re in the realm of public health.

[OnlineEducation.com] So, from a public health perspective, if you’re approaching a subject as potentially amorphous as school climate, you want to identify individual factors that correlate with the kind of outcomes that tell you something about the social climate at any school.

[Dr. Smith] Exactly. How do we measure it in an objective way so that we can apply what we’ve learned across diverse settings to maximize the benefits? If we know that strong student-teacher relationships can reduce substance abuse, that’s an important factor to identify through research. And then my role could be to apply the findings to creating intervention and prevention programs to bolster student-teacher relationships. Or sometimes it’s just about letting people know that that’s important.

I was very fortunate to have someone from the WVU School of Public Health on my dissertation committee because that got me involved more directly in public health work. The person on my dissertation committee was from Iceland, which is how I got involved with the huge, international Planet Youth program, where we use the Icelandic Prevention Model to look at meaningfully create community, school, and family partnerships to build a culture of prevention and health to benefit young people. I am currently working on a CDC funded project through the West Virginia Prevention Research Center that looks at Translating the Icelandic Prevention Model to the West Virginia Context.

[OnlineEducation.com] You went from teaching, which is a field in which women are quite well represented in the workforce, to public health, a field in which women are also well represented. However, when you look at leadership positions in public health, women appear to be underrepresented. Is that something that you have noticed firsthand?

[Dr. Smith] It’s rather interesting. You are correct in saying that if you look at the general field of public health there are a lot of women represented. But it breaks down in different ways. I would say, to start back at the beginning for me, I chose teaching because it was available to me and I could see myself in the profession. However, when I switched from teaching English to math and science, I noticed a difference. While there are math and science teachers who are women, I found myself among a group of teachers who were primarily male. And that’s especially true as you go up in the grades from middle school to high school.

For me, it was inspiring and motivating to be a woman who taught math and science to seventh graders. The seventh grade year can be a critical one for young people. They are at an age where they have begun to think about their identities and about who they are becoming. So I had a lot of young women in my classes who were already saying that they just weren’t good at math. They were giving in to the idea that math and science just weren’t a girl thing. And I was in a position to show them that there were women in math and science.

My first academic position in the field of public health was at WVU. The School of Public Health at WVU was primarily male at the time. So my first experiences were very male centric, even though I was told that that was not very representative of the field in general. I should point out that when I was in my doctoral program, I was fortunate to have a female mentor who taught advanced statistics. She taught me how to do structural equation modeling and I really engaged with that. This particular analysis technique allows you to measure all these different environmental factors together, which is something that is important to the work that I wanted to do. And advanced statistical analysis is an area of public health that is probably less identified with women, although I think that is changing.

If I think back through my own experiences, it wasn’t until I had a high school math teacher who told me that I was good at math that I had the confidence to do it. Fast forward to now. I came to Boise State to teach public health in the Community and Environmental Health Department. And, despite the fact that there are lots of women who come through our graduate program, we had all male teachers in the research and statistics courses. So, there are lots of women coming into the program, but the people they would see teaching research and statistics were men. I have a fabulous graduate director who saw this and who knew that I had taught statistics in the past. So he moved me into that first research core, and I am now teaching statistics to our graduate students.

That was an intentional move. We want women to see themselves in all facets of public health. In fact, we have a woman here who is an epidemiologist as well, so we are re trying to be conscientious about decisions regarding who the students see teaching particular subjects. We don’t want to create those artificial silos that tend to discourage women from engaging in areas of public health that have traditionally been dominated by men.

[OnlineEducation.com] For clarification, when you referenced your experience at WVU, was it the composition of the faculty or of the students in the public health program that was mostly male?

[Dr. Smith] That’s a good question. So in the Human Development and Family Studies program it was primarily women. I think I had maybe two men in my cohort. But when I got to my faculty position at the WVU School of Public Health, most of my faculty peers were men. So, I worked in a department that was almost all male. As a result, I had the impression that public health was a mostly male field when I started because that was my first experience of it. And then you think of department chairs and deans and things like that, you tend to find more men than women in those positions. Which is interesting when you consider how many women there are today in the field of public health, although I’m not sure what the exact breakdown is.

[OnlineEducation.com] I don’t think anybody really disputes the fact that there are at least as many women as men working in public health today. And, while it varies by specialization within the field of public health, by most metrics women are underrepresented in leadership roles, whether you’re looking at deans and department chairs at academic institutions, program directors and administrators at the CDC or WHO, or publication citations and conference speakers.

[Dr. Smith] I think we’re going to see fallout in that regard from COVID-19 in years to come.

[OnlineEducation.com] In what sense?

[Dr. Smith] Well, we’re starting to see initial figures that show, for instance, that women are publishing at a slower rate than men in the field because men who are not in charge of childcare have more space to write in a remote working environment. Whereas it’s more difficult for women who are working from home with children in the house to find that space. We are also seeing women drop out of the workforce. I know this is kind of nerdy, but I am part of a Facebook group for academic moms. It’s called Academic Mamas. It’s interesting anecdotally to hear about women in academia who feel that they need to take a step back or not be the department chair or things like that because of family situations related to the pandemic.

[OnlineEducation.com] You didn’t go to an MPH program, so you came into the field of public health from a different direction. But I am curious, given what you’ve just pointed about the challenges of balancing family and career, did you encounter or become aware of unique hurdles or barriers that women commonly face as they advance in public health?

[Dr. Smith] It’s hard to make general comments about all men or all women in a field. But I do think there are generalities about caregiving responsibilities and career prioritization in even egalitarian marriages that are valid. Even if you have parents who both identify as feminist, there are dynamics in our society that are ingrained. Some things are just thought of as mom things. You might see it when you take your child to the pediatrician. My husband and I have taken our child to the pediatrician together and the pediatrician will direct all the questions to me because I am the mom. The assumption is that mom is responsible. Those natural defaults are something that women have to work through.

I think another important factor is identification and just seeing yourself or not seeing yourself in a particular field. We might call it representation. If you are going into public health and you have never identified as a math and sciences person, you might avoid the data-heavy research side of the field. I think that’s a great disservice to the field in general. The women I know who work in data science are doing incredible things.

I have been very fortunate at both WVU and Boise State to teach an undergraduate research methods class. It’s often a core requirement for students across programs, so students aren’t taking it as an elective; they’re taking it because they have to. For me, that represents an opportunity to introduce women, and other students who may not identify with research, to statistics and research methods and to make sure that they can see themselves in that work. I like to find ways to make the subject accessible to all of my students, regardless of gender or how students might see themselves. I think we need to do more things like that, where we are intentionally opening these worlds to them – statistics, mathematics, science.

[OnlineEducation.com] You’re involved with the American Public Health Association (APHA), specifically with the Women’s Caucus of the APHA. From that perspective, speak to the importance of having women in leadership roles in order to better address issues on women’s health at a community and global level.

[Dr. Smith] Absolutely. I think that this is true with any minority group. Sometimes it takes somebody from that group to open the eyes of people in the majority group to particular issues. The Women’s Caucus historically grew out of a sense that some APHA policies didn’t directly refer to or address or necessarily support women’s health. Both women and men are members of the caucus, although there are a lot more women. Basically, our role now is to make sure that APHA policies are supportive of women’s health and, within the conference and presentation of research, we make sure there is a lane for people who are doing work in the area of women’s health.

We are also always looking for the cutting edge women’s health topics that we should be thinking about. Just by virtue of having the group and asking these fabulously talented women researchers from around the world about what is going on in their area and what their concerns are, we are able to help to keep the focus on women’s health issues and how they relate to global health in general.

The Women’s Caucus also works to do advocacy around certain issues. For example, a few years ago, I can’t remember exactly what year it was, the APHA annual conference was going to be held in a state where they had just voted to make abortion illegal. APHA is a huge international conference that brings tons of money to the host city and state. The Women’s Caucus, in tandem with other groups, worked to make sure that APHA was not held there that year. Why would we invest in a place that had just divested from women’s health? That’s another example of why it’s important to have the Women’s Caucus.

[OnlineEducation.com] Are there specific cutting edge health issues that come to mind that you see elevated through the Women’s Caucus?

[Dr. Smith] Sure. I can talk about a couple of things that I have worked on and then some general things. I know that there has been a lot of energy around the issue of reproductive justice and around menstrual hygiene. So there is ongoing work on how we can destigmatize menstruation because there are still parts of the world where young women are not allowed to participate fully in society when they are menstruating. That’s an area that I am not personally involved in but that we engage in quite deeply.

Right now we are also working on a project around domestic violence, which has been a priority for a long time. But we’re really trying to center the survivors and their voices and needs because we’ve done a lot of work that involves looking at numerical outcomes and we have analyzed the statistics on intimate partner violence. Now we want to focus on hearing from the people who are impacted. So there’s been a new push to look at how we can actually support survivors.

As for my work, there are two specific issues that I have presented for the Women’s Caucus and that I really appreciate them helping me find a platform for. The first involves women running for elected office, which has happened in historic numbers since 2016. I’ve started to do some initial research on who these women are and the contextual factors that allow them to feel that they can run for elected office. I am also beginning to look at the outcomes and trajectories of women who get elected and at whether or not they are reelected and how their leadership impacts health outcomes.

More recently, I’ve begun to look at suicide. I like to try to tie my work with where I live, and Idaho unfortunately has some of the worst suicide rates in the nation.

[OnlineEducation.com] Doesn’t that skew towards men?

[Dr. Smith] Yes. If you look at the general national statistics and even the overall numbers in Idaho it does skew toward middle-aged white men. However, there’s an interesting and horrifying trend we see in the numbers for young women. Basically, the numbers have shot up for young women and these women are completing suicide at a much higher rate than we’ve seen in the past. This started about a decade ago and it’s continuing to climb. Whatever research and prevention work we have been doing has not been working. So at the last Women’s Caucus meeting we did some initial work around trying to identify the contextual factors that may or may not be contributing to suicidal ideation in young women. I’m not sure what the numbers look like in Idaho specifically. But nationally we have seen a major increase over the past decade.

[OnlineEducation.com] That must be one of the frustrating things in the field of public health. Many of the issues that you’re studying are not new. And yet the problems have not been solved.

[Dr. Smith] Yes. That’s what’s fueling me right now. We’ve done so much research on suicide and yet we haven’t moved the needle that much. In fact, the needle is moving in the wrong direction for young women right now. So what are we missing? What are the questions we need to be asking?

It’s similar to the issue of math and science with girls and young women. We know that it’s a problem and we’ve known it for a while. Part of the issue clearly is representation. The more women and women of color we see in roles of leadership in math and science fields, the better. As that happens, I think we’ll see progress. But right now we’re in a place where, for whatever reason, some people are trying to limit the visibility of women in leadership roles. And I think there are a lot of biases that are implicit and ingrained. Even women math teachers have been shown to favor male students. So there are these deeply ingrained biases that we need to keep calling attention to and, hopefully, over time, reducing. We are starting to see that. There is programming for our young girls. At least you now see girls doing science on TV, which was not the case when I was young.

[OnlineEducation.com] Maybe that’s a good place to transition to advice for young women who may be considering a career in public health and for women whose career interests seem to be taking them in the direction of public health, as your interest in teaching and education did. What types of guidance would you offer?

[Dr. Smith] The first thing I would say is that it’s okay to take time to figure out what you’re really interested in doing. One of the things I bring to my work in the field of public health is my past experience as a teacher. I had all of those classroom experiences with young people which helped to inform my research because I already knew where I wanted to focus, and I already had a sense of that population.

Taking the time to have those life and work experiences can be important. So many of our young people, particularly women, are anxious to prove themselves. If we are going to be in academia, then we may want to climb to the top the fastest to prove to everybody that we’re worth it and that we belong there. Sometimes that speed limits people’s explorations of what they could be good at. As I mentioned earlier, in the public health field you often find women who will tell you that they know that they are good at working in the community and they don’t really identify with the science and math part of it. In a two year grad program they are going to play to their strengths, focus on that, and then move on to their career.

My advice would be to try to expand your experiences along the way, even if you think you are not going to be good at something or you don’t think it will interest you. It can augment you as a person and maybe open up a new career pathway. In public health, so much of the work you do out in the field involves drawing on this vast toolbox of theories, methodologies, and skills, and applying the right ones at the right time. Having diverse experiences can only help in that regard.