Anna Rivara, PhD, MPH

My research is focused on non-communicable disease etiology, pathogenesis, and care cascades (specifically type 2 diabetes) in low- and middle-income countries

As an Associate Research Scientist in the Department of Chronic Disease Epidemiology, I currently am investigating factors associated with diabetes care engagement, retention, and loss in high-risk low-resource environments. Specifically, my research heretofore has focused on diabetes risk and care engagement in adult Samoans. As a NIH Fogarty Global Health Postdoctoral Fellow through the Global Health Equity Scholars Program at Yale University in the Department of Epidemiology, Microbial Diseases, I worked under the mentorship of Dr. Nicola Hawley in the Department of Chronic Diseases Epidemiology. With funding secured from the NIH Fogarty International Center and NIH Institute of Digestive, Diabetes and Kidney Diseases (NIDDK), I led a project focused on investigating physical, and socio-cultural barriers to physical activity in adult Samoan women. The results of this project will inform my development and implementation of effective localized interventions that increase physical activity in this demographic and increase their chances of improving overall health. Additionally, I am analyzing how the physical activity patterns of these women are influencing the physical activity of their children through tracked accelerometry in order to better understand how to disrupt transgenerational obesogenic environments. I am also analyzing how pro-inflammatory responses (C-reactive protein, IL-6) in adult Samoans are associated with health status, body composition, and cardiometabolic disease risks.

My postdoctoral career contributions are focused on 1) analyzing factors associated with engagement in diabetes and hypertension cascades of care in Pacific Islanders; and 2) identifying culturally sensitive and preferred care intervention strategies to improve diabetes care retention and efficacy.

Additionally, as a visiting professor in anthropology at the University of Notre Dame, I developed courses in evolutionary medicine and the history of human health and diseases for undergraduate and graduate students. I have been able to use my expansive academic background to construct anthropologically oriented public health courses to provide anthropology, health sciences, and biology, students with a nuanced understanding of human health outcomes.

Research conducted during my graduate career focused on three major foci. 1) Identifying and analyzing immune responses to reproduction, and infectious, and hypersensitivity-producing, pathogens. During my dissertation research, I collected and analyzed biological, reproductive, socio-economic, and ecological data from two different populations: adult women in the United States using National Health and Nutritional Examination Survey (NHANES) data, and adult women of the Kalunga quilombo in Brazil. Using a life history framework, I established that reproduction is positively associated with IgE antibodies, and negatively associated with stature, in both populations. Based on my results, I proposed an innovative means of understanding the evolution of IgE responses to internal gestation in mammals (Rivara and Miller, 2017). Additionally, my research highlighted how health disparities are constructed within both populations due to biological, and external socio-political, pressures. 2) Identifying socio-economic, demographic, biological, and immunological, risk factors of healthcare associated infections in an urban tertiary-level hospital in Florida. My Masters of Public Health thesis focused on epidemiological analyses of healthcare associated infections of toxigenic C. difficile in a major Florida hospital. Through the collection of surveillance, qualitative, and biological data, I established that sex, health history, hospital unit, and healthcare and environmental services workers’ compliance to infection control protocols, were associated with previous and current outbreaks. 3) Understanding how socio-economic and health conditions impact the implementation of effective public health interventions. My role as a project coordinator on a study analyzing the effectiveness of video-conferencing based interventions for smoking cessation in people living with HIV further advanced my skills in participant recruiting and interview, identifying barriers to health intervention, and the use of innovative techniques for public health programming.