Kat Theall is on the edge of something great. Years of research on women at-risk for or living with HIV set the stage for her current and expanding research on neighborhood and interpersonal violence and their impact on women and children’s health. Realizing the salient role of interpersonal and community-level stress in many women’s lives (for much of their lives) and, in turn, their link to maladaptive coping behaviors and negative health trajectories, prompted Kat to shift her lens to address the impact of violence and other stress exposures early in the life course. She also began to take her interest in place effects on health behaviors one step further—drilling down to the biological level and examination of the potential pathways through which the social and physical environments 'get under the skin' to influence disparities in health outcomes that may begin early in life, long before physical or behavioral signs are evident. Through her earlier NIH R01 (R01ES020447, Telomere Length as a Biomarker of Allostatic Load in Children, 09/01/2011-12/31/2013), in collaboration with VPI faculty Dr. Stacy Drury, she has had the opportunity to examine the role of violence and other neighborhood risk factors on biologic stress in children. This work has produced more than 10 publications, including highly publicized work in JAMA Pediatrics, Social Science and Medicine, and the Journal of American Academy of Child & Adolescent Psychiatry. Results, along with her K01, provided some of the first evidence linking social neighborhood environments, and violence in particular, to biologic stress in young children and adolescents. This work continues with an ongoing longitudinal cohort of mothers and infants (R01MH101533, Drury PI), where they are examining biological and behavioral trajectories linked to neighborhood and interpersonal environments with a focus on violence.

While the etiologic results of these studies are striking and have furthered the field in terms of neighborhood effects, the next phase of her work has been to continue her research on neighborhood change as a population-level intervention, building on an earlier NIH award (RC1AA019329, Comparing the Effectiveness of City Policy and Structure in Health, 09/01/2009-08/31/2011) aimed at neighborhood alcohol policy change on health disparities. Since 2016, she has been working closely with the City of New Orleans Code Enforcement Division and with colleagues from the University of Pennsylvania and Columbia to continue this action-oriented work, building a strategic evaluation of the City’s blight removal process as a means of violence reduction and, what they hope will be changes in health for women, children, and families. We hope to continue this work through an NIH R01 (R01HD095609, Place Matters: Adaptable Solutions to Violence at the Community Level), a community randomized trial on neighborhood change as a violence reduction tool. Improving the spaces where we live, work, and play is a key step toward eliminating health disparities and improving equity—two underlying goals of her research.