By Katharine Tyllo
PhD student Theresa Watts had questions. When UW–Madison let her look for answers, she found some. Now the New York Native wants to use her PhD to find solutions to vexing public health problems and to eliminate health disparities.
Theresa Watts is the PhD student that almost never was. She struggled with serious feelings of inadequacy as an undergraduate nursing student at SUNY-Plattsburgh. She nearly dropped out. But her advisor encouraged her to hang on, and she did. By her senior year she started to feel more at home. What made the difference was a course on public health.
“That’s where it all made sense to me,” Watts says. “I wanted to be a public health nurse. And so two weeks after taking my NCLEX, I started my master’s in public health.”
Now, more than a decade later, Watts has a master’s degree in public health from George Washington University and her PhD from UW–Madison. The uncertainty that marked her early undergraduate days has been replaced with confidence and success. Last year, she published findings from her hepatitis C virus research in the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report—a significant achievement for any early-career scientist, let alone one still in training.
Watts acknowledges the attention and sees it as an opportunity to find solutions to public health problems.
“I’m interested in identifying health disparities that form patterns of infectious diseases and afflict the health of disadvantaged populations,” Watts says.
Improving public health through advanced research in nursing practice
Madison first appeared on the Long Island native’s radar when she learned about Susan Zahner, associate dean for faculty affairs, at a conference. Zahner’s research focuses on improving the performance of local public health systems, and she also studies public health nursing practice improvement and public health workforce development. She initiated and directs the Wisconsin Public Health Research Network, a virtual organization that connects public health practitioners across the state to facilitate research that is relevant to public health practice. All of that impressed Watts.
“I based my decision on where to go to get my PhD most strongly on who I wanted to work with,” Watts says. “I really wanted to get mentored by someone who had strong research skills and experience in public health nursing.”
Watts was also drawn to the structure of the PhD program, which allows students to pursue their own research questions. And Watts had questions.
While working as a public health nurse prior to starting the PhD program, she had noticed an increase of hepatitis C virus among young adults. That surprised her because the disease had not been prevalent in that population. When she got to Madison, she was able to dig into some data and explore some of her theories about what was going on and why.
“Nationally, we are seeing an increase in hepatitis C virus, due to an increase in injection drug use associated with the opioid epidemic, because risk behaviors associated with injection drug use are the main way hepatitis C virus spreads,” she says. “This school gave me the space to research this as opposed to other universities where maybe you just research a piece of what your advisor is doing.”
Watts partnered with the Wisconsin Department of Health and Human Services as part of a health policy course. She scoured Medicaid data collected from 2011 and 2015. She found a 93% increase in the number of pregnant women living with hepatitis C virus.
What she found next was also alarming: Of all the infants born to mothers with hepatitis C, only 34% were tested for the virus. “There’s a huge gap in the infant testing and prenatal care,” Watts says. “I believe we should actually be treating everyone for hep C and especially be treating people before they become pregnant. And the goal of this would be to prevent transmission from pregnant parent to child down the road.”
Hepatitis C is curable with antiviral drugs. Yet treatment requires diagnosis, and diagnosis requires screening. The current screening process for adults born after 1965 is a risk-based approach, meaning that individuals must disclose to their provider if they have come into contact with a risk factor, the most common of which is injection drug use. “Yet individuals, especially pregnant people, might have a disincentive to disclose that information,” Watts says, “because it could lead to stigmatized care, incarceration or removal of an individual’s children.”
Watts has a simple answer. Instead of risk-based screening, she proposes universal prenatal screening. That would eliminate the need for disclosure and would enable healthcare providers to identify pregnant women and infants at risk. In the end, more infants would receive the care they need, and fewer parents will be stigmatized or punished because of drug use.
“My research and teaching is not focused on ending drug use.” Watts emphasizes. “We need to end the consequences of drug use, such as the spread of hepatitis C virus, and I believe nurses, as the most trusted medical profession, could be instrumental.”