Faculty Q&A: Karen Stein, PhD, RN, FAAN

Professor Karen Stein, PhD, RN, FAAN, is a distinguished nurse researcher known for her extensive work studying health risk behaviors among adolescents and young adults. Among her notable achievements is her research into the Western New York farmworker community, which centers on addressing concerns related to unhealthy body weight and dietary intake. Stein's innovative research led to the development of a culturally sensitive mobile phone delivered intervention to promote healthy eating.

Notably, she has served as the former editor of the Journal of the American Psychiatric Nurses Association and has been honored with prestigious awards, including the American Psychiatric Nurses Association Award for Excellence in Research and the University of Connecticut Marlene Kramer Distinguished Alumni Award for Research in Nursing, underscoring her dedication to nursing through her community-centered approach.

Stein has spent the last 13 years of her research career at the UR School of Nursing as the Ruth Miller Brody and Bernard Brody Endowed Professor. She retires this summer. 

Can you tell us about your journey into nursing research, and what inspired you to focus on health risk behaviors in adolescent and young adult females?

My journey into nursing research began during the period in my career when I worked as a clinical specialist in psychiatric and mental health nursing.  I worked in several outpatient settings, including Boston City Hospital, as the psychiatric nurse in emergency services and outpatient services in community mental health and community health centers.

Soon after I began a faculty position at the University of Michigan, I received NIH funding for two projects. The first was to study self-cognitions as determinants of health risk behaviors in adolescents and the second was determinants of eating and weight control behaviors in young adult women with anorexia and bulimia nervosa.

Could you share some insights into the unique challenges faced by the farmworker community in Western New York regarding health behaviors, and how your research has addressed these challenges?

My work with the Western New York farmworker community has focused on unhealthy body weight/shape concerns and healthy nutrition and dietary intake. When I arrived at the University of Rochester in 2011, I was conducting a project to extend our model of identity disturbances as a determinant of the eating disorders to college-enrolled women of Mexican origin. In the presentation of this work, I was challenged to extend our focus to other populations of Mexican women with lower levels of education and socio-economic status.

Through my work with the farmworker population, we learned that the community health centers provide excellent care to the farmworker population in our region but are taxed by the provision of care for acute and chronic illnesses.  Few resources are available for the provision of preventive health care. In our early focus groups, women expressed relief in being asked about their concerns about body weight and candidly described unhealthy weight control strategies used. From those focus groups with adult women and men from the farmworker community, we learned about their struggles with body weight and diet, and factors that influence what they eat.

Your work involves developing innovative mobile phone applications to measure and intervene in health behaviors. Can you discuss the impact of technology in promoting health, particularly among underserved populations?

Most federally qualified health centers have limited resources and high demand for managing acute and chronic illnesses. Additionally, few farmworker families have health care insurance, and preventive health care services are expensive. Most farmworkers have cell phones and wireless connectivity in rural communities is improving. Furthermore, apps can be designed to ensure culturally sensitive and relevant interventions that are accessible across varying levels of literacy. To date, health-related apps, including those made available by the CDC, target literate populations. Approximately 40% of the U.S. farmworker population has an education of the 6^th grade level or less.

As you reflect on your tenure at the University of Rochester School of Nursing, what achievements or projects are you most proud of, and why? 

I feel the greatest sense of accomplishment and pride in our work that has brought attention to body weight concerns of farmworker families. Women stated that while they were told that both they and their children needed to lose weight, they did not know how to make that happen. Recommendations to “eat smaller portions” and “avoid sweets” did not provide the detailed information needed to make healthy choices in the U.S. eating environment. This disconnect led to unhealthy approaches to weight control. I believe that our work gave voice to the health concerns of this population.

Can you share any memorable experiences or insights gained from your interactions with the farmworker community in Western New York that have influenced your research or perspectives?

One experience that stands out for me occurred at the very beginning of my work with the farmworker community. I was working to organize our first focus group with the goal of learning about unhealthy weight control behaviors in the community of women. I was surprised when a clinician from the health center invited us to have the focus group meeting at her home. The spirit in the home was relaxed and warm with a level of familiarity of friends. Later, the clinician/hostess shared with us that she and her husband regularly are invited and participate in social events in the community – weddings, quinceaneras, and other important family events. From this event I learned the centrality of relationships in the Mexican culture.

As you prepare to retire, what legacy or impact do you hope to leave behind in the field of nursing research, and what are your plans for the future?

I hope to leave a legacy of my commitment to the discipline of nursing and a future of high-quality nursing research that meaningfully contributes to the health and well-being of all members of our communities, particularly those who are disenfranchised and vulnerable. 

In addition, I serve on the board of directors of two nonprofit organizations that serve immigrant farmworkers in the U.S. Within that context, I will have the opportunity to work on measurement of program outcomes and outcome studies.  I expect to spend a considerable amount of time working on my hobby of metal smithing and as much time as possible with my two darling grandchildren, Mia and Ezra!