About Margie Skeer, ScD, MPH, MSW: Margie Skeer is an Associate Professor at Tufts University’s School of Medicine. Dr. Skeer’s research focuses on adolescent substance abuse prevention and mitigation, including how to design effective interventions, and how family communication and dynamics play a role in lowering the risk of substance misuse in youth. She has led numerous studies on the importance of family meals in the prevention of substance use disorders, and has also engaged in studies around HCV and HIV risk reduction for people who inject drugs.
As an Associate Professor, Dr. Skeer teaches classes on substance use and addiction, and community health intervention design to public health students, health communication students, and medical students. She earned her Doctorate in Social Epidemiology from the Harvard School of Public Health, her Master of Public Health from Boston University School of Public Health, and her Master of Social Work from the Boston University School of Social Work. Following her doctoral degree, Dr. Skeer also completed a two-year fellowship at the Brown Center for Alcohol and Addiction Studies.
[MastersinCommunications.com] Could you elaborate on your work in both social work and health communication, including your research in substance use and addiction?
[Dr. Skeer] I got my bachelor’s degree in psychology and interned at a drug rehabilitation center, doing case management and leading groups. I continued volunteering there and later got a job at the center, which solidified my decision to become a clinical social worker. I’d done a lot of work during my undergraduate career for the Department of Health Education at Rutgers University, and conducted alcohol education and sexual risk education and outreach, which established my interest in public health. Those two experiences inspired me to get my dual degree in social work and public health.
When I was doing my social work internship I continued to focus on addiction as my topic and was working with people who were in recovery or struggling to get into recovery from addiction. While it was very gratifying and impactful work, and I knew it was a skill I wanted to cultivate, I wasn’t sure I could do it long-term because it was so gut wrenching. So I decided to work more on the prevention side, and got my doctorate, where my dissertation focused on family conflict in childhood and the development of substance use disorders later in life during late adolescence and emerging adulthood. I then completed a two-year post-doc at Brown University in their Center for Alcohol and Addiction Studies.
I took those years in my post-doc to figure out what path I wanted to take and I realized that I wanted to do work around prevention at an even younger age, and to design interventions that focused on the family environment and interpersonal, parent-child communication. That is what really got me started in the field of health communication. I wound up spending a lot of time learning about the science behind communication and understanding more of how interpersonal communication impacts relationships, psychology, and behavior. That is where my background as a social and behavioral scientist really helped to enhance my work, as the science behind both fields is similar. My various backgrounds converged such that I found a home in Tufts University’s Department of Public Health and Community Medicine, with the faculty in health communication.
[MastersinCommunications.com] What are some recent research projects you have completed?
[Dr. Skeer] A current research project I am working on focuses on family engagement and family meals, and the role of parent/child communication in substance misuse prevention. The truth of how I first got involved in this work probably began about 18 years ago. I was sitting in my apartment watching television, and a public service announcement came on from the CASA Columbia, which is the substance abuse prevention network (CASA Columbia recently merged with Partnership and is now called the Center on Addiction). The PSA said something to the effect of, “The best way to prevent your kids from using drugs is to have dinner with them.” And I remember thinking to myself, “Could that be true? Is that right?”
Years later, when I was delving into my own research for my dissertation in the field of social epidemiology, I was looking more observationally and epidemiogically at the role of family conflict in childhood and the development of substance use disorders later in life. And based on that work, I was really interested in the family environment and went back in my head to that PSA that I’d seen all those years prior. I started digging in a little more and seeing what kinds of research had been done linking family meals to reduced substance use in adolescence. At that time there was actually a lot of research showing this relationship, but only observationally. Nobody at that time had really looked at using this mechanism as an intervention strategy to prevent substance use amongst young people.
I got involved in this kind of work because I had been interested in the family environment for a while, particularly when I started out doing clinical work with people who were addicted to drugs at rehabilitation centers. I kept hearing, at least anecdotally, all about the adversities they faced as children in their home environments. And it was a pervasive theme for me when I was meeting with clients in sessions. So that’s why I decided to pursue that for my dissertation, which ultimately led to my focusing on family meals as an intervention strategy.
What we learned about family meals and how they are protective is that it’s not actually about the meal itself. There are so many pieces to it but the biggest piece seems to be around communication and connection—the fact that the parents or guardians are sitting around a table with their children and talking, communicating, and getting to know each other. During these interactions parents can understand their children’s patterns and also notice if or how they may be changing. And they are showing their kids that, at least for half an hour (or however long), they are there for them, want to hear from them and talk to them. The context of communication is so important—it is what ties all of the work in substance use prevention. When parents are talking to their kids, the kids are way less likely to start to use substances, and to continue using them over the course of their adult lives.
I have also been doing some work in rural Idaho within the field of dentistry. We are trying to work with hygienists and dentists to design a communication strategy to prevent crystal meth use amongst teens, because crystal meth is a drug that drastically affects the teeth. We are proposing that when hygienists and dentists talk to teens about the things that affect their teeth, like soda and smoking, flossing, etc., they can also talk about drug use because meth really damages your teeth.
[MastersinCommunications.com] What are some of the forms of interpersonal and family communication that are particularly effective in preventing substance use?
[Dr. Skeer] One of the most important elements is expressing expectations. Evidence has shown that kids will often go and do what their parents say is ok in many cases. If they have these expectations and they are discussed in a mutually respectful way, their kids are less likely to start drinking. It doesn’t mean that they won’t, but the likelihood is much less.
A lot of parents hesitate to bring up alcohol, marijuana, and other substances with their kids, such as cigarettes. They don’t know what words to use. During my work with parents and their children, we had to tailor our strategy to match what the relationship was between the children and their parents. A lot of the work we do is to give examples of how and when to bring it up, what things you might say, and what context you might want to say it in. I did a pilot trial of this intervention, where we promoted family meals and parent/child communication in general. I had a publication come out in 2016 about this pilot trial and its results. More recently, I conducted a qualitative study where we asked parents and their kids about family meals, with an eye towards designing and testing an instrument to measure family meals (in terms of frequency and other metrics related to what is happening at the meals) and their efficacy in substance use prevention.
I also just published a qualitative paper on working with people who inject drugs and their readiness and willingness to take new antivirals for hepatitis C. The central learning from that study was that the way providers communicate with their patients matters a great deal in patient openness to and compliance with interventions. There exists either a real or a perceived stigmatization of people who inject drugs, and this stigma reduces patients’ receptivity to taking important health measures. One of the consistent things I’ve heard from many people who are addicted to drugs is the fact that they always feel like a thrown away population. People don’t take the time to go and talk to them or ask them questions. And so that was one of the things that we felt was really important to emphasize.
When you are integrated into society and are not part of a stigmatized population, we take for granted that people will talk to us and will listen to what we have to say. That is not often the case with this population. Even though it wasn’t part of our research question, one of the first things we asked patients was for them to tell us their story. And we similarly encourage providers to stop, ask questions, and listen to their patients, as that can be just as important as the medical information they need to convey about risk and risk prevention. Communication is about more than the transfer of information—it is about connection, empathy, and forming a trust that leads to productive action.
The work we did with people who inject drugs focused not only on reducing barriers for this population, but also on providing more of a voice so that providers could understand what it is like for this population when they are trying to interact with the healthcare system. I feel really lucky that I had that clinical experience with the population so that I could understand best how to prevent drug use amongst members of this demographic. It doesn’t mean I understand it perfectly, but I have such a different perspective than if I had started out in research. The clinical work I did provided me with a different level of empathy, which I try to bring to my work as well. Empathy is incredibly important, and communication is central to developing an empathetic bond.
[MastersinCommunications.com] What is the relationship between public health and health communication? How are these fields distinct, and at the same time interdependent?
[Dr. Skeer] In thinking about health communication as a field, it’s really important to have an understanding of health and public health, as they are definitely related. Public health has a stronger base in epidemiology, biostatistics, and policy and works to integrate these fields. Communication principles do apply to designing, implementing, and evaluating interventions, but in public health it is more about behavioral science, human biology, and environmental factors in community health. Health communication as a science focuses more on the communication aspects of promoting and supporting individual and community health. Health communication is a very broad field that includes interpersonal communication, organizational communication, mass communication and media, and elements of consumer psychology and behavior.
[MastersinCommunications.com] How do you see the field of health communication evolving over the next few years?
[Dr. Skeer] I definitely think health communication has gained prominence over the last ten years. Tufts University’s master’s in health communication was the first health communication program in the country in 1994, and now I think there are upwards of 50 programs now. Health communication has gained momentum and I think it is in part because people did not realize the extent to which there is a science behind health communication.
In the digital age today, we are also seeing digital technologies being used in health communication in ways that were not possible a decade ago. Online health modules, the growth of telemedicine where you don’t actually have to go into an office—such technologies can be incredibly helpful to patients in rural areas and around the world where they do not have access to healthcare. We can actually start conducting more diagnoses and providing medical advice over video.
The growth of social media is also an interesting development with a lot of potential. People are using social media as individuals and through groups to get support from other people. The information that providers are able to get with trackers is also compelling. We have all these apps on our phones and can collect so much more data on ourselves to give to providers to help design health programs and plans. We have never been able to do that before. Health communication professionals are at the forefront of these advancements, working with health care providers, public health specialists, engineers, and other professionals to help build interdisciplinary solutions to current health challenges.
[MastersinCommunications.com] Tufts University’s Department of Public Health and Community Medicine offers a Certificate in Digital Health Communication program and a program in Professional Development in Health Communication. Could you elaborate on the curricula for these two programs?
[Dr. Skeer] The Certificate in Digital Health Communication program is comprised of five courses that students take over the course of a year. Students can start in the summer, fall or spring, but they usually take one class at a time as they typically are taking these classes alongside their full-time jobs. Students are required to take one in-person class that spans one week during the summer, and the rest are online. I believe almost all of the online classes are taught on Thursdays from 5:30-8:30 pm, so there is consistency.
The program is basically designed for people who are more interested in bolstering their resume for immediate implementation in the workplace, rather than starting a full master’s program. Four of the five classes—Writing About Health for Digital Audiences, Health Literacy, Social Media and Health, and Mobile Health Design—are delivered online, while the course Digital Strategies for Health Communication is held in-person so students can have that in-person connection.
We also have a Professional Development Program in Health Communication for any person who wants to take a class with us for professional development. The advantage of this program is that the classes are priced for working professionals who are not seeking a degree or certificate, and are therefore more affordable and accessible for someone who just wants to build some key skills in certain areas without getting course credit. Students who are a part of this program are essentially non-matriculated students who can take classes at a particularly affordable price.
We have on-campus courses that students can take for professional development, which are Medical Journalism, the Digital Strategies for Health Communication course I mentioned earlier, and the Health Literacy Leadership Institute. The Medical Journalism course covers how to pitch medical stories to the media and is taught by the former head of the ABC News Medical Unit. Additionally, all of our online classes that we offer for the certificate program are available as courses for one-off professional development.
That said, we also have systems in place so that somebody who takes several of the professional development classes can actually apply that towards a certificate if they wish. For example, a student might have taken four classes already, and feel that they might as well take one more class to get a formal certificate, and we have that pathway. So we have a lot of flexible options for students at every stage in their career who have different goals.
Thank you, Dr. Skeer, for your excellent insight into the fields of health communication and public health!