I bring a multi-disciplinary research approach, setting forth a new path to explore how social factors shape life for survivors of chronic disease.

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Lorraine T. Dean, ScD
Assistant Professor
John Hopkins University



Ongoing Studies

Assessing Gaps in HIV Pre-Exposure Prophylaxis (PrEP) Initiation and Retention using Pharmacy Claims Data

This study uses the nation’s largest pharmaceutical claims database to assess the frequency with which patients choose not to pay for PrEP prescriptions at the pharmacy point-of-sale, known as a prescription reversal. The results of this first ever study of PrEP prescription reversals will guide who to target for subsequent R series intervention grants focused on increasing retention in PrEP care and can ultimately inform federal safety net programs, industry sponsored medication assistance programs.


Sponsor: NIH/ National Institute of Nursing Research (NINR) R21NR018387


A Mixed-Methods Approach to Identify Intervenable Factors Associated with Breast Cancer Screening and Follow-up for Black Sexual Minority Women

Disparities in breast cancer screening, risk, and mortality have been found both in studies of sexual minority women and studies of racial minority women. Data from both sexual minority women and cisgender Black women (i.e. female at birth who identifies as a woman) indicate lower use of timely screening mammography, despite higher risk of breast cancer for sexual minority women than heterosexual women and higher breast cancer mortality rates for Black than White women. This mixed-methods study investigates breast cancer screening behaviors (i.e. mammography) and follow-up (i.e. ultrasound or clinic visit) after abnormal results for Black sexual minority women.


Sponsor: Faculty Innovation Fund 


Social Determinants of Breast Cancer Survivorship

Upper body breast-cancer related lymphedema (BCRL) is a persistent adverse outcome of cancer treatment that affects the physical health and quality of life of up to 1 in 3 of the 2.9 million breast cancer survivors in the US. For those with BCRL, known predictors of progression include BMI, type of surgery and radiation treatment, all of which are associated with social factors. However, no studies have explored the association of race/ethnicity, geography or other social and environmental factors with BCRL progression. The purpose of this study is to explore the relationship between macro- (neighborhood) and micro-level (individual) social and environmental risk factors for the persistent adverse effects of cancer treatment, and the costs they pose, using the example of breast cancer survivors who have BCRL as a persistent adverse effect of breast cancer surgery.


Sponsor: NIH/National Cancer Institute (NCI) 1K01CA184288

129 women have enrolled into study. Results pending.

Predicting the Impact of Cost on HIV Pre-exposure Prophylaxis Uptake and Racial/Ethnic Disparities among Men who Have Sex with Men

Although pre-exposure prophylaxis (PrEP) is effective in preventing HIV, high out-of-pocket costs (i.e., co-pays, deductibles, and co-insurance) may prohibit uptake of the intervention. This study evaluates the extent to which out-of-pocket costs may limit PrEP uptake. The results of this study will provide insight for public health programs as well as for development of future interventions that address cost as a barrier to PrEP uptake.

Sponsor: NIH/National Institute of Mental Health 1R21MH118019-01


Completed Studies

Social Determinants of Cancer Screening for African-Americans in Philadelphia

Social capital, a characteristic of a collective, has been associated with better health for individuals.  This dissertation work explored the extent to which social capital was associated with cancer preventive behaviors for African-Americans in Philadelphia, and whether or not African-American communities had unique social capital structures compare to other race groups.  This study incorporated propensity scores, geocoding, and multi-level modelling.

Sponsor: NIH/National Cancer Institute (NCI) 1F31CA136236-01

Barriers to Breast Cancer Detection in Venezuelan Women (William J. Fulbright Grant)

Venezuela has very low rates of breast cancer, but there is little research explaining the low rates. This independent mixed methods research project focused on perceptions of breast cancer preventive behaviors by Venezuelan women. Focus groups and surveys unveiled that Venezuelan women in the sample did not have confidence that self-breast exams (which were still advocated at that time) were an effective mode of early detection for breast cancer.

Sponsor: William J. Fulbright Foundation/ IIE

In the News

HealthDay. “Bills mount for breast cancer survivors” Chicago Tribune. September 14, 2018


C. Gourarie. “Most Breast Cancer Studies Don’t Address Race or Socioeconomic Factors” Healthcare Analytics News. July 17, 2018


Southall, Jennifer. “Many women forego adjuvant breast cancer treatment due to distrust of health care system” HemOnctoday. 26 February 2018. https://www.healio.com/hematology-oncology/breast-cancer/news/online/{2badacf4b18497c237e59bb3d2eab58dd97394562be4cd5baf1f5fc723420ffe}7B62b5e19b-1ad7-4971-a858-14974ed6b45e{2badacf4b18497c237e59bb3d2eab58dd97394562be4cd5baf1f5fc723420ffe}7D/many-women-forego-adjuvant-breast-cancer-treatment-due-to-distrust-of-health-care-system


Rubin, Rita. “Distrust In Health-Care System Might Prevent Breast Cancer Patients From Getting Recommended Care” Forbes.com. 1 December 2017.



“Many breast cancer patients forgo post-surgery treatment due to distrust, study suggests.” Johns Hopkins University HUB. November 2017. https://hub.jhu.edu/2017/11/02/breast-cancer-treatment-discordance


Brooks, Megan. “Nearly 1 in 3 Breast Cancer Patients Skip Adjuvant Therapy: Why?” Medscape Public Health. 13 November 2017. https://www.medscape.com/viewarticle/888521

Lorraine T. Dean, ScD
Associate Professor of Epidemiology
Johns Hopkins Bloomberg School of Public Health
615 N Wolfe St, E6650
Baltimore, MD 21205
Phone: 410.502.7205



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