Jennifer Schultz De La Rosa

Interests

Teaching

Co-Director of Pain and Society, FCM 304Bachelor's of Science in Medicine

Research

Chronic Pain, Anxiety/Depression, and Mental Health, Substance Use Disorder, Network Analysis, Health Service Quality, Patient Centered Care, Emotional and Attentional Regulation, Intertemporal Discounting and Delay Aversion, Impulsivity, Daily habits and rythms, Motivation, Goal Directed Persistence, Episodic Future Thinking, Integration of Self Across Past/Present Future, Reward Pathway Adaptation and Plasticity, Disentangling States and Traits, Situational and Contextual approaches, Lived Experience, Self-Determination and Empowerment, Learned Hopefulness.

Courses

Scholarly Contributions

Journals/Publications

• De La Rosa, J., Brady, B., Herder, K., Wallace, J., Ibrahim, M., Allen, A., Meyerson, B., Suhr, K., & Vanderah, T. (2024). The unmet mental health needs of U.S. adults living with chronic pain. Pain, 165(12), 2877-2887. doi:10.1097/j.pain.0000000000003340
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  Previous research suggests that individuals with mental health needs and chronic pain may be less likely to use mental health treatment compared with those with mental health needs only. Yet, few studies have investigated the existence of population-level differences in mental health treatment use. We analyzed data from the National Health Interview Survey (n = 31,997) to address this question. We found that chronic pain was associated with end-to-end disparities in the mental health journeys of U.S. adults: (1) Those living with chronic pain are overrepresented among U.S. adults with mental health needs; (2) among U.S. adults with mental health needs, those living with chronic pain had a lower prevalence of mental health treatment use; (3) among U.S. adults who used mental health treatment, those living with chronic pain had a higher prevalence of screening positive for unremitted anxiety or depression; (4) among U.S. adults living with both chronic pain and mental health needs, suboptimal mental health experiences were more common than otherwise - just 44.4% of those living with mental health needs and co-occurring chronic pain reported use of mental health treatment and screened negative for unremitted anxiety and depression, compared with 71.5% among those with mental health needs only. Overall, our results suggest that U.S. adults with chronic pain constitute an underrecognized majority of those living with unremitted anxiety/depression symptoms and that the U.S. healthcare system is not yet adequately equipped to educate, screen, navigate to care, and successfully address their unmet mental health needs.
• Meyerson, B., Linde-Krieger, L., Carter, G., Allison, A., Brady, B., Crosby, R., De La Rosa, J., Barakat, M., Pava, M., Schaefer, M., & Huff, A. (2024). Methadone clinic staff perceptions of trauma-informed and patient-centered care: the role of individual staff characteristics. Addiction Science and Clinical Practice, 19(1). doi:10.1186/s13722-024-00501-6
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  Background: U.S. policy intervention to increase methadone treatment accommodations during COVID did not result in national adoption of the new patient-centered treatment practices. Staff-level interventions may facilitate adoption of these treatment practices, but this will depend upon knowledge about staff level characteristics and beliefs. Currently, the role of clinic staff characteristics, beliefs about patient-centeredness, and perceptions about the need for treatment practice change is unknown. This study explored the relationship between opioid treatment program staff characteristics, work roles and staff beliefs to identify opportunities for future staff-level treatment practice change interventions. Methods: Staff of three Arizona opioid treatment programs were surveyed (n = 40) from April 11–22, 2023 using a hybrid online survey method. The 161 survey items required less than 30 min to complete. Pearson point biserial correlation coefficients assessed the covariation between staff beliefs, staff characteristics and staff work roles. Perception of the clinic as person-centered was a potential proxy indicator for staff awareness of discontinuity between the clinic’s person-centeredness and person-centered approaches to methadone treatment. Results: Among staff, 47.5% reported lived substance use disorder experience and 27.5% reported lived opioid use disorder experience. Most staff (70%) held at least 1 prior clinic role at the current clinic and 5% had had more than 4 prior roles. Rotation was observed with roles that did not require licensure or degrees. Staff with lived experience with substance use disorder or opioid use disorder treatment reported having more prior roles at the clinic than those without such experience. Abstinence-oriented views were significantly associated with reporting vicarious (work related) trauma symptoms. Those who rated the clinic as significantly more person-centered were staff with lived substance use disorder experience who also held abstinence-oriented views, staff with trauma exposure, and staff with lived opioid use disorder treatment experience who held harm reduction beliefs. In contrast, staff without substance use disorder experience who held harm reduction beliefs perceived the clinic as less person-centered. Conclusions: Staff beliefs, personal and work characteristics are likely factors in the recognition of need for clinic practice change. How these characteristics function in a clinic culture may also be influenced by clinic staffing patterns. A patient-to-provider pipeline with role cycling was observed and this staffing pattern may also influence shared beliefs of trauma-informed care or clinic person-centeredness. Vicarious trauma may also be an important factor. Larger studies should examine these relationships further to understand mechanisms associated with recognition of need for clinic practice change in order to inform staff-level interventions to increase opioid treatment program patient-centeredness.
• Brady, B. R., Taj, E. A., Cameron, E., Yoder, A. M., & De La Rosa, J. S. (2023). A Diagram of the Social-Ecological Conditions of Opioid Misuse and Overdose. International Journal of Environmental Research and Public Health, 20(20), 6950-6969. doi:10.3390/ijerph20206950
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  The United States is experiencing a crisis of opioid misuse and overdose. To understand the underlying factors, researchers have begun looking upstream to identify social and structural determinants. However, no study has yet aggregated these into a comprehensive ecology of opioid overdose. We scoped 68 literature sources and compiled a master list of opioid misuse and overdose conditions. We grouped the conditions and used the Social Ecological Model to organize them into a diagram. We reviewed the diagram with nine subject matter experts (SMEs) who provided feedback on its content, design, and usefulness. From a literature search and SME interviews, we identified 80 unique conditions of opioid overdose and grouped them into 16 categories. In the final diagram, we incorporated 40 SME-recommended changes. In commenting on the diagram’s usefulness, SMEs explained that the diagram could improve intervention planning by demonstrating the complexity of opioid overdose and highlighting structural factors. However, care is required to strike a balance between comprehensiveness and legibility. Multiple design formats may be useful, depending on the communication purpose and audience. This ecological diagram offers a visual perspective of the conditions of opioid overdose.
• Carroll, S. R., Suina, M., Jaeger, M. B., Black, J., Cornell, S. E., Gonzales, A. A., Jorgensen, M., Palmanteer-Holder, N. L., De La Rosa, J. S., & Teufel-Shone, N. I. (2022). Reclaiming Indigenous Health in the US: Moving beyond the Social Determinants of Health. International Journal of Environmental Research and Public Health, 19, 7495-7507. doi:10.3390/ijerph19127495
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  The lack of literature on Indigenous conceptions of health and the social determinants of health (SDH) for US Indigenous communities limits available information for Indigenous nations as they set policy and allocate resources to improve the health of their citizens. In 2015, eight scholars from tribal communities and mainstream educational institutions convened to examine: the limitations of applying the World Health Organization’s (WHO) SDH framework in Indigenous communities; Indigenizing the WHO SDH framework; and Indigenous conceptions of a healthy community. Participants critiqued the assumptions within the WHO SDH framework that did not cohere with Indigenous knowledges and epistemologies and created a schematic for conceptualizing health and categorizing its determinants. As Indigenous nations pursue a policy role in health and seek to improve the health and wellness of their nations’ citizens, definitions of Indigenous health and well-being should be community-driven and Indigenous-nation based. Policies and practices for Indigenous nations and Indigenous communities should reflect and arise from sovereignty and a comprehensive understanding of the nations and communities’ conceptions of health and its determinants beyond the SDH.
• Cunningham, J. K., De La Rosa, J. S., Quinones, C. A., McGuffin, B. A., & Kutob, R. M. (2022). Gender, psychiatric disability, and dropout from peer support specialist training.. Psychological Services, 19(1), 103-110. doi:doi.org/10.1037/ser0000444
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  Although research indicates that the prevalence of psychiatric disability differs depending on gender, a paucity of information exists as to whether men and women with psychiatric disability also differ regarding service program outcomes. For a United States Southwest peer support specialist training program, this study examines whether gender moderates the association between psychiatric disability and a key outcome—training dropout. Data were collected for 78 men and 157 women with psychiatric disability and 137 men and 203 women with mental illness only. Logistic regression was used to examine the association between psychiatric disability and dropout, with gender as a moderator variable, and age, education, race/ethnicity, and substance use disorder as control variables. Of trainees with psychiatric disability, dropout was greater among men than women (34.6% and 20.4%, respectively; p < .05). Dropout was also greater among men with psychiatric disability than among men with mental illness only (34.6% and 15.3%; p < .01). In contrast, dropout was similar for women with psychiatric disability and mental illness only (20.4% and 18.7%; p > .05), and dropout was comparable among men and women with mental illness only (15.3% and 18.7%; p > .05). In summary, risk of dropout was substantially higher among men with psychiatric disability than women with psychiatric disability. Gender tailoring of the program’s services should be considered to better support training completion. This study’s findings also raise questions as to possible underrepresentation of men with psychiatric disability in the peer support workforce training pipeline. 
• Yuan, N. P., Schultz, J. L., Nair, U. S., & Bell, M. (2020). Predictors of Tobacco Cessation Among American Indian/Alaska Native Adults Enrolled in a State Quitline. Substance Use & Misuse, 55(3), 452-459. doi:10.1080/10826084.2019.1683204
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  Background: High rates of smoking are documented among some American Indian and Alaska Native (AI/AN) communities, with potential variability by region and urban/rural settings. Quitlines are a cost-effective strategy for providing evidence-based cessation treatment, but little is known about the effectiveness of quitline services for the AI/AN population. Objectives: This study compared demographic characteristics, tobacco use, and cessation and program utilization behaviors between AI/AN (n = 297) and Non-Hispanic White (NHW; n = 13,497) quitline callers. The study also identified predictors of 30-day cessation at 7-month follow-up among AI/AN callers and determined if predictors were different between AI/AN and NHW callers. Methods: Data from callers to the Arizona Smokers' Helpline between January 2011 and June 2016 were analyzed. Results: At enrollment, AI/AN callers were less likely to use tobacco daily and were less dependent on nicotine compared to NHW callers. Both groups reported similar rates of 30-day cessation at 7-month follow-up (37.3% and 39.7% for AI/AN and NHW callers, respectively). For AI/AN callers, 30-day cessation was significantly associated with tobacco cessation medication use (OR = 2.24, 95% CI: 1.02-4.93), number of coaching sessions (OR = 1.14, 95% CI: 1.04-1.26), and other smokers in the home (OR = 0.41, 95% CI: 0.19-0.91). The effect of other smokers in the home was significantly different between AI/AN and NHW callers (p = .007). Conclusions: Different individual characteristics and predictors of cessation among AI/AN callers compared to NHW callers were documented. Findings may be used to inform the development of culturally-tailored strategies and protocols for AI/AN quitline callers.
• Brady, B. R., De La Rosa, J. S., Nair, U. S., & Leischow, S. J. (2019). Electronic Cigarette Policy Recommendations: A Scoping Review. American Journal of Health Behavior, 1(43), 88-104.
• Carroll, S. R., Carroll, S. R., Schultz, J. L., Schultz, J. L., Briggs, E., Briggs, E., Riggs, P., Riggs, P., Palmanteer-Holder, N. L., & Palmanteer-Holder, N. L. (2017). Data as a Strategic Resource: Self-determination, Governance, and the Data Challenge for Indigenous Nations in the United States. International Indigenous Policy Journal, 5(4), 1-2. doi:10.18584/iipj.2014.5.4.1
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  Data about Indigenous populations in the United States are inconsistent and irrelevant. Federal and state governments and researchers direct most collection, analysis, and use of data about U.S. Indigenous populations. Indigenous Peoples’ justified mistrust further complicates the collection and use of these data. Nonetheless, tribal leaders and communities depend on these data to inform decision making. Reliance on data that do not reflect tribal needs, priorities, and self-conceptions threatens tribal self-determination. Tribal data sovereignty through governance of data on Indigenous populations is long overdue. This article provides two case studies of the Ysleta del Sur Pueblo and Cheyenne River Sioux Tribe and their demographic and socioeconomic data initiatives to create locally and culturally relevant data for decision making.
• de Grenade, R., Rudow, J., Hermoza, R. T., Aguirre, M. E., Scott, C. A., Willems, B., Schultz, J. l., & Varady, R. G. (2017). Anticipatory capacity in response to global change across an extreme elevation gradient in the Ica Basin, Peru. Regional Environmental Change, 17, 789-802. doi:doi.org/10.1007/s10113-016-1075-3
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  Mountainous areas with extreme elevation gradients and corresponding ranges of biophysical and socioeconomic conditions are highly vulnerable to global change. We propose that the ability to anticipate changes in weather, markets, and the availability and cost of resources is crucial to livelihoods and a key component of adaptive capacity. We conducted research in the Ica Basin, an Andes–Pacific watershed in Peru, to assess farmers’ capacity to anticipate changing hydroclimatic and production scenarios as a prerequisite to alter their activities in a way that positively affects livelihoods. We employed a mixed-methods approach to understand how local impacts of global change across the gradient differentially undermine farmers’ resilience and open opportunities for anticipatory and adaptive responses. We find that most farmers have little access to modern weather forecasts or market conditions, even though weather stations are located throughout the basin and many farmers have cellphone, television, and Internet services. Meteorological and hydrologic stations often are not maintained because of difficult physical access, and extreme gradients affect the reach, reliability, and cost of telecommunication networks. Social, political, and environmental conditions have shifted rapidly, eroding traditional knowledge and information networks, and informal social networks cannot keep pace with changing scenarios. Increasing information access and improving telecommunication services in rural areas would strengthen farmers’ proactive decision-making capacity and lead to greater adaptive capacity and more uniform social-ecological resilience over the gradient in the basin.
• Schultz, J. L., Schultz, J. L., Carroll, S. C., & Carroll, S. C. (2014). The Strategic Power of Data: A Key Aspect of Sovereignty. International Indigenous Policy Journal, 5(4), 1-2. doi:https://doi.org/10.18584/iipj.2014.5.4.1
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  The lack of good data about U.S. American Indian and Alaska Native populations hinders tribes’ development activities, but it also highlights a space for sovereign action. In coming years, tribes will no doubt continue to advocate for better national data and at the same time increasingly implement their own “data agendas” by gathering high quality, culturally relevant information about their communities. With more meaningful data, tribal policymakers can make informed decisions about which policies and programs are right for the task at hand. Strategic data planning empowers tribes to tell their communities’ stories through their own data, and not that of others.
• Schultz, J. L., & Breiger, R. L. (2010). The strength of weak culture. Poetics, 38(6), 610-624.