Career Goals: This is a resubmission of an application for a K01 Career Development Award in Population Research for Nadia Diamond-Smith, PhD, MSc, an Assistant Professor at the University of California, San Francisco. Her preliminary research focuses on maternal and child health in South Asia, specifically the role of gender inequality and food insecurity. In the short term, she aims to build on this work, investigating the effect of gender inequality and food insecurity on maternal and child health outcomes in newly married women in Nepal. In the long term, she aspires to conduct research that results in interventions that will improve gender inequality and food access, and ultimately improve maternal and child health outcomes for women across their life course, with a focus on the pre-conception period. The knowledge and experience she will gain from this K01 award will prepare her to compete for NICHD R01 funding to test the household level behavior change and food insecurity intervention to address household dynamics around women's empowerment and access to food and nutrition in Nepal developed in this proposal in a randomized intervention trial. Environment: The University of California, San Francisco (UCSF) provides generous support for junior faculty. UCSF researchers have a long history of pursuing innovative ideas in reproductive health, studying food insecurity, and working in low and middle-income countries. Key Elements of Research Career Development Plan: Dr. Diamond-Smith has a strong background in public health (epidemiology and biostatistics) and demographic methods, with substantial experience analyzing large datasets and conducting qualitative data. This career development award will enable her to address several remaining gaps in her training specific to her career goals, and to gain applied experience planning and executing a primary data collection study on gender inequality and food insecurity, using both qualitative and quantitative methods. She seeks training in (1) maternal and child nutrition and food insecurity; (2) women's empowerment theory and measurement; and (3) implementation sciences, including designing behavioral interventions and evaluating interventions. To achieve these goals, Dr. Diamond-Smith has assembled a unique interdisciplinary training and mentoring team. It includes her Primary Mentor, Sheri Weiser, MD, MPH, in the School of Medicine at UCSF with a secondary appointment in Global Health Sciences at UCSF, who has extensive experience conducting research and developing interventions on food insecurity and health outcomes, and co-mentor Mallory Johnson, PhD, a Clinical Health Psychologist in UCSF's School of Medicine and an expert behavior change interventions and intervention design and evaluation. Her team includes three additional, complementary advisors: Cynthia Harper, PhD, in the Department of Obstetrics, Gynecology and Reproductive Sciences at UCSF, with an expertise in demography and women's reproductive health and experience working in Nepal; Anita Raj, PhD, in the Division of Global Public Health, Department of Medicine, at the University of California, San Diego (UCSD), with training in Developmental Psychology and extensive experience in South Asia on topics including sexual and reproductive health, maternal and child health, and gender based violence; and George W. Rutherford, MD, Vice Chair of the Department of Epidemiology and Biostatistics in the School of Medicine at UCSF, with expertise in pediatric epidemiology and interventions to improve child health. Dr. Diamond-Smith's training will include a combination of structured reading lists and tutorials with mentors, coursework, workshops, conference presentations and attendance, and seminars. Description of the Research Project: Women and children in Nepal are especially vulnerable to malnutrition, which I hypothesize is due to pervasive gender inequality across women's life course combined with food insecurity at the individual and household level. I hypothesize that household dynamics around women's empowerment and access to food are especially crucial in the pre-conception period. The overall objective of this study is to examine the pathways between gender inequality, food insecurity, and maternal, newborn, and child health (MNCH) in newly married households in Nepal and to adapt an existing intervention to this population. My main hypothesis is that gender inequality and food insecurity intersect to compromise pre- conception health, which in turn contributes to poor MNCH. This research will assess this hypothesis through three specific aims.
In Aim 1, I will conduct qualitative interviews with newly married women, their husbands, and mothers-in-law to understand the interactions between gender inequality and food insecurity at the household level.
In Aim 2, I will collect longitudinal data with newly married women for 18 months to evaluate how household gender dynamics and food insecurity impact maternal and child health and change in the first 18 months of marriage.
In Aim 3, I will build off an existing food insecurity intervention developed by Helen Keller International, to adapt it for newly married women and their households and include an empowerment component, and test the feasibility of this intervention in a small subset of households. Ultimately, this mentored research will prepare me for the successful submission of an R01 application to test the intervention developed in Aim 3 in a larger population.

Public Health Relevance

In Nepal in 2011 about 30% of children and 27% of women were underweight and just over 50% of household reported some level of food insecurity. Nepal has high levels of gender inequality, reinforced by house dynamics, where young, newly married women have especially low status in the household and are at increased risk of poor health outcomes, yet little research and few interventions have focused on this population. The knowledge gained and the intervention designed in this study will help improve maternal and child health by addressing the intersection of gender inequality and food insecurity among newly married households in Nepal.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Scientist Development Award - Research & Training (K01)
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Special Emphasis Panel (CHHD1-W)
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King, Rosalind B
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Diamond-Smith, Nadia; Raj, Anita; Prata, Ndola et al. (2017) Associations of women's position in the household and food insecurity with family planning use in Nepal. PLoS One 12:e0176127