Bio

Clinical Focus


  • Family Medicine

Academic Appointments


Administrative Appointments


  • Postdoctoral Research Fellow, General Medical Disciplines (2013 - Present)

Professional Education


  • Medical Education:Univ of California San Francisco (2010) CA
  • Board Certification: Family Medicine, American Board of Family Medicine (2013)
  • Residency:Contra Costa Regional Medical Center (2013) CA
  • M.S., University of California Berkeley, Health and Medical Sciences (2008)
  • M.P.H., University of California Berkeley, Interdisciplinary Studies (2007)
  • A.B., Harvard University, Chemistry (2003)

Research & Scholarship

Current Research and Scholarly Interests


Socioeconomic determinants of health disparities

Publications

Journal Articles


  • Microcredit participation and nutrition outcomes among women in Peru JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Hamad, R., Fernald, L. C. 2012; 66 (6)

    Abstract

    Microcredit services--the awarding of small loans to individuals who are too poor to take advantage of traditional financial services--are an increasingly popular scheme for poverty alleviation. Several studies have examined the ability of microcredit programmes to influence the financial standing of borrowers, but only a few studies have examined whether the added household income improves health and nutritional outcomes among household members. This study examined the hypothesis that longer participation in microcredit services would be associated with better nutritional status in women.Cross-sectional data were obtained in February 2007 from 1593 female clients of a microcredit organisation in Peru. The primary predictor variable was length of time as a microcredit client measured in number of completed loan cycles (range 0 to 5.5 years, average loan size US$350). The outcome variables were age-adjusted body mass index (BMI), haemoglobin levels (g/dl) and food insecurity measured using the US household food security survey module. Extensive data on demographic and socioeconomic status were also collected.Longer microcredit participation was associated with higher BMI (?=0.05, p=0.06), higher haemoglobin levels (?=0.07, p<0.01) and lower food insecurity (?=-0.13, p<0.01). With the inclusion of demographic and socioeconomic variables, the associations with higher haemoglobin (?=0.03, p=0.04) and lower food insecurity (?=-0.08, p<0.01) were sustained.This study supports the notion that microcredit participation has positive effects on the nutritional status of female clients. Further research should explore more definitive causal pathways through which these effects may occur and should examine the effects on other household members.

    View details for DOI 10.1136/jech.2010.108399

    View details for Web of Science ID 000303608800001

    View details for PubMedID 21051776

  • Health education for microcredit clients in Peru: a randomized controlled trial. BMC PUBLIC HEALTH Hamad, R., Fernald, L. C., Karlan, D. S. 2011; 11 (1): 51

    View details for DOI 10.1186/1471-2458-11-51

  • Small individual loans and mental health: a randomized controlled trial among South African adults BMC PUBLIC HEALTH Fernald, L. C., Hamad, R., Karlan, D., Ozer, E. J., Zinman, J. 2008; 8

    Abstract

    In the developing world, access to small, individual loans has been variously hailed as a poverty-alleviation tool - in the context of "microcredit" - but has also been criticized as "usury" and harmful to vulnerable borrowers. Prior studies have assessed effects of access to credit on traditional economic outcomes for poor borrowers, but effects on mental health have been largely ignored.Applicants who had previously been rejected (n = 257) for a loan (200% annual percentage rate - APR) from a lender in South Africa were randomly assigned to a "second-look" that encouraged loan officers to approve their applications. This randomized encouragement resulted in 53% of applicants receiving a loan they otherwise would not have received. All subjects were assessed 6-12 months later with questions about demographics, socio-economic status, and two indicators of mental health: the Center for Epidemiologic Studies - Depression Scale (CES-D) and Cohen's Perceived Stress scale. Intent-to-treat analyses were calculated using multinomial probit regressions.Randomization into receiving a "second look" for access to credit increased perceived stress in the combined sample of women and men; the findings were stronger among men. Credit access was associated with reduced depressive symptoms in men, but not women.Our findings suggest that a mechanism used to reduce the economic stress of extremely poor individuals can have mixed effects on their experiences of psychological stress and depressive symptomatology. Our data support the notion that mental health should be included as a measure of success (or failure) when examining potential tools for poverty alleviation. Further longitudinal research is needed in South Africa and other settings to understand how borrowing at high interest rates affects gender roles and daily life activities. CCT: ISRCTN 10734925.

    View details for DOI 10.1186/1471-2458-8-409

    View details for Web of Science ID 000264286900001

    View details for PubMedID 19087316

  • Social and economic correlates of depressive symptoms and perceived stress in South African adults JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Hamad, R., Fernald, L. C., Karlan, D. S., Zinman, J. 2008; 62 (6): 538-544

    Abstract

    Adults in South Africa demonstrate rates of mental illness at or above levels elsewhere in the developing world. Yet there is a research gap regarding the social context surrounding mental health in this region. The objective of this analysis was to characterize the prevalence and correlates of depressive symptoms and perceived stress among a heterogeneous South African population.Low-income adults (n = 257) in Capetown, Port Elizabeth and Durban were interviewed regarding demographics, income, subjective social status, life events and decision-making. The Center for Epidemiologic Studies Depression Scale (CES-D) and Cohen's Perceived Stress Scale (PSS) were used.CES-D scores were 18.8 (SD 11.7), with 50.4% of men and 64.5% of women exceeding the cut-off at which professional care is recommended (p = 0.03). PSS scores were 18.6 (SD 6.7), with a mean of 17.5 among men and 19.6 among women (p = 0.02). In multivariate regressions, increased CES-D scores were associated with more household members (p<0.1), lower educational attainment (p = 0.07), less income stability (p<0.07), lower subjective social status (p<0.01) and independent decision-making (p = 0.04). Increased PSS scores were associated with female gender (p<0.05), multiracial race (p<0.02), more household members (p<0.1), lower subjective social status (p<0.02) and recent birth or catastrophe (p<0.01).Depressive symptoms and perceived stress are public health concerns in this sample, with more symptoms among those with fewer resources. The prevention of mental illness is critical, especially in vulnerable populations.

    View details for DOI 10.1136/jech.2007.066191

    View details for Web of Science ID 000255805200012

    View details for PubMedID 18477753

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