My Iowa Journey: A ‘Corn’ucopia of Ideas and Collaborations

By Kanika Arora

Published on September 19, 2023

A portrait of Prof. Kanika Arora of the Department of Health Management and Policy at the University of Iowa college of Public Health.
Kanika Arora

I was trained as a public policy researcher by two prolific methodologists – one, a social demographer, and the other, a program evaluation expert. As a fresh PhD, I was interested in examining the motivations for and the implications of providing long-term care in the U.S. Over the course of last eight years, my research has evolved to focusing on broader public health consequences of population aging. Frequently, my work involves secondary analyses of population data using advanced statistical methods and quantitative modeling.

I have also used measurement and mixed methods approaches with primary data collected through surveys and semi-structured interviews. Further, the questions I am interested in now go beyond standard policy evaluations to understanding the design, implementation, and evaluation of public health interventions. What has not changed, though, is my focus on applied gerontology, an interest in health behaviors, and of course – program and policy evaluation.

While I know better than to make sweeping causal statements, I have no doubt that serving as a research scholar and a teacher at the University of Iowa has significantly influenced my career trajectory. This is most evident in my work on dementia risk factors and caregiver outcomes. For example, in collaboration with scholars from the Great Plains Center on Agricultural Health, I provided the first evidence in the U.S. on the relationship between agricultural work and cognitive functioning. Our findings showed a substantially higher prevalence of dementia among older adults reporting a longest-held job in the agricultural sector, with stronger estimates among those with extensive job tenure.

After conducting interviews with farmers and ranchers from across the state of Iowa, I realized that our results uncovered a critical unmet need. Agriculture is one of the most hazardous occupations in the U.S. With over 30% of farm operators over age 65, dementia is likely to exacerbate the heightened risk for injuries and fatalities among older farmers and ranchers. To address this need, I recently received a grant from the Centers for Disease Control and Prevention to develop and test a Stage 1 intervention aimed at farm families coping with dementia. This intervention seeks to enhance our understanding of safety risks associated with dementia in agricultural settings. It also aims to enable family caregivers to learn and implement environmental modification and behavior change strategies to manage these risks.

At the same time, my work has also focused on public policy issues that are national in scope. One prominent example is my scholarship on the role of paid leave policies in long-term care. I started this line of work by evaluating whether California’s Paid Family Leave law influenced nursing home use among older adults in the state. As I fell deeper in the metaphoric “research hole,” I became interested in the effect of a multitude of state paid leave policies on the likelihood of providing personal care to aging parents.

The results of my research reveal significant heterogeneity in the effectiveness of these policies. In other words, not all paid leave policies are created equal – it matters whether you are talking about paid family leave or paid sick leave, and also whether you are talking about California’s paid family leave program or New York’s – and these policies have differential effects on the probability of informal care provision. In light of the rapidly aging population, my aim is to continue contributing to the national debate on a federal paid leave mandate, particularly in the aftermath of COVID-19.

Currently, I find myself intrigued by public policies that potentially impact the likelihood of dementia diagnosis disclosure. Studies during the past decade suggest that diagnostic disclosure of dementia is inconsistent, with up to 50% of clinicians routinely withholding a dementia diagnosis. In contrast, the disclosure rate for a cancer diagnosis is approximately 90%. My previous work has examined the consequences of diagnostic disclosure for patients and their caregivers. Going forward, I see my research evaluating the antecedents – i.e., studying whether care delivery systems policies influence dementia diagnostic disclosure rates, particularly among rural older adults.  

Finally, I believe that teaching and mentoring students in research methods and program evaluation is central to my goal as a health policy researcher. Before beginning my own doctoral program in 2010, I chose to leave a career in international development out of frustration with my inability to generate evidence on programmatic impact. The problem was two-fold. The content in many methods textbooks was often abstract and did not directly address the very real and difficult challenges that lay at the center of health improvement efforts. And I did not have the relevant training to apply these methods to conduct (or assess the feasibility and quality of) impact evaluations in my own field.

My experience over the last decade has made it clear that these problems are solved by teaching methods to future practitioners and researchers in a manner that is not only rigorous, but also accessible and in context. Towards this, I have attempted to incorporate aspects of authentic and active learning in my courses on Program Implementation and Evaluation and Research Methods. In addition, I frequently involve and partner with PhD students in my own research. Indeed, a majority of my published scholarship includes doctoral students as co-authors. As the current Director of Graduate Studies for our department, my goal is to further foster the academic strength of our degree programs and augment the educational and professional success of our students.