Providing Unbiased Data for Sexual Health Decisions and Policy
Education
I grew up in Clearwater, FL, and left for college at University of North Carolina, Chapel Hill in 1986. I met my wife and the mother of my children there. My major was business administration, but I didn’t really like it at the time.
My senior year, I took a class related to public health. I became so interested in the field that, when I graduated from college in the Summer of 1990 (in a bad job market), I chose a summer internship at Emory University under a contraceptive technology expert over permanent job offers from Macy’s and Ferguson Enterprises (a wholesale plumbing company). I lived with students, nurses, and other interns in Armstrong Hall at Grady (Emory University’s teaching hospital) and helped conduct a study of the acceptability and performance of a new female condom. My job was to recruit 50 couples to test the condom, and I eventually became a subject matter expert (SME) on condoms!
When the summer ended, Emory hired me to continue the work. Back then, Emory gave courtesy scholarships to fulltime employees. I used the benefit to earn an MPH, completed in 1993. Years later, I earned a PhD in Epidemiology at Emory while working part time at CDC (described below).
Jobs Prior to CDC
After my MPH, I worked for the Georgia Department of Public Health (GDPH) under a CDC employee on detail there. The state had a grant from CDC to study risk factors for congenital syphilis among women receiving prenatal care at Grady Hospital.
My project officer for that study was a CDC mathematician. To triangulate records on all 180 congenital syphilis cases from a 3-year period, we had to build a consortium of people from the Fulton County Health Department, Grady, the GDPH, the Emory University Department of Gynecology and Obstetrics, and CDC. We had to figure out who met the case definition and what happened to these women with untreated syphilis during pregnancy. Since this was before there were e-health records, I walked from agency to agency. They would put me in dark rooms at Grady hospital to go through stacks of records that I wasn’t allowed to take out. It was hard to piece together what was going on; for example, I’d request 10 records and maybe get 5 that were complete and identifiable, but I persevered and eventually had a good idea of what transpired in each case.
We found that, even though Grady and the county health department were across the street from each other, there was little follow-up of patients seen at one service site by the other site. Prenatal care was sporadic; many of the women had only one prenatal visit, and only half of those who got prenatal care were being tested for CS. This was during the 1990’s when there were high levels of crack cocaine use and exchanging sex for money. congenital syphilis is at an all-time high now and its risk factors are basically the same, so our findings are still relevant.
First CDC Job
Later, I became Georgia’s state analyst for CDC’s national Behavioral Risk Factor Surveillance System. I was on soft money (i.e., grant-dependent) and thought that an internal position at CDC would have more stability and CDC was every epidemiologist’s dream job! I had tried to get a permanent CDC job before going to the state, but there was a federal hiring freeze. In retrospect, having the experience at the state health department was invaluable for my later work at CDC. When things finally opened up at CDC in 1996, I was hired by the Seroincidence Branch of the Division of HIV/AIDS Prevention. My title was GS-12 Epidemiologist. I served as project officer for 3 sites of a 13-site project that helped STD clinics around the country estimate HIV incidence by integrating anonymized medical records into single cases. Having worked at the state health department conducting the CS project and others, I had instant credibility with local and state health departments and could appreciate their challenges. My next CDC assignment was to work with a communications expert, and two physicians to develop CDC’s 1st evidenced-based fact sheet on condom effectiveness. That was around 2000, when the effectiveness of condoms for STD prevention was being questioned as part of the condoms vs. abstinence debate.
Later CDC Jobs
During this period, I was friendly with the Graduate Program Director of the Department of Epidemiology at the Emory School of Public Health. She told me that 1997 would be a good year to apply to the PhD program. Even though I had just started at CDC, I did apply, planning to tell my CDC supervisors if I was admitted. I was prepared to leave the agency, if necessary, even though it’s the gold standard for jobs in my field. Emory did admit me, and I told my supervisors that I had worked really hard to get my position at CDC and wondered if there was a way to work this out. They were very supportive, told me that it was possible to split an FTE with someone else, and that they already had given someone a 20-hour position. If I took the other half-time slot, my role would be developing CDC’s HIV Counseling, Testing, and Referral (C&T) guidance. I took the position, and it wound up being a terrific experience for me.
My dissertation dealt with methodological limitations of prior studies of condom effectiveness against gonorrhea and chlamydia. Based on a NIH review of the literature conducted for a consensus conference in 2000, I could have predicted the outcome. I found that, while observational HIV studies were quite strong for HIV, the gonorrhea and chlamydia studies were fundamentally flawed by incomplete assessment of condom use and horribly confounded by failure to ascertain the infected status of partners. I used STD clinic data from studies led by CDC researchers to confirm my conclusions, taking into account typical vs. consistent and correct use of condoms and measurement error from not knowing the infection status of partners.
After the C&T guidelines came out, I joined a group in which work had begun work on a brief, single session, STD Clinic-based intervention that would promote condom use for HIV prevention when people came in to be tested and treated for other STDs. Before applications from site candidates even came in, the project lead left the country for a two-year assignment. I had worked on the request for applications from possible sites, so I stepped forward to lead the new project. We were holding the expert review panel meeting on Sept 11, 2001, when the planes hit. We watched it on TV. At the Double Tree Hotel. I’ll never forget that day.
I passed the project to another senior scientist (but remained involved) when I was offered a GS-14 position in the Division of Reproductive Health (DRH), Women’s Health and Fertility Branch. I had received my doctorate in epidemiology just before, and this was much more responsibility, although not a promotion. I accepted it because I thought it might lead to additional leadership opportunities. My title in DRH was senior health scientist, a job I held from 2004-2009. In this position, I was responsible for all scientific matters that came from the branch, including clearing human subjects protection documents and scientific manuscripts, and conducting strategic planning.
In 2009, I became the Associate Director for Science (ADS) for DRH, a position I held until 2015. This division-level role carried a budget of nearly $50 million and 175 staff. It involved strategic planning at a higher level, engaging with the Center on scientific matters, and final clearance of initial study protocols, data analysis strategies, and manuscripts and presentation proposals so they could be sent out for external peer review.
Final CDC Job
After 6 years at the division level, I wanted the experience of directly supervising staff and hands-on creation and management of real budgets so, in 2016, I accepted the position of chief of the Applied Sciences Branch in DRH. It was re-organized 3 times and I ended up as chief of the Women’s Health and Fertility Branch, with a staff of 55 and a budget of $13,000,000.
I was in charge of the 3 major surveillance systems that track the health of women and children. They included:
The Pregnancy Risk Assessment Monitoring System (PRAMS), which had been founded in 1987 and was the branch’s largest budget item,
An abortion surveillance system which had no budget but had been produced annually since 1969 because states complied with data collection requirements voluntarily, and
The National Assistive Reproductive Technology Surveillance System (NASS), which had conducted annual tracking of fertility clinic procedures and success rates in around 500 clinics since 1995.
I also oversaw the development of evidence-based guidelines for the safe use of contraceptives by reproductive-aged patients and a suite of projects for making reproductive health services more widely available to adolescents.
Proudest Achievement
I am most proud to have worked for the premier health agency and to have had an impact on the health of Americans—men, women and infants—in the reproductive health space, the focus of my entire career. I am proud that the updates of contraception guidance improved decisions about providing contraceptives safely in a wide variety of clinical environments, and that our guidance changed attitudes and spurred work about infertility and men’s health. I was proud of the reproductive health surveillance systems I oversaw. I was so proud to have been a supervisor of those dedicated staff. Things may have been slow and frustrating, but I knew we were doing our best to get things done.
My work on condom effectiveness in preventing gonorrhea and chlamydia quantified the effectiveness of condoms and showed that it had been understated. In concert with the NIH expert panel report, my work helped swing the pendulum towards condoms, especially for sexually active teens, quashing concerns that they don’t work. And my work on infertility and male reproductive health raised the profile of these issues and informed work that is still being conducted today.
Impact of the Work
It’s really important to get out objective data on women’s reproductive health quickly. We did it as fast as we could, partnering with health departments to make sure the data were timely, complete, and of high quality. All 3 surveillance systems were critically important for monitoring reproductive health in the United States. The contraceptive guidelines helped providers give the most up-to-date advice about safe and effective use of various methods, affecting the lives of some 50 million women a year. And we demonstrated why infertility should be viewed as a public health problem, caused largely by various public health exposures, and not just as a private personal issue.
We investigated male reproductive health as well, and that was one of my proudest accomplishments. Female infertility had received a lot of attention, but we increased awareness of the importance of examining male infertility too. We also piloted the first-ever PRAMS survey for expectant male partners some 30 years after the first survey of postpartum women. Our group at CDC convened the first-ever agency symposium regarding male reproductive health, attended by representatives of fields including family planning, sexually transmitted infections, urology, and mental health, all in the same room! We released a request for applications for funding for studies of ways to involve men in their partner’s contraceptive choices, and we funded 3 applicants—really innovative projects—to involve males better in teen pregnancy prevention.
Leaving CDC
In the early morning of April 1st, Reduction in Force (RIF) notices went out and I started getting calls from staff and team leads. No one had any warning, or knew who would get the notices, or why some did and some didn’t. Eventually we learned that the entire staff in the division director’s office had been eliminated, as had all the staff in two of the three branches in our division.
I didn’t get a termination notice because I had applied for retirement. I had been planning to retire in 3-5 years and had given thought to what retirement would look like. I qualified by age and years served and my wife is employed, so I applied for early retirement when it was offered. I was brought up to the division level to be deputy division director for my last 3 weeks. I’ve never worked so hard as I did between the 1st and the 19th of April, clearing documents in the queue, scraping and clawing to get data out, trying to help RIF’d staff, and attempting to save the surveillance systems. At one point, I was told teams had been fired by mistake, especially PRAMS and NASS staff, and I tried to justify their reinstatement, but to no avail.
After I left the agency, I traveled extensively to see family and friends, which was very therapeutic. Then I enrolled in a 6-month Executive Coach training program at the Emory business school, and I now have had my first coaching client. I’ve talked to press a lot because the rest of the DRH leadership is still at CDC or on administrative leave and can’t talk. I’ve spoken to a couple of Maternal Child Health organizations about coaching, am volunteering at NE GA Food Bank, and am on the board of the Athens Wellness Clinic which serves the uninsured in the county.
Public Health is a lifelong calling for me. I could see playing a consulting or advisory role if CDC was looking for help to rebuild, especially in reproductive health or HIV or STD areas where I have 35 years of experience. But in other areas too; for 4 months, for example, I was chief scientific officer (ADS) for the covid response which was very hard but rewarding.
During my career, I could have made more money in the private sector, and part of me thought that Elon Musk might make a good difference. He could have eliminated long delays from OMB reviews, for example. He could have reduced the 17 touches required to clear COVID materials. But DOGE did everything the wrong way, saved no money, and discarded valuable surveillance data collected over many years and valuable, experienced staff too.
Future Plans
Since you initially interviewed me nearly eight months ago, the status of CDC’s work in the reproductive area has changed, but it’s still very confusing and the future is uncertain. However, my professional plans and activities have taken shape.
Two of the projects I oversaw in my last CDC job, updating contraceptive guidelines and conducting abortion surveillance, have not been reinstated. Some aspects of the other two, the PRAMS survey and the NASS, were funded in the 2026 Federal budget. Financial support was provided to states to collect PRAMS and to CDC for systems of data submission and storage for both surveys, but there was no support for CDC staff to write the notices of funding opportunities, oversee the awards to sites, write the study protocols, provide technical assistance, collect, process and analyze the data, and write-up and present the data. This leaves a huge gap with no apparent plans to fill it. Approximately three quarters of the reproductive health staff are still on administrative leave, drawing pay and benefits but not being allowed to work, even if they wanted to. At present, there is no technical assistance to sites, no analysis of the data to reveal national or state trends, and no oversight of operations.
Other Comments
In terms of my career, I have now merged two of my long-term interests—business management and public health. I was certified as an executive coach by the Emory school of Business last Fall and am coaching several leaders in nonprofit organizations, higher education, government, and public health. I’m consulting with several MCH organizations as well. I’ll also be teaching introductory epidemiology at the University of Georgia College of Public Health next fall.
I’m very happy in my new role, but I would still consider going back to CDC part time, on a consulting basis, to coach agency leaders or to lend expertise and institutional knowledge to the rebuilding of surveillance systems and registries.