About

Elizabeth Joanne Gifford is a Research Professor in the Sanford School of Public Policy at Duke University. She serves as the Faculty Director of the Health Policy Undergraduate Certificate of the Margolis Institute for Health Policy and is a Professor of Pediatrics. Additionally, she is an Affiliate of the Center for Child and Family Policy and a Core Faculty Member of the Duke-Margolis Institute for Health Policy. Her work focuses on health policy, with a particular emphasis on child and family health, contributing to the development and dissemination of health policy research and education.

Research topics

• Environmental health
• Internal medicine
• Virology
• Medicine

Selected publications

• Genomic interplay between deployment exposures and Gulf War illness in Million Veteran Program participants

  Human Genomics · 2026-03-27

  articleOpen access

  Veterans of the 1990–1991 Gulf War (GW) experienced an elevated burden of chronic health conditions, most notably Gulf War Illness (GWI). While the disease etiology remains unclear, it is hypothesized that both genetic susceptibility and deployment exposures contribute to GWI risk. We investigated 6,882 GW-deployed Veterans, assessing genetic and epigenetic interactions with GW exposures (ground combat, insect baits, oil well smoke exposure, pyridostigmine bromide pills, biological/chemical warfare agents, and pesticides). We observed nominal evidence of a genome-wide gene–environment interaction variance component (0.38 ± 0.22) related to biological/chemical warfare-agent exposure and identified three loci showing genome-wide significant interactions (p < 5 × 10− 8; rs78441512, rs145790544, and rs117997207). Also, type-2 diabetes polygenic risk association with GWI is reduced in Veterans exposed to biological/chemical warfare agents, pesticides, and oil well fire smoke during GW deployment. An exploratory computational drug-repurposing analysis highlighted clebopride, rifampicin, and fisetin as compounds potentially targeting GWI-associated molecular pathways. Our GWI epigenome-wide association study identified five sites showing epigenetic interaction with four GW exposures: ground combat, biological/chemical warfare agents, pyridostigmine bromide pill use, and pesticide use. In conclusion, our study demonstrates that both genetic and epigenetic factors interact with GW military exposures to influence GWI vulnerability, highlighting potential druggable pathways to develop novel therapeutic interventions.

  PublisherDOI

• Property dynamics and displacement: How multifamily sales, renovations, and demolitions influence moves for children

  Journal of Urban Affairs · 2026-04-20

  article
  PublisherDOI

• Juvenile Records and Adult Gun Violence: Evidence From Three States With Divergent Firearm Age Policies

  Journal of Interpersonal Violence · 2026-01-31

  article

  Young adults with a history of juvenile justice involvement are more likely than their peers to be arrested for a violent gun crime, but unlike felony convictions, juvenile adjudications are typically expunged and do not convey a federal firearm prohibition. In response, many states have enacted their own laws to delay legal firearm purchase or possession for young adults with juvenile justice histories. The specific age thresholds in these laws vary widely across states, and their relative effectiveness remains empirically untested. This study helps to fill a gap in the evidence with findings from a state-comparative longitudinal analysis of violent crime arrests, both with and without firearm involvement, among large cohorts of young adults with juvenile delinquency records in three states with divergent firearm age-of-access standards applicable to this population: North Carolina ( N = 51,059; age 18), Delaware ( N = 17,522; age 25), and Virginia ( N = 44,432; age 29). Arrest rates for violent crime were found to be markedly higher in these cohorts than in the general population, but declined with age. Adjusted Cox proportional hazards models revealed that individuals in Virginia—the state with the most restrictive age standard—had a significantly lower risk of arrest for gun-involved violent crime than their peers in Delaware and North Carolina ( HR = 0.72 and 0.70, respectively; p &lt; .0001). Importantly, this pattern did not extend to arrests for non-firearm-related violent offenses. The findings suggest that extending minimum age requirements for firearm purchase and possession by young adults with a juvenile justice history may, at least modestly, reduce gun violence risk in this population, perhaps especially when implemented with robust background checks and enforcement efforts to prevent extralegal firearm acquisition.

  PublisherDOI

• Overwhelming Need, Insufficient Health Care for Justice-involved North Carolinians.

  UNC Libraries · 2025-07-24

  articleOpen access

  AJ was a 34-year-old African American male who was incarcerated for eight years for drug-related convictions. He suffered from diabetes, hypertension, chronic kidney failure, depression, and substance use disorder. Upon release from prison he was not connected with health services and he was uninsured, which was an additional barrier to accessing medical care. His own perceived need for care was limited as he had significant cognitive deficits with extremely low health literacy. Two years following his release from prison, an aunt concerned about his health brought him to clinic. His clinical course was fraught with complications that would likely have been preventable if he had been connected to care upon release. With treatment, his depression eventually improved and his substance use disorder was under better control. However, he endured multiple amputations from diabetic foot infections, partial vision loss, severe pain from diabetic neuropathy, temporary dialysis for end stage kidney disease, and two months of a feeding tube for severe gastroparesis. AJ's story is not unique, and it highlights the terrible personal costs of inadequately addressing the health needs of people during periods of incarceration and following their release.

  PublisherDOI

• Upper gastrointestinal symptoms and Gulf War Illness in a clinical cohort of US veterans: a retrospective, cross-sectional study

  BMJ Open Gastroenterology · 2025-09-01

  articleOpen access

  OBJECTIVE: Approximately 30% of the 700 000 US Gulf War Veterans (GWVs) report symptoms collectively termed Gulf War Illness (GWI), a multisymptom illness of uncertain pathophysiology. Prior studies in GWI focus on overlap with irritable bowel syndrome. This study examines the associations between upper gastrointestinal (UGI) symptoms, GWI and specialty GI care. METHODS: This cross-sectional study analysed GWVs referred to a Veterans Health Administration clinical War-Related Illness and Injury Study Center (2008-2020). Symptoms, demographics, military service and clinical history were obtained from self-reported intake packets. GWI was defined by the Centers for Disease Control and Prevention criteria requiring moderate-to-severe symptoms in at least two of three domains: fatigue, musculoskeletal and mood cognition. UGI symptoms were analysed individually as a composite variable and additively (0-5). Logistic regression models estimated ORs for associations between UGI symptoms, GWI and GI specialty care. RESULTS: The cohort included 596 GWVs (mean age 49.3 years, 88% men). Most (93.5%) reported at least one UGI symptom, with a mean of 2.8 symptoms. GWI was identified in 413 (69%). Veterans with GWI were more likely to report UGI symptoms (98.3% vs 82.5%) and had a higher mean symptom count (3.1 vs 2.1). Adjusted ORs for UGI symptoms in GWI ranged from 1.79 (dysphagia) to 3.57 (nausea/vomiting). CONCLUSION: UGI symptoms are common among GWVs and strongly associated with GWI. Clinicians should screen for UGI symptoms and follow standard protocols for treatment and referral.

  PublisherOA PDFDOI

• Barriers and facilitators to social-emotional health screening in pediatrics: Results from a qualitative study of practitioner perspectives

  Social and Emotional Learning Research Practice and Policy · 2025-08-05

  articleOpen access

  Social-emotional health (SEH) affects well-being and outcomes across the lifespan and is most malleable when addressed before age five. Despite the importance of early screening, SEH screening does not occur at most well-child visits. This study aimed to evaluate the barriers and facilitators to implementing SEH screening across individual, community, and statewide levels and to develop implementation strategies for SEH screening among children ages 0-5 years at each level. We employed a qualitative descriptive design using semi-structured interviews with SEH experts across the United States ( N =38). Our final sample included pediatric clinicians, educators, and policymakers. We identified three themes to encompass relevant considerations for implementing SEH screening: (1) Prioritizing SEH , (2) Selecting a SEH measure , and (3) Accountability. All informants stressed the criticality of universal SEH screening, although our findings underscore the complex nature of implementing such strategies. Within each theme, informants emphasized the need for actions to prioritize equity and prevent harm that can be inflicted by tools and strategies lacking intentional health equity focus. Our results identified significant gaps preventing universal SEH screening from being implemented. Existing efforts and other potential solutions could be leveraged to address this. Improved infrastructure is necessary to make universal SEH screening achievable. When implementing SEH screening and selecting measures, both feasibility and equity should be considered. Such investments could facilitate the implementation of SEH screening and ultimately bolster children's mental health and well-being.

  PublisherDOI

• Unraveling the genetics of gulf war illness in diverse participants enrolled in the million veteran program

  Human Molecular Genetics · 2025-05-14 · 1 citations

  article

  Gulf War Illness (GWI) is a multi-symptom chronic condition that affects Veterans who served in the 1990-1991 Gulf War (GW). To generate novel information about GWI pathogenesis, we used genome-wide data available from 33 523 Veterans of diverse ancestral backgrounds who served during the 1990-1991 Gulf War era (34% deployed). Polygenic score (PGS) analysis showed GWI pleiotropy for several traits with the strongest evidence for type-2 diabetes (T2D), anxiety, and depression. While T2D PGS was associated with higher GWI odds in GW Veterans, anxiety and depression PGSs were associated with higher odds of GWI in non-deployed GW-era Veterans. Seven independent variants were identified (P < 5 × 10-8). Two of them were supported by independent transcriptomic and phenome-wide analyses. Rs4675853 was associated with AGXT, MAB21L4, and ATG4Btranscriptomic regulation and with sex hormone-binding globulin levels. Rs138168412 was associated with AOPEPtranscriptomic regulation and with respiratory function and physical strength. The TWAS identified five additional loci such as CEMIPin the cerebellum and SNCGin the adrenal gland. The results provide a comprehensive assessment of the polygenic architecture of GWI research definitions, identifying mechanisms potentially relevant to the disease pathogenesis.

  PublisherDOI

• Child Maltreatment Re-report, Substantiation, and Foster Care Placement: A Latent Class Analysis of Child, Caregiver, and Household Risk Factors Across Screened-In and Screened-Out Cases

  Child Maltreatment · 2025-07-21

  articleSenior author

  Children reported to Child Protective Services (CPS) face elevated risks of adverse outcomes. It is essential to identify vulnerable populations and opportunities for early intervention. This study combined qualitative coding of CPS intake reports with latent class analyses to explore the typologies of children and families based on documented risk factors, both across all CPS intake reports (N = 4,344) and separately for screened-in and screened-out cases. We further examined their associations with maltreatment re-report, substantiation, and foster care placement over a three-year follow-up. Results revealed four latent classes: "Financial Hardship," "Caregiver Drug Use," "Child Health Issues," and "Domestic Violence," with the "Financial Hardship" group having the highest risk of experiencing re-reports and foster care placements. We observed variations in risk profiles between screened-in and screened-out reports. Findings highlight the importance of a person-centered approach in identifying high-risk groups and co-occurring risk factors for both screened-in and screened-out reports.

  PublisherDOI

• Association of deployment characteristics and exposures with persistent ill health among 1990-1991 Gulf War veterans in the VA Million Veteran Program

  Environmental Health · 2024-10-25 · 3 citations

  articleOpen access

  BACKGROUND: Veterans of the 1990-1991 Gulf War have experienced excess health problems, most prominently the multisymptom condition Gulf War illness (GWI). The Department of Veterans Affairs (VA) Cooperative Studies Program #2006 "Genomics of Gulf War Illness in Veterans" project was established to address important questions concerning pathobiological and genetic aspects of GWI. The current study evaluated patterns of chronic ill health/GWI in the VA Million Veteran Program (MVP) Gulf War veteran cohort in relation to wartime exposures and key features of deployment, 27-30 years after Gulf War service. METHODS: MVP participants who served in the 1990-1991 Gulf War completed the MVP Gulf War Era Survey in 2018-2020. Survey responses provided detailed information on veterans' health, Gulf War exposures, and deployment time periods and locations. Analyses determined associations of three defined GWI/ill health outcomes with Gulf War deployment characteristics and exposures. RESULTS: The final cohort included 14,103 veterans; demographic and military characteristics of the sample were similar to the full population of U.S. 1990-1991 Gulf War veterans. Overall, a substantial number of veterans experienced chronic ill health, as indicated by three defined outcomes: 49% reported their health as fair or poor, 31% met Centers for Disease Control and Prevention criteria for severe GWI, and 20% had been diagnosed with GWI by a healthcare provider. Health outcomes varied consistently with veterans' demographic and military characteristics, and with exposures during deployment. All outcomes were most prevalent among youngest veterans (< 50 years), Army and Marine Corps veterans, enlisted personnel (vs. officers), veterans located in Iraq and/or Kuwait for at least 7 days, and veterans who remained in theater from January/February 1991 through the summer of 1991. In multivariable models, GWI/ill health was most strongly associated with three exposures: chemical/biological warfare agents, taking pyridostigmine bromide pills, and use of skin pesticides. CONCLUSIONS: Results from this large cohort indicate that GWI/chronic ill health continues to affect a large proportion of Gulf War veterans in patterns associated with 1990-1991 Gulf War deployment and exposures. Findings establish a foundation for comprehensive evaluation of genetic factors and deployment exposures in relation to GWI risk and pathobiology.

  PublisherOA PDFDOI

• Longitudinal Patterns of Multimorbidity in Gulf War Era Veterans With and Without Gulf War Illness

  Journal of Aging and Health · 2024-04-09 · 1 citations

  articleSenior authorCorresponding

  Objectives: To examine whether severe Gulf War illness (SGWI) case status was associated with longitudinal multimorbidity patterns. Methods: Participants were users of the Veteran Health Administration Health Care System drawn from the Gulf War Era Cohort and Biorepository ( n = 840). Longitudinal measures of multimorbidity were constructed using (1) electronic health records (Charlson Comorbidity Index; Elixhauser; and Veterans Affairs Frailty Index) from 10/1/1999 to 6/30/2023 and (2) self-reported medical conditions (Deficit Accumulation Index) since the war until the survey date. Accelerated failure time models examined SGWI case status as a predictor of time until threshold level of multimorbidity was reached, adjusted for age and sociodemographic and military characteristics. Results: Models, adjusted for covariates, revealed that (1) relative to the SWGI− group, the SGWI+ group was associated with an accelerated time for reaching each threshold and (2) the relationship between SGWI and each threshold was not moderated by age. Discussion: Findings suggest that veterans with SGWI experienced accelerated aging.

  PublisherDOI

Recent grants

• The Intergeneration Effects of Criminal Justice Policies on Substance Use Crimes

  NIH · $716k · 2016–2020

• NIH Grant R03DA019029

  NIH · $153k · 2009

Frequent coauthors

• Elizabeth R. Hauser

  Durham VA Health Care System

  132 shared

• Drew A. Helmer

  Foundation for Advancing Veterans Health Research

  91 shared

• Kellie J. Sims

  79 shared

• Jacqueline Vahey

  Durham VA Health Care System

  76 shared

• Sarah T. Ahmed

  Baylor College of Medicine

  56 shared

• Alice B. S. Nono Djotsa

  Michael E. DeBakey VA Medical Center

  56 shared

• Kelly E. Evans

  Center for Child and Family Health

  54 shared

• Stephen H. Boyle

  43 shared