About

Sian Curtis, PhD, is a Professor in the Department of Maternal and Child Health at UNC Gillings School of Global Public Health. She is also a Faculty Fellow at the Carolina Population Center. Her research activities include international reproductive and maternal health, monitoring and evaluation methods for population and health programs, and statistical demography. Dr. Curtis has contributed to understanding contraceptive use dynamics, family planning, and reproductive health through her work on various international surveys and impact evaluations. She has served as co-chair of the Gillings School of Global Public Health Conflict of Interest Committee since 2019 and is the Director of the MCH doctoral program since 2022. Her practice activities include providing technical assistance to USAID/Bangladesh for impact evaluations of maternal and child health programs. Dr. Curtis has received honors such as the International AIDS Society TB/HIV research award in 2018 and the President's Award for Excellence from the International AIDS Society in 1995.

Research topics

• Medicine
• Economics
• Computer Science
• Economic growth
• Business
• Environmental health
• Nursing
• Pediatrics
• Marketing
• Finance
• Demography

Selected publications

• FAST MRI: DYAMOND trial protocol (can an abbreviated MRI scan detect breast cancers missed by mammography for screening clients with average mammographic density attending their first screening mammogram?)—a diagnostic yield study within the NHS population-risk breast screening programme

  BMJ Open · 2025-09-01

  articleOpen access

  INTRODUCTION: First post-contrAst SubtracTed (FAST) MRI, an abbreviated breast MRI scan, has high sensitivity for sub-centimetre aggressive breast cancer and short acquisition and interpretation times. These attributes promise effective supplemental screening. Until now, FAST MRI research has focused on women above population-risk of breast cancer (high mammographic density or personal history). DYAMOND aims to define the population within the population-risk NHS Breast Screening Programme (NHSBSP) likely to benefit from FAST MRI. The study population is the 40% of screening clients aged 50-52 who have average mammographic density (BI-RADS (Breast Imaging Reporting and Data System) B) on their first screening mammogram. DYAMOND will answer whether sufficient numbers of breast cancers, missed by mammography, can be detected by FAST MRI to justify the inclusion of this group in a future randomised controlled trial. METHODS AND ANALYSIS: Prospective, multicentre, diagnostic yield, single-arm study with an embedded qualitative sub-study: all recruited participants undergo a FAST MRI. An internal pilot will assess the willingness of sites and screening clients to participate in the study. Screening clients aged 50-52, with a clear first NHSBSP mammogram and BI-RADS B mammographic density (by automated measurement) will be invited to participate (recruitment target: 1000). The primary outcome is the number of additional cancers detected by FAST MRI (missed by screening mammography). A Fleming's two-stage design will be used as this allows for early stopping after stage 1, to save participants, funding costs and time continuing to the end of the study if the question can be answered earlier. ETHICS AND DISSEMINATION: The NHSBSP Research and Innovation Development Advisory Committee and the Yorkshire and Humber-Sheffield Research Ethics Committee (23/YH/0268, study ID (IRAS): 330059) approved this research protocol. Participation involves a two-stage informed consent process, enabling screening for eligibility through automated mammographic density measurement. Patients with breast cancer helped shape the study design and co-produced participant-facing documents. They will disseminate the results to the public in a clear and meaningful way. Results will be published with open access in international peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: ISRCTN74193022.

  PublisherOA PDFDOI

• Neighborhood‐level racialized socioeconomic deprivation and contraceptive use in the United States, 2011–2019

  UNC Libraries · 2025-04-15

  articleOpen accessSenior author

  INTRODUCTION: The social and structural environments where people live are understudied in contraceptive research. We assessed if neighborhood measures of racialized socioeconomic deprivation are associated with contraceptive use in the United States. METHODS: We used restricted geographic data from four waves of the National Survey of Family Growth (2011-2019) limited to non-pregnant women ages 15-44 who had sex in the last 12 months. We characterized respondent neighborhoods (census tracts) with the Index of Concentration at the Extremes (ICE), a measure of spatial social polarization, into areas of concentrated privilege (predominantly white residents living on high incomes) and deprivation (predominantly people of color living on low incomes). We used multivariable binary and multinomial logistic regression with year fixed effects to estimate adjusted associations between ICE tertile and contraceptive use and method type. We also assessed for an interactive effect of ICE and health insurance type. RESULTS: Of the 14,396 respondents, 88.4% in neighborhoods of concentrated deprivation used any contraception, compared to 92.7% in the most privileged neighborhoods. In adjusted models, the predicted probability of using any contraception in neighborhoods of concentrated deprivation was 2.8 percentage points lower than in neighborhoods of concentrated privilege, 5.0 percentage points higher for barrier/coital dependent methods, and 4.3 percentage points lower for short-acting methods. Those with Medicaid were less likely to use any contraception than those with private insurance irrespective of neighborhood classification. CONCLUSIONS: This study highlights the salience of structural factors for contraceptive use and the need for continued examination of structural oppressions to inform health policy.

  PublisherDOI

• Impacts of Medicaid Expansion on Contraceptive Use Among Women in Neighborhoods of Racialized Socioeconomic Deprivation in the United States

  Women s Health Issues · 2025-08-15

  articleOpen access
  PublisherOA PDFDOI

• Obstetric fistula in Bangladesh: estimates from a national survey with clinical validation correction

  UNC Libraries · 2025-04-08

  articleOpen access
  PublisherDOI

• A standard SI traceable phantom suitable for qMRI: design, manufacture and characterisation

  Metrologia · 2025-03-05

  articleOpen access

  Abstract Quantitative MRI uses conventional clinical MRI hardware to make measurements of physical quantities. It also offers the opportunity to benchmark scanners in specific applications by characterising their measurement performance. This allows independent assessment of different scanners, products and services. Quantitation requires evaluation of the uncertainty and bias in the measurement process and as such requires a metrological framework. This process can be supported by the use of a reference object (phantom) that contains clinically relevant MRI quantities that are traceable to primary standards. Currently, there are very few traceable MRI standards available, and none cover all the forms of quantitative MRI that are being deployed clinically. The objective of this paper is to provide a metrological framework to build on and support the standardisation of qMRI through the provision of improved reference standards that are compatible with quantitative approaches. Here, we describe the design, construction, characterisation and measurement uncertainty of a traceable and metrologically quantified phantom. The phantom design is modular and comprises 30 distinct vials containing well-characterised, traceable solutions with reported uncertainty for the following MRI measurands: T 1 , T 2 , iron content and fat fraction.

  PublisherDOI

• A comparison of approaches to measuring maternal mortality in Bangladesh, Mozambique, and Bolivia

  UNC Libraries · 2025-04-08

  articleOpen access
  PublisherDOI

• Assessing the Effect of the COVID-19 Pandemic on Abortion Care Utilization and Delays and Whether There Was a Differential Impact Among Latinas in North Carolina

  Women s Health Issues · 2025-12-27

  articleOpen accessSenior author

  OBJECTIVE: We evaluated the effect of the COVID-19 pandemic on abortion service utilization and delays to care among people in North Carolina and assessed whether there was a differential impact between Latinas and non-Hispanic white patients. METHODS: We used state-level data to examine abortions performed in North Carolina health facilities from 2016 to 2021 (N = 167,058). We employed an interrupted time-series analysis to assess changes in the monthly number of abortions and the monthly proportion of abortions at 13 weeks or later gestation both at the pandemic onset (March 2020) and after (April 2020-December 2021). Primary analyses were conducted for all abortion patients and secondary analyses were limited to Latina patients and compared with non-Hispanic white patients. MAIN FINDINGS: There was no significant change in the monthly number of abortions at the pandemic onset. After March 2020, there was a significant increase in the monthly number of abortions among the total study population. The monthly abortion count also increased for both groups between April 2020 and December 2021, though Latina patients had a greater monthly increase than non-Hispanic white patients. The proportion of abortions at 13 weeks or later dropped significantly at the pandemic onset among the total population by 1.5 (95% confidence interval [-2.3, -.7]) percentage points and remained at approximately the same level thereafter. PRINCIPAL CONCLUSIONS: The COVID-19 pandemic was associated with an increase in monthly abortion counts through 2021 and a decrease in the proportion of abortions after the first trimester at the pandemic's onset.

  PublisherOA PDFDOI

• Enabling reproducible measurements of Fat Fraction and Iron content using an SI traceable reference phantom

  Proceedings on CD-ROM - International Society for Magnetic Resonance in Medicine. Scientific Meeting and Exhibition/Proceedings of the International Society for Magnetic Resonance in Medicine, Scientific Meeting and Exhibition · 2024-11-26 · 1 citations

  article

  Motivation: Quantitative MRI is a powerful tool for measuring a variety of biological parameters, with two common biomarkers of interest being fat fraction and Iron content. Goal(s): We present here a test object for these parameters which is supported by fundamental metrology and traceable to the SI system. Approach: Initial scan data taken at 1.5T is compared with traceable measurements of phantom propertiesResults: We see significant variation seen in clinical results of the same phantom even with standardised protocols, outside the range of phantom validation. Impact: We demonstrate a new gold standard and verified phantom for fat and iron measurement, traceable to primary standards. We present results using standardised MRI protocols which is vital for understanding and improving standards and best practice guidelines in the future.

  PublisherDOI

• Neighborhood‐level racialized socioeconomic deprivation and contraceptive use in the United States, 2011–2019

  Perspectives on Sexual and Reproductive Health · 2024-06-01

  articleOpen access

  INTRODUCTION: The social and structural environments where people live are understudied in contraceptive research. We assessed if neighborhood measures of racialized socioeconomic deprivation are associated with contraceptive use in the United States. METHODS: We used restricted geographic data from four waves of the National Survey of Family Growth (2011-2019) limited to non-pregnant women ages 15-44 who had sex in the last 12 months. We characterized respondent neighborhoods (census tracts) with the Index of Concentration at the Extremes (ICE), a measure of spatial social polarization, into areas of concentrated privilege (predominantly white residents living on high incomes) and deprivation (predominantly people of color living on low incomes). We used multivariable binary and multinomial logistic regression with year fixed effects to estimate adjusted associations between ICE tertile and contraceptive use and method type. We also assessed for an interactive effect of ICE and health insurance type. RESULTS: Of the 14,396 respondents, 88.4% in neighborhoods of concentrated deprivation used any contraception, compared to 92.7% in the most privileged neighborhoods. In adjusted models, the predicted probability of using any contraception in neighborhoods of concentrated deprivation was 2.8 percentage points lower than in neighborhoods of concentrated privilege, 5.0 percentage points higher for barrier/coital dependent methods, and 4.3 percentage points lower for short-acting methods. Those with Medicaid were less likely to use any contraception than those with private insurance irrespective of neighborhood classification. CONCLUSIONS: This study highlights the salience of structural factors for contraceptive use and the need for continued examination of structural oppressions to inform health policy.

  PublisherOA PDFDOI

• Optimising the diagnostic accuracy of First post-contrAst SubtracTed breast MRI (FAST MRI) through interpretation-training: a multicentre e-learning study, mapping the learning curve of NHS Breast Screening Programme (NHSBSP) mammogram readers using an enriched dataset

  Breast Cancer Research · 2024-05-28 · 2 citations

  articleOpen access

  BACKGROUND: Abbreviated breast MRI (FAST MRI) is being introduced into clinical practice to screen women with mammographically dense breasts or with a personal history of breast cancer. This study aimed to optimise diagnostic accuracy through the adaptation of interpretation-training. METHODS: A FAST MRI interpretation-training programme (short presentations and guided hands-on workstation teaching) was adapted to provide additional training during the assessment task (interpretation of an enriched dataset of 125 FAST MRI scans) by giving readers feedback about the true outcome of each scan immediately after each scan was interpreted (formative assessment). Reader interaction with the FAST MRI scans used developed software (RiViewer) that recorded reader opinions and reading times for each scan. The training programme was additionally adapted for remote e-learning delivery. STUDY DESIGN: Prospective, blinded interpretation of an enriched dataset by multiple readers. RESULTS: 43 mammogram readers completed the training, 22 who interpreted breast MRI in their clinical role (Group 1) and 21 who did not (Group 2). Overall sensitivity was 83% (95%CI 81-84%; 1994/2408), specificity 94% (95%CI 93-94%; 7806/8338), readers' agreement with the true outcome kappa = 0.75 (95%CI 0.74-0.77) and diagnostic odds ratio = 70.67 (95%CI 61.59-81.09). Group 1 readers showed similar sensitivity (84%) to Group 2 (82% p = 0.14), but slightly higher specificity (94% v. 93%, p = 0.001). Concordance with the ground truth increased significantly with the number of FAST MRI scans read through the formative assessment task (p = 0.002) but by differing amounts depending on whether or not a reader had previously attended FAST MRI training (interaction p = 0.02). Concordance with the ground truth was significantly associated with reading batch size (p = 0.02), tending to worsen when more than 50 scans were read per batch. Group 1 took a median of 56 seconds (range 8-47,466) to interpret each FAST MRI scan compared with 78 (14-22,830, p < 0.0001) for Group 2. CONCLUSIONS: Provision of immediate feedback to mammogram readers during the assessment test set reading task increased specificity for FAST MRI interpretation and achieved high diagnostic accuracy. Optimal reading-batch size for FAST MRI was 50 reads per batch. Trial registration (25/09/2019): ISRCTN16624917.

  PublisherOA PDFDOI

Frequent coauthors

• Ilene S. Speizer

  26 shared

• Gustavo Ángeles

  University of North Carolina at Chapel Hill

  17 shared

• Kavita Singh

  9 shared

• Adam Smith‐Collins

  St Michael’s Hospital

  9 shared

• Morris Weinberger

  University of North Carolina at Chapel Hill

  8 shared

• Dhayendre Moodley

  Centre for the AIDS Programme of Research in South Africa

  8 shared

• Katherine Tumlinson

  8 shared

• Heather M. Marlow

  8 shared

Education

• PhD, Social Statistics

  University of Southampton

  1992

Awards & honors

• International AIDS Society TB/HIV research award 2018
• International AIDS Society President's Award for Excellence…