THere’s one reason why the nation’s largest and longest-running study of cardiovascular disease in African Americans is based in Jackson, Mississippi. This community, like others in the Southeastern United States, has a long history of disproportionately high rates of cardiovascular disease.
Since its inception in 1998, the Jackson Heart Study has followed more than 5,300 participants to better understand the role of biological, environmental and genetic factors in the development of the disease. The study, jointly funded by the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities, also emphasizes community involvement in how it approaches research and prepares young African Americans other students of color to careers in health sciences. .
April Carson, an epidemiologist who has worked to identify and address the root causes of the disparities associated with diabetes and cardiovascular disease, is the new director of the Jackson Heart Study. Associate Professor of Epidemiology and Associate Dean for Diversity, Equity and Inclusion at the University of Alabama at Birmingham School of Public Health, she also brings experience working in public health through government. of State. Carson recently spoke with STAT a week after starting his new job. Here’s that conversation, condensed and edited for clarity.
What led you to the Jackson Heart Study?
My research program focuses on understanding the risk factors for diabetes and cardiovascular complications. And what we see all the time is that for African Americans there is a greater risk of diabetes, and then we also see the complications associated with it. Because of this goal, I am very familiar with the wealth of resources available through the Jackson Heart Study.
What attracted me the most to the job was thinking about how we could really build on the foundation that is there to really, really promote health equity. And I think that’s scientifically where we’re trying to go. We know there are these disparities in health outcomes. We know there are racial disparities depending on where you live. But what can we do about it? And I think the Jackson Heart Study is really in a good position to answer these questions and really make an impact.
Is that how you see the study’s mission to put research into action?
Research is important in providing us with information, but information alone is not enough. So how do we take this information and how do we implement it in communities? One example is diabetes. We know there are effective programs that can prevent diabetes. But we also know that it has been more difficult for people to participate in these programs in different communities. So how do we adapt some of these programs to certain communities so that we reach people and really adapt to where they are, what they can do when they have access to it, so prevent diabetes and not worsen disparities? When you talk about putting research into action, that’s really what we’re talking about: taking that information and then using it to improve the health of communities.
The study examines both environmental and genetic factors. Can you change both?
In a certain way. We have seen where environmental factors can actually affect genetics. What we understand is how where you live can impact not only the food you have and access to physical activity, but we also ask how it affects your genetics. Changing your genome – or epigenetics – how does it all interact? It is to think of “the environment” in a very broad way, therefore of air pollution and other factors.
I think that’s really the beauty of the Jackson Heart study because we have studies on air pollution, we have studies on food, supermarkets, access to food. We have studies that look at how active people are. We cover that in addition to all the genetic studies as well.
What is the place of the training of scientists and students?
One of the fundamental principles of the study is to train underrepresented students in science. We have a well-established partnership with Tougaloo College and Jackson State University, as well as the University of Mississippi Medical Center. Part of that is introducing them to science and all aspects of studying, but also getting them involved so that they can invest some of the ideas they may have in the study. It has a slightly different training program just because of the level of the students, undergraduate versus graduate, but they get training on how we do this study, what types of studies are usually done , how the data is collected and how is the data verified, how do you actually arrive at the research question. They therefore benefit from this visibility and participate in some of our communities.
The Framingham Heart Study was one of the first population-based research studies. In his first generation, he was almost predominantly white. What do you think of when people mention the Framingham Heart Study and the Jackson Heart Study in the same sentence?
I think both have their place. Framingham initiated earlier and really highlighted some of the key risk factors we are well aware of for cardiovascular disease today: lipid measurement, blood pressure control, etc. But the added value of the Jackson Heart Study is that it is not only targeted at African Americans, who we know have a higher prevalence of many of these conditions, but it is also concentrated in the South. is from the United States, which geographically we know there is a greater burden of different risk factors in that particular region. So I think the two are more complementary in that they tell us, what do we know about these populations when it comes to cardiovascular disease?
I think the additional contribution of the Jackson Heart study is really its focus not only on understanding the disparities that directly affect African Americans, but also its focus on training the next generation of scientists, as well as engaging. for community engagement.
What has been your experience working in state government?
It was very interesting as my first assignment was to tour the entire state of Alabama and meet with our community partners, helping them collect data for the state agency. It was a real-time snapshot of the location of the various capacities. We had community partners who could collect data and deliver programs, and there was no problem. And then we had others that just didn’t have the capacity, whether it was people, technology, or some other limitation. And so for me, it opened my eyes because it reflects, again, where we are now, where when we have these programs, some work very well in some communities and in other communities they won’t. not this ability. And so, come to think of it, how do we make sure that we are really promoting health equity in different communities and adapting it to what they may need?
What effect has the Covid pandemic had on your work?
We just started our fourth review visit this summer, which, due to the pandemic, was delayed by more than a year. Now we have participants returning for our standard exam: blood pressure, blood sugar readings – the first exam in eight or nine years. The fact that they want to come back, I think, is a testament to their commitment to the study. Another element, given the timeline, is to really understand how the pandemic has impacted our participants. And so we also collect data on this.
What is your vision for success?
I would love to see the Jackson Heart Study be a leader in preventing the onset of cardiovascular risk factors. In an ideal world, Mississippi has the fewest problems with hypertension, Mississippi is really making strides in preventing cardiovascular risk factors. Also to train these exceptional researchers, these students who become leaders in the fields of health and scientific research, in medicine and in all these different disciplines and who really have this connection with the Jackson Heart Study. Really what I want to see is that the Jackson Heart Study has that long term impact.