There’s a reason why the nation’s largest and longest-running study of cardiovascular disease in African Americans calls Jackson, Miss., home. That community, like others in the southeastern United States, has long experienced disproportionately high rates of cardiovascular disease.
Since its founding 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 disease development. The study, jointly funded by the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities, also emphasizes involving the community in how it approaches research and preparing young African American other students of color for careers in health sciences.
April Carson, an epidemiologist who has worked to identify and address the root causes of disparities associated with diabetes and cardiovascular disease, is the Jackson Heart Study’s new director. An 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 state government. Carson recently spoke with STAT one week into her new job. Here’s that conversation, condensed and edited for clarity.
What led you to the Jackson Heart Study?
My research program primarily focuses on understanding risk factors for diabetes and cardiovascular complications. And what we consistently see is that for African Americans, there is a greater risk for diabetes, and then we also see the complications that are associated with it. Because of that focus, I’m very familiar with the wealth of resources that are available through the Jackson Heart Study.
What attracted me most to the position was thinking about how we could really build upon the foundation that’s here to really, truly 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 that there are race disparities by where you live. But what is it that we can do about it? And I think the Jackson Heart Study is really well-positioned to answer those questions and really to make an impact.
Is that how you see the study’s mission of putting research into action?
Research is important to provide us with information, but information alone is not enough. So how do we take that information and how do we implement it in communities? An example is diabetes. We know that there are successful programs available that can prevent diabetes. But we also know that it’s been harder for people to actually participate in those programs in different communities. So how can we tailor some of those programs to certain communities so that we’re reaching people and really accommodating where they are, what they’re able to do when they have access to, so that we are preventing diabetes and not making disparities worse? When you’re talking about putting the research into action, that’s really what we’re talking about: taking that information and then using that to improve the health of communities.
The study is looking at both environmental and genetic factors. Can you change both?
To some degree. We’ve seen where environmental factors can actually have effects on genetics. What we’re understanding is how where you live can impact not only the food you have and access to physical activity, but we’re also asking how that is impacting your genetics. The modification of your genome — or epigenetics — how does all of that interact? That’s thinking about “environment” very broadly, so air pollution and other factors.
I think that’s really the beauty of the Jackson Heart Study because we have studies that are looking at air pollution, we have studies that are looking at food, the supermarkets, food access. We have studies that are looking at how active people are. We’re covering that in addition to all the genetic studies as well.
Where does training scientists and students fit in?
One of the core tenets 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 the study, but also getting them involved so that they can invest some of the ideas that they may have in the study. It includes a slightly different training program just because of the level of students, undergraduate versus graduate, but they’re getting training in how do we do this study, what are the types of studies that are typically done, how is the data collected and how is data checked, how do you actually come up with the research question. So they’re getting that exposure as well as participating in some of our communities.
The Framingham Heart Study was one of the early population-based research studies. In its first generation, it was almost overwhelmingly 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 of them have their place. Framingham initiated earlier and really highlighted some of the key risk factors that we’re well aware of right now for cardiovascular disease: lipid measurement, blood pressure control, etc. But the added value of the Jackson Heart Study is that not only is it focused on African Americans, who we know have a higher prevalence of many of these conditions, but it’s also concentrated in the southeast United States, which, from a geographic standpoint, we know that there’s a greater burden of different risk factors in that particular area. So I think both of them are more complementary in that they’re telling us, what is it that we know about these populations with respect to cardiovascular disease?
I think the added contribution of the Jackson Heart Study is really its focus not only on understanding disparities that directly affect African Americans, but also its focus on training the next generation of scientists, as well as a commitment for community engagement.
What was your experience working in state government like?
It was very interesting because my first assignment was to go around the entire state of Alabama and meet with our community partners, helping them collect data for the state agency. That was a real-time peek into where the different capacities were. We had some community partners who could collect data and provide programs, and there was no problem. And then we had others who just didn’t have the capacity, whether it was people or technology or some other limitation. And so to me, that was eye-opening because it’s, again, reflective of kind of where we are now, where when we have these programs, some work very well in certain communities and in other communities will not have that capacity. And so just thinking through, how can we make sure that we are really promoting health equity across different communities and tailoring it to what they may need?
What effect has the Covid pandemic had on your work?
We just started our fourth exam visit this summer, which because of the pandemic was delayed over a year. We’re having participants now come back for our standard exam: blood pressure, glucose measures — the first exam in eight or nine years. That they’re wanting to come back again, I think, speaks to their commitment to the study. Another component, given the timing, is really understanding how the pandemic has impacted our participants. And so we’re also collecting data regarding that.
What is your vision for success?
I would love to see the Jackson Heart Study be a leader in preventing the occurrence of cardiovascular risk factors. In an ideal world, that’s Mississippi having the lowest problems of hypertension, Mississippi really making strides in the prevention of cardiovascular risk factors. Also training these outstanding scholars, these students who are becoming leaders in health care and science research, in medicine and in all of these different disciplines and really having that connection back to the Jackson Heart Study. Really, what I want to see is the Jackson Heart Study having this impact long term.