DR. JOYCE HUNTER: GOOD AFTERNOON, EVERYONE. GOOD AFTERNOON, EVERYONE. AUDIENCE MEMBERS: GOOD AFTERNOON. DR. JOYCE HUNTER: I AM DR. JOYCE HUNTER, DEPUTY DIRECTOR OF THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES FOR EXTRAMURAL RESEARCH. I BRING YOU GREETINGS ON BEHALF OF DR. JOHN RUFFIN, WHO IS THE DIRECTOR OF THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES. HE COULD NOT BE WITH US TODAY, BUT I AM DELIGHTED TO INVITE YOU TO OUR SEMINAR, THE NIH HEALTH DISPARITIES SEMINAR, WHICH COMMEMORATES NOT ONLY BLACK HISTORY MONTH BUT HEART HEALTH MONTH. OUR SEMINAR TODAY WILL FOCUS ON CARDIOVASCULAR DISEASE, WHICH IS THE LEADING CAUSE OF DEATH IN THE U.S. AND WHICH ALSO DISPROPORTIONATELY IMPACTS AFRICAN AMERICANS. AFRICAN AMERICANS ARE MORE LIKELY TO BE DIAGNOSED WITH HEART DISEASE THAN THE GENERAL POPULATION. ONE IN EVERY TWO AFRICAN AMERICANS HAS HEART DISEASE. AFRICAN AMERICANS ARE 30 PERCENT MORE LIKELY THAN OTHERS TO DIE FROM HEART DISEASE. IT'S OKAY. COME ON IN. WE HAVE PLENTY OF ROOM. ELIMINATING DISPARITIES IN CARDIOVASCULAR DISEASE REQUIRES AN ENHANCED EFFORT AT PREVENTING THE DISEASE. THE JACKSON HEART STUDY, FUNDED BY THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE AND THE NIMHD, HAS BECOME THE LARGEST SINGLE SITE PROSPECTIVE EPIDEMIOLOGICAL INVESTIGATION OF CARDIOVASCULAR DISEASE AMONG AFRICAN AMERICANS. LED BY OUR SPEAKER TODAY, DR. HERMAN TAYLOR, THE JACKSON HEART STUDY EXPLORES HOW LIFESTYLE HABITS, MEDICAL HISTORY, SOCIAL AND CULTURAL INFLUENCES, STRESS, AND GENETIC FACTORS ALL IMPACT HEART DISEASE IN AFRICAN AMERICANS. TODAY, DR. TAYLOR WILL SHARE WITH US THE PRESENT STATUS OF THE JACKSON HEART STUDY AS WELL AS THE FUTURE PROMISE OF THE LANDMARK STUDY. IN ADDITION TO BEING DIRECTOR AND PRINCIPAL INVESTIGATOR OF THE JACKSON HEART STUDY, DR. TAYLOR IS ALSO AN AARON SHIRLEY PROFESSOR FOR THE STUDY OF HEALTH DISPARITIES, A PROFESSOR OF MEDICINE, AND ATTENDING PHYSICIAN AT THE UNIVERSITY OF MISSISSIPPI MEDICAL CENTER. HE IS VISITING PROFESSOR OF BIOLOGY AT TOUGALOO COLLEGE AND CLINICAL PROFESSOR OF EPIDEMIOLOGY AND PREVENTIVE MEDICINE AT JACKSON STATE UNIVERSITY, AND THESE ARE ALL PARTNERS IN THE JACKSON HEART STUDY. A GRADUATE OF PRINCETON UNIVERSITY, DR. TAYLOR EARNED HIS M.D. FROM HARVARD MEDICAL SCHOOL, TRAINED IN INTERNAL MEDICINE AT THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL, AND COMPLETED A CARDIOLOGY FELLOWSHIP AT THE UNIVERSITY OF ALABAMA IN BIRMINGHAM. HE IS A FELLOW OF THE AMERICAN COLLEGE OF CARDIOLOGY AND THE AMERICAN HEART ASSOCIATION. DR. TAYLOR IS THE RECIPIENT OF NUMEROUS AWARDS, INCLUDING THE MINORITY ACCESS ROLE MODEL AWARD AND THE HERBERT W. NICKENS AWARD FOR EXCELLENCE IN EPIDEMIOLOGICAL RESEARCH. PLEASE JOIN WITH ME IN GIVING AN EXTREMELY WARM WELCOME TO DR. HERMAN TAYLOR. [APPLAUSE] DR. HERMAN TAYLOR: THANK YOU VERY MUCH. I APPRECIATE IT. WELL, GOOD AFTERNOON, LADIES AND GENTLEMEN. IT IS INDEED A PLEASURE TO BE HERE WITH YOU. I HAVE A LOT OF FRIENDS IN THE AUDIENCE, AND IF I START NAMING PEOPLE, I'M GOING TO MISS SOMEBODY. BUT I JUST WANT TO BE SURE TO ACKNOWLEDGE I APPRECIATE YOUR SUPPORT AND YOUR PRESENCE HERE TODAY. BUT I HAVE TO GIVE A SPECIAL THANK YOU TO DR. HUNTER, SPECIAL ACKNOWLEDGEMENT TO DR. SUSAN SHURIN, DR. RUFFIN IN HIS ABSENCE, AND ALSO A SPECIAL ACKNOWLEDGEMENT TO MY OLD MEDICAL SCHOOL ROOMMATE, DR. ROY WILSON, WHO IS IN THE AUDIENCE AS WELL. I THANK YOU ALL FOR BEING INTERESTED IN THIS TOPIC AND INTERESTED IN THE JACKSON HEART STUDY. ACKNOWLEDGING THE FRIENDS IN THE AUDIENCE MAY SEEM TO SUGGEST THAT I'M GOING TO BE PREACHING TO THE CHOIR. TO THE EXTENT THAT THAT'S TRUE, I'M GLAD TO BE PREACHING TO YOU. BUT I ALSO ENCOURAGE YOU AS CHOIR MEMBERS TO TAKE THE MESSAGE BEYOND THIS SEMINAR BECAUSE I THINK THERE'S SOMETHING HERE THAT'S RELEVANT FOR ALL OF US OF ANY ETHNICITY. JUST AS THE FRAMINGHAM STUDY HAS PROVEN ITS WORTH, ALTHOUGH IT IS FAIRLY ETHNICALLY RESTRICTED BEING ALL WHITE -- IN FACT, ALL MOSTLY ITALIAN, IRISH, OR IRISH-ITALIAN -- I THINK THAT THE JACKSON HEART STUDY HOLDS SIMILAR PROMISE. AND I WANT TO DESCRIBE FOR YOU WHERE WE ARE RIGHT NOW AND THE PATH THAT WE HOPE TO TAKE FOR THE FUTURE. NOW, TO BEGIN WITH, THE TITLE OF THIS TALK, "ERASING THE COLOR LINE IN HEALTH," MAY SEEM CURIOUS TO A LOT OF YOU, PARTICULARLY THE YOUNGER FOLKS IN THE CROWD, BECAUSE "COLOR LINE" IS SOMEWHAT OF AN ANTIQUATED TERM IN TODAY'S DISCUSSIONS ABOUT RACE. BUT IT WAS ACTUALLY -- THE STUDENTS OF HISTORY AND SOCIOLOGY KNOW THIS VERY WELL -- THAT W.E.B. DU q BOIS COINED THE PHRASE, OR AT LEAST MADE IT A PERMANENT PART OF OUR LEXICON, IF YOU WILL, WHEN WE'RE TALKING ABOUT RACE IN HIS FAMOUS "THE SOULS OF BLACK FOLK." AND, OF COURSE, THIS IS AT THE BEGINNING OF THE 20TH CENTURY. AND OBVIOUSLY, THE ISSUES IN RACE WERE STARKLY DRAWN THEN WITH VERY ACTIVE JIM CROW SEGREGATION AND ALL OF THE VIOLENCE THAT ATTENDED RACE RELATIONS BACK IN THOSE DAYS. SO, HE SAID IN HIS PRESCIENT WAY THAT THE PROBLEM OF THE 20TH CENTURY IS THE PROBLEM OF THE COLOR LINE. AT THE OPPOSITE END OF THAT CENTURY, ANOTHER BLACK HISTORIAN -- AND I'M GIVING A NOD TO BLACK HISTORIANS AND SOCIOLOGISTS SINCE IT IS BLACK HISTORY MONTH -- BUT AN EMINENT HISTORIAN BY ANYBODY'S MEASURE, JOHN HOPE FRANKLIN, SAID THIS: "THAT TO SUGGEST THAT THE PROBLEM OF THE 21ST CENTURY WILL BE THE PROBLEM OF THE COLOR LINE IS MERELY TO TAKE NOTE OF THE FACT THAT THE CHANGES HAVE NOT BEEN SUFFICIENT TO ELIMINATE IT AS A PROBLEM, ARGUABLY, THE MOST TRAGIC AND PERSISTENT IN THE NATION'S HISTORY." IF WE SUBSTITUTE DISPARITIES FOR HEALTH DISPARITIES, I THINK WE HAVE A ROUGHLY EQUIVALENT NOTION OF WHAT THE COLOR LINE MEANS. SO, THAT'S A TOUCH OF BLACK HISTORY. A TOUCH OF HEART HISTORY, IF YOU WILL, TELLS A VERY INTERESTING TALE THAT I THINK MOST OF YOU ARE AWARE OF, BUT I WANT TO REFRESH YOUR MEMORY. OVER THE COURSE OF THAT SAME HUNDRED YEAR OR SO SPAN, AND THIS ACTUALLY LOOKS AT THE SECOND HALF OF THE 20TH CENTURY, THE STORY OF HEART DISEASE WAS ONE THAT ACTUALLY WAS A STORY OF SIGNIFICANT PUBLIC HEALTH SUCCESS. AND WHAT THE RED LINE DEPICTS IS THE RATHER MARKED DECLINE IN MORTALITY FROM CARDIOVASCULAR DISEASE THAT WE SEE STARTED IN THE '60S AND HAS BEEN DOWN FOR THE NATION IN A FAIRLY CONSISTENT WAY OVER THE COURSE OF THE LAST 40 YEARS. PIVOTAL EVENTS ARE LISTED THERE BY DR. NABEL AND ONE OF OUR MUTUAL MENTORS, DR. BROWNWALL [SPELLED PHONETICALLY]. THERE'S ANOTHER ONE IN THE TRAY, OKAY. AND DR. WILSON, YOU REMEMBER DR. BROWNWALL VERY WELL ALSO. THIS SHOWS A LOT OF THE SEMINAL EVENTS AND ACCOMPLISHMENTS OVER THE COURSE OF THAT, AGAIN, PUBLIC HEALTH SUCCESS STORY. I WOULD POINT OUT HERE IN 1961, THE FRAMINGHAM HEART STUDY MADE ITS CONTRIBUTION TO THIS, OR BEGAN TO MAKE A TREMENDOUS CONTRIBUTION TO THIS TREND BY PUBLISHING A PAPER THAT DESCRIBED THE CARDIOVASCULAR RISK FACTORS THAT ARE ALL ON THE TIPS OF OUR TONGUES THESE DAYS, WHICH WERE SOMEWHAT IN DOUBT BEFORE THEY ACTUALLY PUBLISHED BAD THINGS LIKE HYPERCHOLESTEROLEMIA, DIABETES, SEDENTARY LIFESTYLE, SMOKING, ET CETERA, ACTUALLY WORSENED THE RISK FOR CARDIOVASCULAR DISEASE. AND THAT DROVE A LOT OF THE SUBSEQUENT RESEARCH, A LOT OF THE SUBSEQUENT LINES OF RESEARCH ONCE WE HAD THOSE RISK FACTORS FAIRLY FIRMLY IN MIND. SO, TAKEN TOGETHER, ALL OF THESE ADVANCES, AND SOME NOT LISTED, LED TO THIS ALMOST CONTINUOUS DROP, WELL, THIS INDEED CONTINUOUS DROP OVER THE LAST THREE OR FOUR DECADES. AND THE FRAMINGHAM STUDY, AGAIN, A TYPICAL AMERICAN TOWN -- HERE'S DR. KANNEL, THE LATE DR. KANNEL, AND ONE OF THE PARTICIPANTS IN THAT LANDMARK STUDY. WELL, YOU MAY RECALL IN THAT SLIDE BY DR. NABEL THAT FRAMINGHAM WAS ON -- IT OCCURRED ON THAT PLATEAU BEFORE THE PRECIPITOUS DROP. BUT AT THAT PLATEAU, THIS WAS A VERY URGENT SITUATION WITH HIGH CORONARY HEART DISEASE AND CARDIOVASCULAR DISEASE MORTALITY EXISTING IN THE NATION. FRAMINGHAM COMES ALONG AND IDENTIFIES RISK FACTORS AND CONTINUES RESEARCH THERE ALONG WITH COMPLEMENTARY AND EMPLOYED RESEARCH IN OTHER AREAS OF CARDIOVASCULAR MEDICINE LED TO THAT DECLINE. WELL, WE STAND AT AN INTERESTING JUNCTURE IN THE AFRICAN AMERICAN CARDIOVASCULAR DISEASE EPIDEMIC. WHILE WE LOOK -- IF WE LOOK AT THE DATA IN TOTALITY, YOU WILL SEE IN TERMS OF MORTALITY THAT CARDIOVASCULAR DISEASE MORTALITY FOR THE NATION AGAIN HAS PRECIPITOUSLY DROPPED. THERE'S A TREND DOWNWARD OVERALL FOR AFRICAN AMERICANS AS WELL, BUT FAR BEHIND. NUMBERS TODAY IN MISSISSIPPI ARE COMPARABLE TO NATIONAL— NUMBERS 20 AND 30 YEARS AGO. IF WE LOOK AT A PARTICULAR SUBSET OF CARDIOVASCULAR DISEASE, HEART ATTACKS, MYOCARDIAL INFARCTION, WE SEE A VERY CONCERNING PICTURE. THESE DATA ARE DERIVED FROM THE ARIC STUDY, AND IT LOOKS AT THE INCIDENTS OF FIRST-TIME HEART ATTACKS IN THE POPULATION. IN WHITES, MEN AND WOMEN, WE SEE AGAIN A REFLECTION OF THAT DOWNWARD TREND, THAT IMPORTANT IMPROVEMENT IN CARDIOVASCULAR DISEASE. THIS TIME REPRESENTED BY, AGAIN, MYOCARDIAL INFARCTION. THIS IS WHAT WE'D EXPECT TO SEE. LOOKING AT AFRICAN AMERICANS IN THE ARIC CITIES, WHICH INCLUDE JACKSON; WINSTON-SALEM, NORTH CAROLINA; MINNEAPOLIS, MINNESOTA; AND AN AREA OUTSIDE OF BALTIMORE, MARYLAND, BLACKS PRINCIPALLY FROM JACKSON SHOW AN INCREASE, AN ABSOLUTE INCREASE OVER TIME OF THE RATE OF MYOCARDIAL INFARCTION. THIS, I THINK, IS AN IMPORTANT OBSERVATION. AND IF THERE'S NO OTHER JUSTIFICATION FOR LOOKING CAREFULLY AND COMPREHENSIVELY AT THE HEALTH OF THE AFRICAN AMERICAN POPULATION IN JACKSON AND ELSEWHERE THAN THAT -- I THINK THAT SLIDE MAKES THE CASE. BUT WHAT IS THE JACKSON HEART STUDY? MANY OF YOU KNOW, SO I'LL GO THROUGH THIS SOMEWHAT QUICKLY. FIRST, YOU HEARD IN THE INTRODUCTION THAT IT IS FIRST OF ALL A SISTERHOOD OF HIGHER -- INSTITUTIONS OF HIGHER EDUCATION IN JACKSON: TOUGALOO COLLEGE, JACKSON STATE UNIVERSITY, AND THE STATE'S ONLY ACADEMIC MEDICAL CENTER, THE UNIVERSITY OF MISSISSIPPI MEDICAL CENTER, WORK TOGETHER TO MAKE THE JACKSON HEART STUDY THE JACKSON HEART STUDY. WE ARE SUPPORTED BEAUTIFULLY BY NIMHD AS WELL AS THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE. THESE ARE OUR PRINCIPAL SPONSORS OVER THE LIFE OF THE STUDY. WE HAVE RECENTLY ALSO GAINED SUPPORT FROM THE IMAGING INSTITUTE AS WELL FOR SOME OF THE IMAGES I'LL SHOW YOU SHORTLY. SO, WE HAVE A SISTERHOOD OF LOCAL SCHOOLS. WE HAVE SUPPORT FROM THE NIH. AND WE HAVE A CHARGE THAT IS TO DO SOMETHING IN RESPONSE TO THIS DISPARITY IN CARDIOVASCULAR HEALTH THAT IS PARTICULARLY PROFOUND IN THE SOUTH AND IN JACKSON, MISSISSIPPI. SO, HOW DO WE THEN, WITH ALL OF THAT, TURN THIN PAPER INTO THICK ACTION? AGAIN, HISTORY FANS WILL NOTE THAT THAT'S -- I STOLE THAT FROM MARTIN LUTHER KING. HOW DO WE DO THAT? HOW DID WE DO THAT, PARTICULARLY, GIVEN THE CLIMATE OF THE TIMES? DR. HENDERSON IS HERE, AND SHE TOOK PART IN THE EARLY PHASES OF LOOKING AT THE COMMUNITY AND SEEING IF THEY WOULD ACCEPT, BE A PART OF, A MAJOR STUDY BY THE FEDERAL GOVERNMENT EXCLUSIVELY ON AFRICAN AMERICANS. I WANT TO PUT YOU IN THE CONTEXT OF THE TIME THAT THIS IDEA CAME TOGETHER. IN 1997, PRESIDENT CLINTON ISSUED AN APOLOGY FOR THE TUSKEGEE SYPHILIS STUDY. FROM THAT APOLOGY, THE PEOPLE WHO RAN THE TUSKEGEE STUDY DIMINISHED THE STATURE OF MAN BY ABANDONING THE MOST BASIC ETHICAL PRECEPTS. SO, THIS BRINGS THE TRAGEDY OF THE TUSKEGEE STUDY BACK INTO THE PUBLIC VIEW. IT'S REINTRODUCED FOR EXAMINATION, THOUGHT, CONSIDERATION, BY ALL OF US, ESPECIALLY IN THE AFRICAN AMERICAN COMMUNITY. SO, IT WAS BACK ON THE FRONT PAGE. AND TO FURTHER DRAMATIZE, THERE WERE DRAMATIC INTERPRETATIONS OF WHAT HAPPENED. SOME OF YOU MAY REMEMBER THE HBO SPECIAL STARRING ALFRE WOODARD. THERE WAS ALSO A VERY POPULAR PLAY CALLED "MISS EVERS' BOYS," WHICH TALKED ABOUT THE ABUSES OF THE TUSKEGEE STUDY. THIS WAS 1997. SO, OF COURSE, IN 1998, WE HAD THE IDEA OF THE JACKSON HEART STUDY. MY POINT IS THAT THIS WAS, IN FACT, AN IMPORTANT CONTEXT AND A CHALLENGING CONTEXT TO BEGIN A STUDY, AGAIN, BY THE FEDERAL GOVERNMENT EXCLUSIVELY INVOLVING AFRICAN AMERICANS. AND THE SURVEY THAT WE TOOK AT THE TIME ACTUALLY REFLECTED THAT SOMEWHAT. THIS, AMONG MANY FOCUS GROUPS AND INTERVIEWS AND SURVEYS THAT WERE DONE BEFORE WE BEGAN, SHOWED THAT THERE WAS A LARGE MINORITY OF INDIVIDUALS IN THE COMMUNITY WHO WOULD BE AGE-ELIGIBLE FOR THE JACKSON HEART STUDY WHO HAD SOME FAIRLY DEEP SUSPICIONS. IN GENERAL, MEDICAL RESEARCH TREATS PEOPLE FAIRLY. ONLY ABOUT 60 PERCENT SAID YES. THAT MEANS 40 PERCENT OF THE PEOPLE OUT OF THE BLOCK HAD SOME SERIOUS -- POTENTIALLY VERY SERIOUS RESERVATIONS. AND AMONG THE VERY SERIOUS RESERVATIONS IS THIS MINORITY WHO FELT THAT MEDICAL RESEARCH IS A WAY FOR THE GOVERNMENT TO KEEP BLACK PEOPLE DOWN, 15 PERCENT. THAT'S NOT A LUNATIC FRINGE. THAT'S 15 PERCENT. SO, THIS IS THE ENVIRONMENT THAT WE MARCHED INTO. SO, WHAT DO YOU DO ABOUT THAT? ONE OF THE PARTICIPANTS GAVE US THIS INSIGHT INTO WHERE THEY STOOD: "I'M SUSPICIOUSLY GOING ABOUT THIS BECAUSE THIS IS MY LIFE AND YOU'RE DEALING WITH MY HEART. I DON'T KNOW WHAT YOU INTEND TO DO. YOU ALL LOOK KIND AND GOOD AND RIGHT, BUT YOU NEVER KNOW." SO, CLEARLY, WE HAD TO DO SOMETHING SPECIAL. AND I'LL DESCRIBE SOME OF THAT, BUT LET ME JUST GIVE YOU THE RESULTS. WE WERE SUCCESSFUL IN RECRUITING 5,300 AFRICAN AMERICANS, 5,300-PLUS. AND AT EXAM TWO ABOUT FOUR YEARS LATER, OVER 85 PERCENT OF THOSE SURVIVORS HAVE RETURNED. SO, WE COUNT THAT AS A SUCCESS. AND WHY? I THINK IT REALLY IS EMBEDDED IN THE STRUCTURE OF THE JACKSON HEART STUDY AND THE OVERALL INTENTIONS, MISSION OF THE JACKSON HEART STUDY AND THE MOTIVATION OF THE STAFF AS WELL AS WHAT I'LL CALL THE MOTIVATION OF THE COMMUNITY TO IMPROVE SOME OF THE TOUGH STATISTICS RELATING TO HEALTH. THE JACKSON HEART STUDY REALLY CAN BE SUMMARIZED AS A STUDY THAT DEMONSTRATES A COMMITMENT TO SERVICE, TRAINING, RESEARCH, AND A TRUE COLLABORATION. SO, THIS THEN TAKES US OUT OF THE DESCRIPTOR OF AN EPIDEMIOLOGICAL LONGITUDINAL STUDY. THAT'S VERY IMPORTANT, AND WE'RE VERY PROUD AND FOCUSED ON DOING RIGOROUS SCIENCE TO MEET THAT DESCRIPTION. BUT CLEARLY, THERE'S MORE GOING ON THAN JUST THE STUDY. THIS IS NOT YOUR GRANDFATHER'S EPIDEMIOLOGICAL STUDY. THERE ARE OTHER ASPECTS TO WHAT WE ARE ABOUT IN JACKSON. SO, SERVICE: COMMUNITY PARTICIPATION, USING PRINCIPLES OF COMMUNITY-BASED PARTICIPATORY RESEARCH. WE INVOLVED THE COMMUNITY IN VARIOUS ASPECTS OF WHAT WE DO, EVEN UP TO AND INCLUDING PUBLICATIONS COMMITTEES, STEERING COMMITTEES, AS WELL AS HAVING ETHICS ADVISORY BOARDS -- AN ETHIC ADVISORY BOARD TO HELP US THROUGH SOME OF THE CHALLENGING ISSUES PARTICULARLY RELATED TO GENETICS AND GENETICS RESEARCH. SO, WE ARE A PART OF A COMMUNITY. WE ARE NOT APART FROM THE COMMUNITY. HERE'S A PICTURE OF ONE OUR EVENTS IN THE JACKSON MEDICAL MALL, WHICH IS A UNIQUE FACILITY THAT HOUSES THE JACKSON HEART STUDY. AND THIS -- THANKS TO DR. SHURIN FOR THIS SLIDE -- THIS IS OUR VERY FIRST PARTICIPANT, WHO REPORTS, AGAIN, A VERY POSITIVE ATTITUDE ABOUT THE STUDY. THIS IS NOT ACCIDENTAL. THIS TOOK INTENTION, AND WE ARE CERTAINLY GRATEFUL TO THE VISION OF NHLBI AND NIMHD IN SUPPORTING AND HELPING US AFFORD TO DO THE KIND OF RESEARCH AHEAD OF TIME TO SET UP A VERY POSITIVE INTERACTION WITH THE COMMUNITY. TRAINING. I THINK MOST OF YOU ARE AWARE OF THESE STATISTICS, OR ROUGHLY AWARE, THAT MINORITIES, ALTHOUGH THEY MAKE UP 28 PERCENT OF THE U.S. POPULATION, ARE ONLY THREE PERCENT OF MEDICAL SCHOOL FACULTY. ONLY SEVEN PERCENT OF PHYSICIANS ARE MINORITIES, AND 16 PERCENT OF PUBLIC HEALTH SCHOOL FACULTY, AND 17 PERCENT OF ALL CITY AND COUNTY HEALTH OFFICERS. NINETY-EIGHT PERCENT OF SENIOR LEADERS IN HEALTH CARE ARE WHITE. AND THOSE OF YOU IN HERE ARE VERY FAMILIAR, I'M SURE, WITH THE GINTHER PUBLICATION IN SCIENCE THAT SHOWED THAT WITH THE LOW LEVEL OF FUNDING IN TERMS OF R01S FOR AFRICAN AMERICAN SCIENTISTS. A LOT OF THIS LOOKS LIKE IT MAY STAY THE SAME UNLESS THERE ARE SPECIAL EFFORTS PUT FORTH. OUR RESPONSE TO THOSE STATISTICS INCLUDES WHAT IS HAPPENING AS A PART OF THE JACKSON HEART STUDY, BUT BASED AT TOUGALOO COLLEGE, WHICH IS ONE OF THE THREE SISTER SCHOOLS I MENTIONED EARLIER. THIS IS JUST A GROUP PHOTO OF ONE OF THE CLASSES OF FRESHMEN AT TOUGALOO WHO WENT THROUGH THE SCREENING PROCESS TO BECOME WHAT'S CALLED JACKSON HEARTY STUDY SCHOLARS, ALLOWING THEM TO RECEIVE STIPENDS FROM SCHOLARSHIP SUPPORT AND SPECIAL EXPOSURE TO THE SCIENCES OF PUBLIC HEALTH, OF BIOETHICS, AS WELL AS BEING INVOLVED WITH SOME TRULY UNIQUE MENTORS FROM AROUND THE WORLD. THEY MAKE AN ANNUAL VISIT TO THE NIH CAMPUS AND SPEND TIME GOING FROM INSTITUTE TO INSTITUTE. I DON'T HAVE IT HERE, BUT A LOVELY PICTURE WITH DR. SHURIN AND OTHERS ON ONE OF THOSE VISITS. BUT, BESIDES THOSE SCHOLARS, WE ALSO TAKE FULL ADVANTAGE OF THE MINORITY SUPPLEMENT AWARD, AND WE ALSO REACH DOWN INTO THE HIGH SCHOOLS WITH SUMMER PROGRAMS THAT ARE CONCENTRATED ON IMPROVING AND ENRICHING SCIENCE, LANGUAGE, AND MATH SKILLS SUCH THAT WE HAVE MORE CANDIDATES FOR BIOMEDICAL PURSUITS IN COLLEGE. I MENTIONED DIVERSITY SUPPLEMENTS, AND JUST ABOUT EVERYBODY PICTURED HERE IS A RECIPIENT. THIS IS OUR PROJECT OFFICER. CHERYL [SPELLED PHONETICALLY] HASN'T RECEIVED ONE OF THESE. SHE WORKS WITH US IN A VERY IMPORTANT WAY AND HAS BEEN A STAUNCH SUPPORTER OF US OVER THE YEARS. BUT THIS IS NOT ALL OF OUR DIVERSITY SUPPLEMENT AWARDEES, BUT THIS GIVES YOU A SAMPLE OF THE CURRENT CLASS AND THE DIVERSITY -- SOME FROM JSU, SOME FROM THE MEDICAL CENTER, ALL OF THE TOUGALOO SCHOLARS I'VE ALREADY MENTIONED, AND, IN ADDITION TO THAT, THERE ARE ALSO DIVERSITY AWARDEES AT TOUGALOO. BUT THE PIPELINE DOESN'T STOP THERE. THIS IS A GROUP OF ACTUALLY ALL MEN IN THIS PARTICULAR SLIDE WHO ARE AT A RESIDENT OR FELLOW LEVEL, WHO ARE CONTRIBUTING SCIENTIFICALLY TO THE WORK OF THE JACKSON HEART STUDY. EACH AND EVERY ONE OF THEM HAS PRESENTED NATIONALLY. SEVERAL OF THEM ARE PUBLISHED AND SOME ARE REMOTE, LIKE DR. BELFORD AT WAKE FOREST, WHO IS PARTICULARLY INTERESTED IN BIOMARKERS AND THE METABOLIC SYNDROME. SO, ALL OF THIS AND MORE, SOME OF OUR K AWARDEES. AGAIN, A GRADUATE -- SHE'S NO LONGER -- SHE'S ASSOCIATE PROFESSOR BY NOW, I THINK. AND SO IS ERVIN [SPELLED PHONETICALLY] BUT THESE ARE -- ALL THESE PEOPLE HAD K AWARDS TIED TO THE JACKSON HEART STUDY, AND THERE ARE HOPEFULLY MANY MORE TO COME. SO, TRAINING OBVIOUSLY IS SOMETHING THAT IS IMPORTANT. WE'RE DOING THIS, AGAIN, IN THE DEEP SOUTH, BUT WE'RE REACHING OUT TO OTHER INSTITUTIONS ACROSS THE COUNTRY, PARTICULARLY INTERESTING -- PARTICULARLY BEING INTERESTED IN THE TRAINING OF UNDERREPRESENTED MINORITIES. SO, WHAT ABOUT RESEARCH? WE'VE DONE ALL OF THAT TALKING ABOUT AREAS THAT YOU DON'T TYPICALLY EXPECT TO HEAR WHEN YOU COME INTO A TALK ABOUT AN WE'LL JUST TAKE A COUPLE OFL, EXAMPLES. LOOKING AT ADIPOSITY AND RISK, I THINK EVERYBODY'S SEEN THESE TYPES OF SLIDES AD NAUSEAM, AND THEY TELL THE MISERABLE STORY OF EXCESS OBESITY AMONG AFRICAN AMERICANS IN THE SOUTH IN PARTICULAR, WITH MISSISSIPPI BEING RIGHT THERE BETWEEN ALABAMA AND LOUISIANA. AND THEY'RE IN A DEAD HEAT FOR WHO'S GOING TO BE THE WORST, BUT MISSISSIPPI CURRENTLY WEARS THE CROWN UNFORTUNATELY. AND IF WE DO A DIRECT COMPARISON WITH ONE OF OUR SISTER STUDIES, THE FRAMINGHAM STUDY, YOU SEE THE EXPECTED PREVALENCE RATES. THAT IS, IF YOU LOOK AT BMI AS A MEASURE OF ADIPOSITY AND LOOK AT NORMAL BMIS, YOU SEE THAT THREE TIMES AS FREQUENTLY FRAMINGHAM PARTICIPANTS ARE SEEN -- ARE IN THE NORMAL RANGE, 37 PERCENT VERSUS 12. IF YOU LOOK AT STAGE 2 OBESITY, SO, THE SUPER HEAVYWEIGHTS -- ALTHOUGH, UNFORTUNATELY IN JACKSON, WE ALSO HAVE A WHOLE OTHER CATEGORY OUT HERE FOR OBESITY -- YOU SEE, AGAIN, THREE TIMES THE PREVALENCE OF AFRICAN AMERICANS FROM JACKSON IN THAT SUPER HEAVYWEIGHT CATEGORY. THAT PERHAPS IS NO GREAT SURPRISE. THIS TOO MAY NOT BE A SURPRISE. IT'S A SOMEWHAT COMPLICATED SLIDE, BUT GIVE ME JUST A MOMENT TO HELP YOU WALK THROUGH IT. EACH OF THE PAIRS OF BARS REPRESENT BMI CATEGORIES. THE FIRST, THE LEADING PAIR IN EACH CLUSTER REPRESENTS NORMAL BMI, OKAY. THE NEXT PAIR REPRESENTS OVERWEIGHT, OKAY. YOU SEE SOME OF THE STANDARD CARDIOVASCULAR RISK FACTORS ARRAYED ON THIS AXIS. IF WE LOOK AT EACH CLUSTER, THE GENERAL TREND IS THAT AT EVERY BMI. AFRICAN AMERICANS HAVE HIGHER LEVELS OF RISK, HIGHER LEVELS OF THE CLASSICAL RISK FACTORS. THE POSSIBLE EXCEPTION IS HIGH TRIGLYCERIDE, BUT, IN EVERY OTHER INSTANCE, THE DIFFERENCES ARE CLEAR. HDL IS PRETTY CLOSE IN SOME OF THE LARGER WEIGHT CLASSES, BUT AFRICAN AMERICANS HAVE THIS DISADVANTAGE APPARENTLY NO MATTER WHAT BMI CATEGORY THEY'RE IN. AND IF YOU LOOK EXCLUSIVELY AT NORMAL -- THIS IS THE SAME SLIDE WITH A WHOLE LOT OF THE NOISE REMOVED -- THESE ARE ALL NORMAL. YOU SEE THE INCREDIBLE INCREASE IN RISK, AGAIN, EXCEPT FOR HIGH TRIGLYCERIDES, AMONG AFRICAN AMERICANS. THE PREVALENCE OF THESE BEING OUT OF RANGE, THREE TIMES -- THREE TIMES THE PREVALENCE OF DIABETES AMONG NORMAL AFRICAN AMERICANS VERSUS NORMAL WHITES IN FRAMINGHAM, THREE TIMES THE RATE OF HYPERTENSION. ALL OF THIS IS VERY IMPORTANT AND CURIOUS. THERE IS NO OBVIOUS REASON WHY THAT SHOULD BE. WHY SHOULD PEOPLE WHO LOOK THE SAME IN TERMS OF THEIR BMI BE AT SUCH VASTLY DIFFERENT RISK FOR THESE CLASSICAL RISK FACTORS? WELL, PART OF THE ANSWER MIGHT BE THAT FAT, WE KNOW, IS DISTRIBUTED DIFFERENTLY IN DIFFERENT PEOPLE. AND WE'RE ALL FAMILIAR WITH THE PEAR- AND THE APPLE-SHAPED ANALOGIES. BUT IT'S A LOT MORE SUBTLE THAN THAT. THERE ARE ECTOPIC DEPOTS OF FAT THAT ALL OF YOU ARE FAMILIAR WITH THAT OCCUR IN VARIOUS PARTS OF THE BODY. FROM THE LIVER, FROM AROUND THE VISCERA OF THE ABDOMEN, THE PERICARDIUM, THE KIDNEY, EVEN INTRAMYOCARDIALLY, THERE CAN BE FAT DEPOSITS. AND THE QUESTION IS: DOES THAT ADD TO THE HETEROGENEITY OF RISK? WHY ARE SOME PEOPLE WITH A BMI OF 18 AT GREATER RISK THAN OTHERS WITH A BMI OF 18? WELL, THIS IS SOMETHING THAT WE'RE PARTICULARLY INTERESTED IN AT JACKSON HEART STUDY. AND PART OF WHAT WE DID IN OUR SECOND EXAMINATION WAS TO DO ABDOMINAL CTS ON ALL OF THOSE WHO -- ALL OF THOSE PARTICIPANTS WHO VOLUNTEERED. AND THIS WAS APPROXIMATELY 2,400 INDIVIDUALS WHO VOLUNTEERED FOR THE ABDOMINAL CT. PART OF THAT CT SCAN WAS ALSO A CARDIAC CT TO LOOK FOR CORONARY CALCIUM -- ANOTHER WAY, OF COURSE, TO LOOK AT RISK FOR CORONARY EVENTS. AND A LOT OF PEOPLE WERE INTERESTED IN GOING THROUGH BOTH THESE TESTS. SO, WE CAN, WITH CT SCANNING, LOOK AT THE DISTINCTION OR DISTINCT PHENOTYPES AND JUDGE THE LEVEL OF SUBCUTANEOUS FAT VERSUS THE LEVEL OF VISCERAL FAT. AND LIKE SO MANY OTHER INVESTIGATIONS, WE ARE FINDING THAT VAT, VISCERAL FAT, VISCERAL ADIPOSITY, IS TIED TO INCREASED ODDS OF THE DEVELOPMENT OF HYPERTENSION, DIABETES, HIGH TRIGLYCERIDES, LOW HDL CHOLESTEROL, AND METABOLIC SYNDROME. AND METABOLIC SYNDROME SORT OF JUMPS OUT IN TERMS OF ITS LEVEL OF RISK, BUT ALL OF THEM ARE, WITH THE POSSIBLE EXCEPTION HERE, SHOW AN INCREASED ODDS BASED ON THE LEVEL OR THE VOLUME OF FAT ADHERING TO ABDOMINAL VISCERA. TAKING IT FURTHER, THE VISCERAL FAT HAS ITS IMPACT PRIMARILY IN A SYSTEMIC WAY, CHANGING LEVELS OF CARDIAC -- CARDIOVASCULAR RISK FACTORS. THERE ARE SOME FAT DEPOTS THAT HAVE THEIR PRINCIPLE IMPACT IN A MUCH MORE LOCALIZED WAY, WE THINK. AND WITH, AGAIN, WITH THE CT SCANS, WE CAN LOOK DIRECTLY AT PERICARDIAL FAT DEPOSITS. AND EARLY EVIDENCE SUPPORTS THE NOTION THAT ECTOPIC -- THAT PERICARDIAL ADIPOSITY PROMOTES THE DEVELOPMENT OF ATHEROSCLEROSIS AND HEART FAILURE. THIS ANALYSIS LOOKS AT CORONARY CALCIFICATION AS A SUBCLINICAL MANIFESTATION OF CORONARY DISEASE. AND AGAIN, YOU SEE THIS MODEL BASICALLY TELLS US THAT, AFTER MULTIPLE ADJUSTMENTS, THE RISK OF CORONARY ARTERY CALCIFICATION IS SIGNIFICANTLY HIGHER WITH INCREASING LEVELS OF PERICARDIAL FAT, SUGGESTING A LOCAL EFFECT ON THE LARGE EPICARDIAL VESSELS THAT SUPPLY THE HEART. AND, AGAIN, IT APPEARS TO BE A LOCALIZED EFFECT BECAUSE, IF YOU LOOK AT THE SAME INDIVIDUAL'S AORTA, YOU SEE NO INCREASE IN CALCIFICATION OVER CONTROLS. SO, THIS IS AN IMPORTANT -- IT GOES BACK TO THE NOTION, IT SUPPORTS THE NOTION THAT THERE ARE FAT DEPOTS THAT HAVE SYSTEMIC IMPACT AND OTHERS THAT HAVE LOCAL IMPACT, BUT THAT LOCAL IMPACT CAN BE QUITE IMPORTANT IF IT INVOLVED THE CIRCULATION TO THE MYOCARDIAL. SO, IN SUMMARY OF SOME OF THE WORK THAT'S GOING ON WITH THE FAT DISTRIBUTION IDEA -- THAT IS, THAT DIFFERENCES IN ECTOPIC FAT DEPOSITION CAN HELP EXPLAIN SOME OF THE HETEROGENEITY WE SEE IN RISK RELATED TO BMI, VAT, PERICARDIAL ADIPOSE TISSUE DOES HAVE AN ASSOCIATION WITH LOCAL CORONARY ARTERY CALCIFICATION, AGAIN, NOT SEEING ANY MORE REMOTE CIRCULATORY -- MORE REMOTE CIRCULATORY BEDS. THE BOTH VISCERAL FAT AND I DIDN'T SHOW SLIDES FOCUSING ON SUBCUTANEOUS FAT, BUT BOTH OF THEM ARE ASSOCIATED WITH ADVERSE CARDIOMETABOLIC RISK FACTORS. BUT VAT IS THE WINNER IN TERMS OF BEING MOST STRONGLY ASSOCIATED. AND FATTY LIVER -- OH, I DIDN'T SHOW DATA ON THIS EITHER FOR THE SAKE OF TIMEWz BUT OUR EARLY FINDINGS WITH FATTY LIVER SHOWED THAT, EVEN AFTER ADJUSTING FOR VISCERAL FAT, FATTY LIVER HAS A PARTICULAR INDEPENDENT LEVEL OF RISK THAT IS ASSOCIATED WITH HEAVY FAT DEPOSITION IN THE LIVER. WE ALSO LOOK AT SOCIAL DETERMINANTS. THIS IS -- I'VE HEARD IT DESCRIBED THAT SOME OF THE THINGS THAT WE DO, LIKE CT SCANS AND MRIS, ALL RELATE TO VERY HARD SCIENCE, THE VERY HARD SCIENCE. THE RESPONSE THAT I HEARD FROM A SOCIAL SCIENTIST WAS THAT, WELL, IF THAT'S HARD SCIENCE, SOCIAL SCIENCE IS EVEN HARDER. AND I WOULD TEND TO AGREE. WE ARE LOOKING AT THIS TYPE OF RISK AND WHAT IT MEANS IN A VARIETY OF MANIFESTATIONS OF DISEASE. THIS WOULD JUST BE SORT OF A LAUNDRY LIST OF SOME OF THE AREAS THAT ARE -- WE ARE PUBLISHING IN AND HOPE TO PUBLISH MORE. SO, THE PAPER PICTURE HERE LOOKS AT SOCIOECONOMIC STATUS AND CHRONIC KIDNEY DISEASE AMONG AFRICAN AMERICANS. THE OTHER AUTHORS HERE FOCUS ON THINGS LIKE FAST FOOD RESTAURANTS AND CALORIC INTAKE -- LET'S SEE -- SOCIAL POSITION, AND THE NIGHTTIME DIPPING OF BLOOD PRESSURE. AS YOU ALL KNOW, ALL OF OUR BLOOD PRESSURES ARE SUPPOSED TO GO DOWN DURING SLEEP. WHAT DR. HICKSON FOUND HERE IS THAT THAT HAPPENS FOR THOSE OF US WHO ARE ECONOMICALLY WELL OFF. IT HAPPENS LESS FREQUENTLY FOR THOSE OF US WHO ARE IN THE POOR CATEGORY. PERHAPS NOT A SURPRISE, BUT AN IMPORTANT FINDING, IS THAT THIS NON-DIPPING PROBLEM HAS BEEN TIED TO THINGS LIKE CHRONIC KIDNEY DISEASE, WHICH IS EPIDEMIC IN THE AFRICAN AMERICAN POPULATION. AND THERE THE LIST CONTINUES AND SOME OF THE OTHER IMPORTANT LINES OF INVESTIGATION. SO, LOOK FOR PUBLICATIONS IN THESE AREAS SOON. ACTUALLY,x THIS IS ALREADY PUBLISHED, "PERCEIVED DISCRIMINATION AND HYPERTENSION," WHICH FOUND A LINK BETWEEN LIFETIME LEVELS OF PERCEIVED DISCRIMINATION AND LIKELIHOOD FOR HIGH BLOOD PRESSURE. LET'S SEE, AND DISCRIMINATION -- AGAIN, PERCEIVED DISCRIMINATION HAS AN IMPACT ON HOW PEOPLE WILL BEHAVE AND WHETHER THEIR BEHAVIORS ARE ADVERSE IN TERMS OF WHAT WILL HAPPEN TO THEIR CARDIOVASCULAR SYSTEM. THE MORE A PERSON FEELS DISCRIMINATED AGAINST, THE MORE THEY'LL ENGAGE IN UNHEALTHY BEHAVIORS IS THE LONG AND SHORT OF THAT. AND WE'RE LOOKING ALSO, BEGINNING TO LOOK AT DIET [SPELLED PHONETICALLY] QUALITY RISK AND OUTCOMES WITH DR. LIU [SPELLED PHONETICALLY]. AND THIS IS DR. BRUCE'S [SPELLED PHONETICALLY] PSYCHOSOCIAL/BIOLOGICAL MODEL OF CKD. I WILL WALK YOU THROUGH THIS. I WILL SAY, THOUGH, LOOKING UPSTREAM FROM THE USUAL FOCUS -- HYPERTENSION, DIABETES, AND OBESITY -- DR. BRUCE'S MODEL INTEGRATES ALL OF THESE, AND HE IS SYSTEMATICALLY WALKING THROUGH HOW THINGS MECHANISTICALLY MIGHT BE RELATED IN THIS WEB OF CAUSALITY. SO, IT'S NOT JUST HYPERTENSION, DIABETES, AND OBESITY. IT'S MUCH MORE COMPLICATED THAN THIS, AND ONE OF THE EFFORTS THAT THE JACKSON HEART STUDY IS PUTTING FORTH IS TO TRY TO TEASE OUT AS MUCH OF THAT AS WE CAN, AGAIN, TO CREATE AN EVIDENCE BASE FOR EFFECTIVE INTERVENTION. THAT HAS TO BE THE END GAME. I WON'T GO INTO THE NOW NUMEROUS PUBLICATIONS IN GENETICS EXCEPT TO SAY THAT THESE ARE OFTEN DONE IN THE CONTEXT OF OUR PARTICIPATION IN LARGE CONSORTIA, AND WE'RE VERY PROUD OF THE PRODUCTIVITY THAT IS COMING OUT OF THOSE COLLABORATIONS. THE SCIENTIFIC PRODUCTIVITY IS WE'RE FINALLY HITTING OUR STRIDE IN THE JACKSON HEART STUDY, SO LAST YEAR WITH 35 MANUSCRIPTS IN A VARIETY OF AREAS, A HOST OF ANCILLARY STUDIES ONGOING, AND OBVIOUSLY MORE SUBMISSIONS THAN ACTUAL GRANTS -- BUT QUITE AN IMPRESSIVE ARRAY, INCLUDING A NEW SECOND- AND THIRD-GENERATION PILOT TO LOOK AT EARLY INDICATORS OF DISEASE IN A VERY VULNERABLE POPULATION. SO, I WILL DESCRIBE THEN ANOTHER PART OF WHAT I THINK MAKES THE JACKSON HEART STUDY SPECIAL, AND THAT IS -- THAT IT IS INDEED A COLLABORATION LOCALLY AND NATIONALLY AND EVEN BEYOND THAT. FOUR ASPECTS: WORKING GROUPS, WHAT WE CALL OUR VANGUARD CENTERS, THE RECENT RFA THAT IS AIMED AT TARGETED ANALYSIS GROUPS, AND OUR GENETIC CONSORTIA WHICH I'VE ALREADY ALLUDED TO. THE WORKING GROUPS ARE A FAIRLY STRAIGHTFORWARD CONCEPT ALTHOUGH IT HAS TAKEN LOTS OF EFFORT AND CREATIVITY TO ACTUALLY BRING SEVERAL OF THEM ONLINE. THIS IS A NATIONAL LEVEL; THIS IS NOT LOCAL. THIS IS A NATIONAL LEVEL OUTREACH. LOCALLY, WE OBVIOUSLY HAVE SCIENTISTS INVOLVED. BUT WE ALSO ARE ENGAGED IN THE COORDINATION OF THE WORKING GROUPS. PARTICULARLY LOGISTICS AND WEBSITES, ANALYTICAL SUPPORT, AND THE ESTABLISHMENT OF THESE NEAT WEBSITE HOMES THAT OUR STATISTICIAN ANALYST DR. MIKE GRISWOLD ACTUALLY INTRODUCED ME TO, WHERE HE HAS HELPED SET UP WEB HOMES FOR THE GROUPS. SO, IN THIS INSTANCE, WE HAVE THE PSYCHOSOCIAL WEB GROUP. THERE'S ONE FOR IMAGING. AND WITH THAT, IF YOU, SAY, ARE SOMEONE WHO'S JOINING THE GROUP AND IT'S BEEN OPERATING FOR AWHILE -- JUST AS AN EXAMPLE OF HOW USEFUL THIS CAN BE -- YOU CAN CLICK AND PULL UP THIS EXPANDED PAGE THAT TELLS YOU A LITTLE BIT MORE ABOUT WHAT'S AVAILABLE ON THE ANALYSIS THAT'S GOING ON IN SUPPORT OF THIS MANUSCRIPT, PO251 ON PERICARDIAL FAT AND LV STRUCTURE AND FUNCTION. YOU SEE THE PI LISTED. YOU SEE THE ANALYST IDENTIFIED. YOU SEE THE JACKSON HEART STUDY LIAISON -- BECAUSE DR. CARR, FOR INSTANCE, IS AT WAKE FOREST. SO, HIS LIAISON IS DR. GRISWOLD. YOU SEE VARIOUS LEVELS OF DETAIL OF THE ANALYSIS, AND THE RESULTS ARE ALSO AVAILABLE TO YOU AS A MEMBER OF THE WORKING GROUP. SO, THIS IS SET UP IN ORDER TO MAKE THE JACKSON HEART STUDY A TRUE NATIONAL RESOURCE TO PEOPLE INTERESTED IN THIS TYPE OF WORK WHETHER YOU'RE IN JACKSON OR BIRMINGHAM OR LOS ANGELES OR BETHESDA. THE VANGUARD CENTER CONCEPT -- THIS IS A LENGTHY SLIDE. I'LL JUST SAY THAT THE IDEA HERE IS TO ESTABLISH FIRM TIES WITH OUTSIDE COLLABORATORS AT VARIOUS INSTITUTIONS WHEREBY -- AFTER GOING THROUGH, JUMPING THROUGH THE REGULATORY RED TAPE -- THESE INSTITUTIONS THEN GET THE SAME DATA THAT WE GET IN JACKSON. THEY GET ACCESS TO THE DATABASE THAT IS PARTICULARLY EASY, PARTICULARLY WELL MANAGED. YOU GET ATTENTION IN TERMS OF STATISTICIANS AND ANALYSTS TALK TO EACH OTHER ABOUT WHAT ALL THE VARIABLES MEAN. YOU KNOW, THEY ARE AVAILABLE TO BE SURE THAT THE WORK YOU'RE TRYING TO DO ON BEHALF OF THESE INDIVIDUALS, THAT WE'RE TRYING TO HELP THROUGH THE JACKSON HEART STUDY, THAT THAT WORK GOES ON UNIMPEDED. IT IS A CATALYST FOR SCIENTIFIC PRODUCTIVITY. NOW, SO FAR, WE'VE ESTABLISHED 15 OF THESE. AND THERE ARE FOUR OTHERS WHO ARE INTERESTED. AGAIN, DATA ACCESS IS THE MAIN FEATURE. THEIR DELIVERABLES ARE TWO PAPERS ANNUALLY TO ADD TO THE PRODUCTIVITY OF THE JACKSON HEART STUDY AND TO CONSTRUCT ONE ANCILLARY STUDY PROPOSAL PER YEAR. AND THERE ARE MEETINGS OBVIOUSLY, AND THE SUPPORT MODEL WAS SOMETHING THAT WE ARE -- IS SOMETHING THAT WE'RE WORKING ON. THE CHALLENGE IS HAVING FUNDS TO SUPPORT INDIVIDUALS AT THESE VARIOUS SITES TO GIVE DEDICATED TIME. THE ONES WHO ARE DOING IT SO FAR, THROUGH THE VANGUARD CENTER, ARE REALLY DOING IT BECAUSE OF SCHOLARLY INTEREST AND OPPORTUNITIES FOR SCIENTIFIC ADVANCEMENT, PUBLICATION, AND SO FORTH. BUT A NEW DEVELOPMENT, THE RECENT RFA THAT I'LL PUT UP IN JUST A SECOND, ACTUALLY TAKES THIS CONCEPT AND REALLY FLESHES IT OUT IN TERMS OF FUNDING PEOPLE AT THEIR HOME INSTITUTIONS TO DO WORK ON THE JACKSON HEART STUDY IN CRITICAL AREAS. AND HERE'S THE ANNOUNCEMENT, AND JANE IS AVAILABLE FOR QUESTIONS. SHOULD I IDENTIFY YOU? DR. JANE HARMAN IS HERE, AND SHE CAN GIVE YOU DETAILED RESPONSES TO ANY QUESTIONS THAT ANY OF YOU MIGHT HAVE. BUT ITS FOCUS IN THESE AREAS, AND THE IDEA IS TO NOT ONLY STIMULATE GREATER, BROADER INTEREST IN THE JACKSON HEART STUDY BUT TO SUPPORT THAT IN A MEANINGFUL WAY SO THAT PEOPLE ACTUALLY PRIORITIZE THIS WORK AND GET IT DONE. I MENTIONED GENETIC CONSORTIA. I WILL NOT GO INTO GREAT DETAIL HERE EXCEPT TO SAY THERE ARE SEVERAL THAT ARE ACTIVE AND ARE SCIENTIFICALLY PRODUCTIVE. SO, THERE'S A LOT GOING ON. THE JACKSON HEART STUDY IS NOT AN EPIDEMIOLOGICAL STUDY IN THE SENSE THAT YOU HAVE HEARD IN THE PAST. IT ENDEAVORS TO DO SOMETHING MUCH MORE AUDACIOUS, MUCH MORE BOLD, I THINK. THAT IS TO REACH BEYOND THE SCIENCE; TO USE THE SCIENCE AS A PLATFORM FOR THE ESTABLISHMENT OF SERVICE TO THE COMMUNITY; TRAINING FOR UNDERREPRESENTED MINORITIES PRIMARILY, BUT ALSO PEOPLE WHO ARE NOT UNDERREPRESENTED MINORITIES; FOR A COLLABORATION THAT IS NOT FOCUSED ENTIRELY IN JACKSON BUT TAKES ADVANTAGE HOPEFULLY OF THE ENTIRE SCIENTIFIC COMMUNITY WHO MAY HAVE AN INTEREST IN DISPARITIES WORK -- BUT EVEN MORE BROADLY, WHO ARE INTERESTED IN ANYTHING THAT THREATENS CARDIOVASCULAR HEALTH. WE FEEL THAT WORKING IN JACKSON, WORKING WITH THE JACKSON HEART STUDY MAKES A LOT OF SENSE WHETHER YOU ARE FOCUSED ON AFRICAN AMERICAN HEALTH OR HEALTH IN GENERAL. IT'S SORT OF LIKE SUTTON'S LAW. EVERYBODY KNOWS -- EVERYBODY KNOWS SUTTON'S LAW, WILLIE SUTTON, THE BANK ROBBER, RIGHT, WAS ASKED, "WHY DO YOU ROB BANKS?" WHAT'S THE ANSWER? [LAUGHTER] "BECAUSE THAT'S WHERE THE MONEY IS." NOW, IN JACKSON, IN THE SOUTH, WHEN IT COMES TO CARDIOVASCULAR DISEASE, THERE'S AN OVERABUNDANCE. THERE ARE UNANSWERED QUESTIONS. THERE'S AN UNCHECKED EPIDEMIC. SO, IT MAKES SENSE TO WALK INTO THAT ENVIRONMENT, TO WALK INTO THAT MILIEU AND TRY TO UNDERSTAND WHAT THINGS PUT THE POPULATIONS AT PARTICULARLY GREAT RISK. NOT ONLY WILL WE GET INSIGHTS FOR THAT POPULATION, BUT, JUST AS IN THE FRAMINGHAM EXAMPLE, WE EXPECT THAT OUR INCREASING INSIGHT WILL BENEFIT PEOPLE WHO ARE NOT SELF-DESCRIBED AS AFRICAN AMERICAN. WHAT ARE SOME OF OUR FUTURE SCIENTIFIC DIRECTIONS? WELL, THIS MAY BE A LITTLE WORDY, BUT IT SOMETIMES TAKES THAT TO ARTICULATE SOME VERY IMPORTANT CONCEPTS. SO, WHAT WE HOPE TO DO GOING FORWARD IS TO PROVIDE A BETTER UNDERSTANDING OF THE INDEPENDENT AND JOINT EFFECTS OF LIFESTYLE, PSYCHOSOCIAL, NUTRITION, GENETICS, ET CETERA, SUCH THAT WE THEN ELUCIDATE THE MODIFIABLE RISK IN A POPULATION THAT CONTINUES AT EXTRAORDINARY RISK AND FOR OTHERS, AS I'VE JUST STATED, SO WE CAN PRODUCE AN EVIDENCE BASE FOR THE DEVELOPMENT AND IMPLEMENTATION OF EFFECTIVE INTERVENTIONS FOR THIS POPULATION, A HUGE AMERICAN DEMOGRAPHIC, HUGELY IMPORTANT TO DO. HERE'S AN EXAMPLE OF THAT. SOME PRELIMINARY DATA LOOKS AT, IN THE JACKSON HEART STUDY, HOW CLOSE ARE PEOPLE ADHERING TO THE RECOMMENDATIONS OF THE DASH EATING PLAN. I THINK MOST OF YOU ARE FAMILIAR WITH THE DASH EATING PLAN. IF NOT, GIVE ME A NOD. OKAY, THERE ARE SOME PEOPLE WHO ARE SHAKING THEIR HEADS. SO, THE DASH EATING PLAN IS AN APPROACH TO CONTROLLING HIGH BLOOD PRESSURE THAT IS BASED ON DIET. AND WHAT LARRY APPEL AND HIS LONG LIST OF CO-INVESTIGATORS FOUND IS THAT BY FEEDING PEOPLE CERTAIN FOODS -- NOT SPECIAL SUPPLEMENTS, NOT DRUGS, NOT SPECIAL EXERCISE PROGRAMS, JUST FEEDING THEM CERTAIN FOODS IN THE SAME CALORIC AMOUNTS AS THEY NORMALLY TAKE IN -- THAT YOU COULD DROP THEIR BLOOD PRESSURE. THIS IS NOT TIED TO WEIGHT LOSS. AND AGAIN, IT WASN'T TIED INITIALLY TO EVEN SODIUM RESTRICTION -- JUST FOODS THAT WERE HIGH IN POTASSIUM, HIGH IN CALCIUM, LOW IN FAT, HIGH IN FIBER. THAT COMBINATION ITSELF DROPPED BLOOD PRESSURE. AND ACTUALLY, IT WAS PARTICULARLY PROFOUND IN THE AFRICAN AMERICAN SUBGROUP. NOW, THESE WERE OBVIOUSLY HIGHLY CONTROLLED CIRCUMSTANCES. YOU WERE GETTING YOUR MEALS HANDED TO YOU, SO PEOPLE CONTROLLED THE INTAKE VERY WELL. ANYWAYS, SO, WITH THAT, THEY PROVED THE CONCEPT THAT FOOD SELECTION, PARTICULARLY OUT OF THOSE CATEGORIES, COULD HAVE IMPORTANTLY SALUTARY EFFECTS ON CARDIOVASCULAR HEALTH. HOWEVER, HOW MANY PEOPLE ARE DOING IT? HOW MANY AFRICAN AMERICANS ARE DOING IT? THAT'S THE QUESTION. AND WHY THE SLOW UPTAKE? WELL, WE LOOKED AT HOW MANY PEOPLE -- IN QUINTILES, WE LOOKED AT OUR POPULATION AND SAW HOW CLOSELY PEOPLE WERE ON THEIR OWN ADHERING TO THE PRINCIPLES OF THE DASH DIET AND HOW THAT RELATED TO THE INCIDENCE OF METABOLIC SYNDROME. AND WHAT YOU SEE IS A DIET ORIGINALLY DESIGNED TO LOOK AT CONTROL OF HIGH BLOOD PRESSURE ACTUALLY HAS AN IMPACT APPARENTLY ON THE DEVELOPMENT OF METABOLIC SYNDROME, WHICH IS A LOT MORE THAN BLOOD PRESSURE. SO, THE CLOSER YOU WERE TO THE DASH IDEAL, THE LOWER YOUR RISK OF DEVELOPING METABOLIC SYNDROME. SO, THERE'S AN EMERGING OBSERVATION THAT SAYS -- THAT POINTS TO A SPECIFIC INTERVENTION AND A LOOK AT DIET QUALITY MAY ACTUALLY, IN THIS POPULATION, HAVE AN IMPORTANT POSITIVE EFFECT ON CARDIOVASCULAR RISK. THE QUESTION IS: HOW DO YOU DESIGN SOMETHING THAT PEOPLE WILL ACTUALLY DO? HOW DO YOU DISSEMINATE THAT? HOW DO YOU TEST IT IN AN APPROPRIATE POPULATION AND SCALE IT UP HOPEFULLY FOR COMMUNITY ADOPTION? SO, THE JACKSON HEART STUDY WANTS TO FIGURE LARGELY IN THAT FUTURE. OKAY, ANOTHER DIRECTION. BY STUDYING EARLY MARKERS OF DISEASE, SUCH AS CARDIAC STRUCTURE AND FUNCTION, NOVEL BIOMARKERS, ET CETERA, THE JACKSON HEART STUDY INTENDS TO HELP IDENTIFY PRECLINICAL MANIFESTATIONS IN CELLULAR DISEASE THAT MAY BE REVERSIBLE OR MORE AMENABLE TO INTERVENTION. AN EXAMPLE OF THAT, IN TERMS OF OUR DATA GATHERING, NOW COULD BE FOUND IN OUR CARDIAC MRI EXAMINATION. THIS JUST DESCRIBES HOW MANY PEOPLE WE'VE EXAMINED TO DATE; IT'S A LITTLE MORE THAN THAT RIGHT NOW. THIS GIVES US A COMPREHENSIVE MEASURE OF CARDIAC FUNCTION, INCLUDING A CONCEPT CALLED STRAIN, WHICH IS AVAILABLE MOST ACCURATELY THROUGH MRI ASSESSMENT. AND WE THINK THAT ABNORMAL LEVELS OF STRAIN ARE THE EARLIEST PREDICTOR OF RISK FOR THE DEVELOPMENT OF HEART FAILURE. SO, WE CAN THEN TIE STRAIN TO SOME EARLY RISK FACTORS, SAY STRAIN AND NIGHTTIME DIPPING, STRAIN AND SLEEP ABNORMALITIES, ET CETERA. WE CAN THROUGH THIS EXQUISITE ACCUMULATION OF DETAILED DATA THAT'S UNAVAILABLE IN JUST ABOUT ANY OTHER WAY. THERE ARE THINGS LIKE TISSUE DOPPLER THAT CAN BE DONE WITH ECHO, BUT NOTHING DOES IT AS WELL AS MRI. WE CAN GET DATA THAT MIGHT GUIDE US TO HOW WE MIGHT DETECT IN HIGH RISK INDIVIDUALS THE EARLY SIGNS OF HEART FAILURE AND WHAT WE MIGHT BE ABLE TO DO TO STAVE OFF ITS PROGRESSION. AND I THINK THIS IS THE SECOND-TO-LAST SLIDE. BY IDENTIFYING EARLIER OR SUBCLINICAL STAGES OF DISEASE, WE WILL ENABLE IDENTIFICATION OF PREVENTION MEASURES. AND I THINK, REALLY, THIS IS WHERE WE HAVE TO GO. YOU RECALL THE SLIDE WHERE I SHOWED THE INCIDENCE OF FIRST MYOCARDIAL INFARCTIONS IN AFRICAN AMERICANS IN JACKSON IS ACTUALLY GOING IN THE WRONG DIRECTION. WE'VE SEEN 40 YEARS OF IMPROVEMENT, BUT NEW MIS ARE ACTUALLY INCREASING ACCORDING TO ARIC SURVEILLANCE DATA. THAT, TO ME, IS A FAILURE OF PREVENTION. THAT MEANS THAT USUAL CARE, USUAL APPROACHES TO THE POPULATION ARE NOT PRODUCING WHAT WE ALL WANT AND WHAT IT LOOKS LIKE THE NATION IS ACHIEVING WHEN YOU LOOK AT THE NATION AS A WHOLE. SO, I BELIEVE THAT, LOOKING AT A WELL-CONSTRUCTED EVIDENCE BASE, WE CAN THEN MOVE TO THE NEXT LEVEL OF DESIGNING THE APPROPRIATE INTERVENTIONS THAT WILL PRODUCE BETTER HEALTH FOR AFRICAN AMERICANS AND OTHERS THREATENED BY THESE DISEASES. AN EXAMPLE OF THAT IS THESE DATA THAT SHOW EXTRAORDINARY RISK FOR HEART FAILURE IN AFRICAN AMERICANS IN THE CARDIA STUDY AS OPPOSED TO WHITES. HERE, BLACK MEN AND WOMEN, WHITES, AND THESE AREN'T OLD PEOPLE. THESE ARE MORE MIDDLE-AGE PEOPLE, YEAH, 40 TO 50. SO, THERE'S REALLY A NEED THEN, PARTICULARLY IN AFRICAN AMERICANS, TO LOOK AT EARLY CHANGES THAT MIGHT INDICATE HEART FAILURE DOWN THE ROAD. SO, I'VE TAKEN YOU THROUGH A LOT, AND THIS IS A DIFFICULT, BEDEVILING PROBLEM. DISPARITIES ARE NOT NEW. OUR ATTENTION AND FOCUS ON THEM PERHAPS IS. AND WE NEED TO STAY FOCUSED AND STAY MOTIVATED TO RESOLVE THESE DISPARITIES AND, HERE AGAIN, IN THE PARLANCE OF W.E.B. DU BOIS AND JOHN HOPE FRANKLIN, TO END THE COLOR LINE. AND THIS IS FROM JOHN HOPE FRANKLIN: "WE SHOULD NOT EXPECT A QUICK FIX TO A SITUATION HOARY WITH AGE AND INTERLAID WITH SUCH! COMPLEXITIES. THE APPROACH MUST BE INFORMED THROUGH UNDERSTANDING OF THE VERY COMPLEX PROBLEMS THAT PRODUCED THE SITUATION." AND WITH THAT APPROACH, I THINK THESE CHILDREN HAVE REASON TO SING. WE HOPE TO LEAVE A LEGACY OF HEALTH THROUGH WHAT WE'RE DOING IN THE JACKSON HEART STUDY. AND WE REALLY APPRECIATE THE SUPPORT OF THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE AND AT THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES. THANK YOU VERY MUCH. [APPLAUSE] DR. JOYCE HUNTER: EXCELLENT. THE FLOOR IS NOW OPEN FOR QUESTIONS. WE'LL TAKE QUESTIONS. EDGAR, CAN YOU HELP US WITH THE MICROPHONES? AND WE'RE GOING TO ASK YOU TO RAISE YOUR HAND, AND WE'LL GET THE MICROPHONE TO YOU. DON'T BE SHY. WE'VE JUST HAD AN EXCEPTIONAL SEMINAR, AND I KNOW THERE ARE SOME VERY EXCITING QUESTIONS OUT THERE. YEAH. NOT ALL AT ONCE. MALE SPEAKER: DR. TAYLOR, YOU MENTIONED THE GENETIC CONSORTIUM, CAN YOU SAY A LITTLE BIT MORE ABOUT THAT? DR. HERMAN TAYLOR: OKAY, THANK YOU, DR. WILSON. IN FACT, THERE ARE SEVERAL THAT WE'RE INVOLVED IN. THERE ARE -- AND THEY ARE TRULY HUGE. FOR INSTANCE, ONE THAT WE ACTUALLY STARTED OURSELVES IS CALLED COGENT. DON'T ASK ME TO BREAK DOWN THAT ACRONYM FOR YOU, BUT THE IDEA THERE IS TO REACH OUT TO A WIDE VARIETY OF STUDIES THAT MAY HAVE GENETIC DATA, PARTICULARLY GWAS DATA IS WHERE WE'RE STARTING, AND TO WORK ON PROJECTS WHERE EACH STUDY CAN DO META-ANALYSES LOOKING AT VARIOUS PHENOTYPES SUCH THAT WE, THROUGH POOLING OF THE GWAS DATA, BECAUSE JUST HAVING 5,000 PEOPLE GENERALLY IS NOT ENOUGH TO REALLY SEE A REAL CORRELATION. SOME OF THE STUDIES THAT WE HAVE PARTICIPATED IN HAVE HAD 15,000 OR SO INDIVIDUALS FROM A VARIETY OF DIFFERENT STUDIES. SO, THE CONSORTIA REALLY ARE A PLATFORM FOR PEOPLE TO POOL DATA RELATED TO -- GENETIC DATA RELATED TO PHENOTYPES THAT THE DIFFERENT STUDIES HAVE IN COMMON. SO, WHAT YOU NEED THERE ARE, OF COURSE, GENETICISTS, BUT YOU ALSO NEED THE PHENOTYPERS, PEOPLE WHO CAN REALLY BE CAREFUL IN MAKING SURE THAT HYPERTENSION IS DEFINED THE SAME WAY IN ALL THOSE STUDIES SO THAT WE KNOW, IF THERE'S ANY CORRELATION BETWEEN SOME VARIANT AND HYPERTENSION, THAT IT MEANS SOMETHING -- THAT WE'RE NOT ALL OVER THE PLACE, THAT HEART FAILURE MEANS THE SAME FROM STUDY TO STUDY TO STUDY. THAT ACTIVITY HAS BEEN, I THINK, VERY PRODUCTIVE AND -- BUT YOU NEED LARGE NUMBERS. AND THE ONLY WAY YOU CAN GET NUMBERS OF THE APPROPRIATE SIZE GENERALLY SPEAKING IS THROUGH THESE CONSORTIA. SO, OURS IS CALLED COGENT. THE BIG ONE THAT NHLBI SPONSORS IS CHARGE, WHICH INCLUDES STUDIES LIKE FRAMINGHAM, JACKSON HEART, ARIC, CARDIA, CHS, AND SOME OTHERS. AGAIN, WE'VE POOLED DATA LOOKING AT SPECIFIC POSSIBLE CORRELATIONS BETWEEN GWAS AND CERTAIN PHENOTYPES. NOW, NOT BEING A GENETICIST, I CAN'T TAKE IT MUCH FURTHER THAN THAT. DR. JOYCE HUNTER: WE HAVE A QUESTION OVER HERE. DR. JANINE CLAYTON: I REALLY ENJOYED YOUR PRESENTATION, REALLY, VERY ELOQUENT AND COVERED SO MANY AREAS. I NOTICED ONE, MAYBE TWO SLIDES WHERE YOU WERE ABLE TO BREAK DOWN SOME OF THE DATA BY SEX. WITH SUCH A DATASET AND YOUR WORK GROUPS THAT YOU HAVE, THE WEB HOMES THAT YOU HAVE, THE COLLABORATIONS THAT YOU HAVE, HAVE YOU BEEN ABLE TO DEVELOP ANY QUESTIONS FOR DETAILED ANALYSIS BY SEX? DR. HERMAN TAYLOR: WELL, THE POTENTIAL THERE IS TREMENDOUS. THE JACKSON HEART STUDY IS 65 PERCENT FEMALE. THERE ARE SO MANY INTERESTING QUESTIONS. YOU KNOW, I FOCUSED ON, FOR INSTANCE, OBESITY AND ADIPOSITY TODAY. YOU KNOW, THERE'S CLEARLY SEXUAL DIMORPHISM THERE. WE NEED TO LOOK SPECIFICALLY AT EFFECTS OF EXCESS ADIPOSITY, ECTOPIC FAT DEPOTS, AND SO FORTH BY SEX. AND THAT WORK IS UNDERWAY. I THINK IT ALSO REPRESENTS AN OPPORTUNITY FOR A DIFFERENT TYPE OF CONSORTIUM. THE CONSORTIA WE'RE MOSTLY INVOLVED IN NOW ARE GENETICS. I THINK OTHER POOLING PROJECTS NEED TO BE ENTERTAINED WHERE WE LOOK AT LARGER NUMBERS OF WOMEN AND MEN TO SEE IF SOME OF THESE EFFECTS CAN BE MORE STRONGLY PROVEN, IF YOU WILL, WITH LARGER NUMBERS, MORE STATISTICALLY SOLID. SO, I WOULD ENCOURAGE ANYBODY WHO'S INTERESTED IN THAT TO GET IN TOUCH WITH US AND BECOME ONE OF OUR COLLABORATORS. DR. JANINE CLAYTON: THANK YOU. DR. JOYCE HUNTER: DR. CLAYTON IS FROM THE OFFICE OF RESEARCH ON WOMEN'S HEALTH. DR. HERMAN TAYLOR: OH, I SHOULD HAVE GUESSED THAT. THANK YOU, DR. CLAYTON, FOR THAT QUESTION. [LAUGHTER] FEMALE SPEAKER: MY QUESTION IS -- I BELIEVE THERE WAS A SLIDE THAT SAID AFRICAN AMERICANS WERE LARGER THAN THEIR COUNTERPARTS, WHITE COUNTERPART. WAS THAT CORRECT? DR. HERMAN TAYLOR: OKAY, GO ON. I -- FEMALE SPEAKER: AND I ASK THAT -- WELL, NOW YOU JUST SAID THAT THE HEART STUDY IS STUDYING 65 PERCENT MORE WOMEN. DR. HERMAN TAYLOR YES. FEMALE SPEAKER: DO YOU LOOK AT THE SOCIOECONOMIC STATUS OF THE AFRICAN AMERICAN OR WHITE WOMAN? AND IS THERE A CORRELATION BETWEEN SINGLE BLACK MOTHERS AND WHITE MOTHERS AND BLACK MOTHERS NOT HAVING THE ACCESS TO GO EXERCISE, TAKE CARE OF THEIR SELF BECAUSE THEY MIGHT BE TAKING CARE OF MORE CHILDREN THAN THEIR WHITE COUNTERPART, TO HAVE A HUSBAND OR SOMEONE AT HOME? SO, ALL OF THOSE, I'M SURE, ISSUES THAT ONE COMMUNITY MIGHT HAVE TO THE OTHER ONE. AND IF SO, AND WE SAW THAT, WHAT DO YOU DO TO PROVIDE HEALTHY FOODS FOR THE WOMEN AND ACCESS OR OPPORTUNITIES TO EXERCISE? DR. HERMAN TAYLOR: YOU KNOW, YOU NEED TO COME WORK FOR US. [LAUGHTER] THOSE ARE ALL CRITICALLY IMPORTANT QUESTIONS. AND WE ARE BLESSED IN THIS STUDY TO HAVE A COUPLE OF SOCIAL EPIDEMIOLOGISTS WHO ARE INTENSELY INTERESTED IN THOSE QUESTIONS. WE ALSO HAVE A COLLABORATION GOING WITH DR. ANA DIEZ-ROUX AT THE UNIVERSITY OF MICHIGAN WHERE WE WORK THROUGH SUB-CONTRACTUAL ARRANGEMENTS ON JUST THAT LINE OF INVESTIGATION. SO, I DON'T -- AS I STAND HERE, I CAN TELL YOU -- I CAN'T GIVE YOU RESULTS FOR YOUR QUESTIONS, BUT I CAN TELL YOU THAT A LOT OF THE DATA TO APPROACH YOUR QUESTIONS. ACTUALLY, THOSE DATA DO RESIDE IN THE JACKSON HEART STUDY DATABASE TO A LARGE EXTENT. AND AT LEAST I CAN TELL YOU THIS WITH ASSURANCE THAT YOU WILL NOT FIND MORE COMPLETE DATA IN THAT REGARD, IN A STUDY THAT ALSO HAS ALL THESE PHYSIOLOGIC POSSIBLE CORRELATIONS. SO, ONE OF THE TRUE STRENGTHS IS TO HAVE THAT PSYCHOSOCIAL/BIOLOGICAL DATA ALL ON THE SAME INDIVIDUALS, AND YOU CAN REALLY BEGIN TO MAKE SOME NOVEL ASSOCIATIONS TO ANSWER SOME OF THE QUESTIONS. FEMALE SPEAKER: CAN I [INAUDIBLE]? DR. HERMAN TAYLOR: SURE, YEAH. FEMALE SPEAKER: I AM JUST [INAUDIBLE], NOT A J.D. -- DR. HERMAN TAYLOR: DON'T SAY "JUST," PLEASE. FEMALE SPEAKER: YEAH, I'M TRYING TO FIGURE OUT WHAT TO DO NEXT. BUT DURING MY MPH PROGRAM, WE WERE -- THERE ARE STUDIES AND STUDIES AND STUDIES ABOUT THE HEALTHY HEART BIBLE -- OR NO, WHAT -- [UNINTELLIGIBLE] -- THE SOUTHERN HEALTH DISPARITIES. DR. HERMAN TAYLOR: OKAY, ALL RIGHT. FEMALE SPEAKER: AND THERE WOULD BE COMPLETE INFORMATION AND SO-AND-SO DID A STUDY AND SO-AND-SO DID ALL THIS INFORMATIONAL DATA ANALYSIS, BUT IT WAS NEVER LIKE WHAT IS GOING BACK TO THOSE COMMUNITIES THAT HAVE THOSE ISSUES. DR. HERMAN TAYLOR: [AFFIRMATIVE] RIGHT, RIGHT.Y/– FEMALE SPEAKER: SO, I MEAN, I'VE GOT A LOT FRUSTRATED, BUT MY CURIOSITY AND MY LOVE FOR PUBLIC HEALTH IS THERE. BUT I FEEL LIKE WE DO A LOT OF STUDYING FOR COMMUNITIES, BUT THEN WE DON'T COME BACK WITH RESOURCES TO THEM. DR. HERMAN TAYLOR: YOU KNOW, WE'VE GOT TO CLOSE THAT LOOP, DON'T WE? YEAH, I AGREE WITH YOU. MALE SPEAKER: YEAH, I DON'T HAVE A QUESTION. I THANK YOU FOR YOUR PRESENTATION. I DON'T HAVE A QUESTION BUT A COMMENT IN RESPONSE TO THE -- TO QUESTIONS EARLIER. AND I WANT TO THANK YOU FOR PRESENTING THE DATA ON VISCERAL ADIPOSE TISSUES, THE FATS THAT ARE IN VISCERAL ADIPOSE TISSUES AS WELL AS SUBCUTANEOUS TISSUES, BECAUSE THIS IS A BIG CONCERN AMONG FILIPINO WOMEN. THE FILIPINO -- THERE'S A STUDY IN SAN DIEGO THAT SHOWS THAT FILIPINO WOMEN ARE SKINNY WITH SMALL WAISTS, BUT THEY HAVE HIGH RATE OF HYPERTENSION AND DIABETES. AND ONE OF THE POSSIBLE EXPLANATIONS FOR THAT IS BECAUSE OF THE HIGH VISCERAL ADIPOSE TISSUE. SO, THEY'RE NOT IN THE SUBCUTANEOUS AREA, BUT THEY ARE IN THE VISCERAL AREA, AROUND INTESTINAL AREAS. SO, THAT -- THE VISCERAL -- THAT'S THE IMPORTANCE OF LOOKING AT THAT VISCERAL ADIPOSE TISSUES. AND ALSO, THEY SECRETE A LOWER ADIPONECTIN LEVEL. SO, THOSE ARE TWO RISK FACTORS AMONG FILIPINO WOMEN THAT CAUSE HIGHER RATE OF HYPERTENSION AS WELL AS DIABETES. AND THEN, IN REGARDS TO THE QUESTION ABOUT DISSEMINATION, NIMHD OR CBPR, COMMUNITY-BASED PARTICIPATORY RESEARCH PROGRAM, WE HAVE THREE PHASES. SO, WE HAVE THE PLANNING PHASE FOR THREE YEARS, FIVE YEARS INTERVENTION PHASE, AND THEN IF IT'S EFFECTIVE INTERVENTION, WE GIVE AWARDS FOR THREE-YEAR DISSEMINATION PHASE, SO THAT THE FINDINGS ARE SHARED BACK WITH THE COMMUNITY. SO, YOU KNOW, THE WHOLE CIRCLE, THE WHOLE LOOP IS CIRCLED THERE. THANK YOU. DR. HERMAN TAYLOR: OKAY. DID I HEAR A FUNDING OPPORTUNITY THERE? [LAUGHTER] WE SHOULD TALK AFTER. FEMALE SPEAKER: I KNOW THAT YOU WERE JUST TALKING ABOUT SOME OF THE SOCIAL FACTORS THAT YOU WERE ASSESSING, AND I DON'T KNOW SPECIFICALLY -- I WAS JUST WONDERING WHAT KIND OF PSYCHOSOCIAL FACTORS YOU'RE ASKING, LIKE WHAT KIND OF QUESTIONNAIRES. AND ALSO, I KNOW THAT YOU SAID THERE WERE OVER 5,000 PARTICIPANTS RECRUITED, BUT WHAT MEAN OF THE AGES AND THEIR AGE RANGE? DR. HERMAN TAYLOR: OKAY, YOU KNOW, I -- THERE WAS SO MUCH TO COVER THAT I DIDN'T COVER SOME OF THOSE BASICS. THANK YOU FOR YOUR QUESTION. SO, EVERYONE WAS OVER 21 YEARS AT BASELINE. BASELINE WAS BETWEEN 2000 AND 2004, SO THEY ARE NOW APPROXIMATELY 10 YEARS OLDER. AND THE MEAN AGE RIGHT NOW IS RIGHT AROUND 58, 59 YEARS. I HAD MENTIONED 64 PERCENT WOMEN. IN TERMS OF -- LET'S SEE. I HOPE I HIT ON ALL OF YOUR QUESTIONS. BUT IN TERMS OF WHAT KIND OF QUESTIONNAIRES -- THERE'S, I MEAN, A HOST OF THEM. AND I'LL TRY TO HIT ON A COUPLE THAT MIGHT BE MOST INTERESTING. SO, THERE ARE THINGS LIKE CDS, A STANDARD DEPRESSION SCALE. THERE ARE THREE DIFFERENT STRESS INVENTORIES, YOU KNOW: MAJOR LIFE EVENTS, WEEKLY STRESS, DAILY HASSLES. THERE'S SOMETHING CALLED THE JOHN HENRY SCALE. THERE'S JOB STRAIN. THERE'S SOCIAL SUPPORT. LET'S SEE, THERE ARE QUESTIONNAIRES THAT GET AT ANGER, HOSTILITY, NEIGHBORHOOD VIOLENCE, COPING MECHANISMS. YOU KNOW, THE LIST IS LONG. I MEAN, WE KEPT PEOPLE THERE FOR FIVE HOURS, SO WE HAD TIME TO ASK A LOT OF -- AND MOST OF THAT TIME WAS TALKING. IN MORE RECENT EXAMS, WE'RE LOOKING AT COGNITIVE FUNCTION AS WELL. SO, AGAIN, I INVITE YOU TO GO TO OUR WEBSITE, AND YOU'LL FIND LISTED ALL OF THE FORMS AND MANUALS --AND YOU CAN ACTUALLY SEE WHAT QUESTIONS WERE ASKED IN EXAM ONE, EXAM TWO, EXAM THREE. AND IN ADDITION TO THAT, WE HAVE ANNUAL FOLLOW-UP PHONE CALLS WHICH, SINCE THE ACTUAL EXAMINATIONS HAPPEN ON A CYCLE OF ABOUT EVERY FOUR OR FIVE YEARS IN BETWEEN, WE KEEP IN CONTACT EACH YEAR. THAT NOT ONLY HELPS US ASSURE WHAT THE VITAL STATUS IS OF THE INDIVIDUAL, BUT IT ALSO KEYS US INTO ANY PROBLEMS, ANY HOSPITALIZATIONS WE MIGHT HAVE MISSED WITH OUR SURVEILLANCE. AND IT'S AN OPPORTUNITY TO GIVE OTHER QUESTIONNAIRES TO PEOPLE WITHOUT -- HOPEFULLY, WITHOUT OVERBURDENING THEM. FEMALE SPEAKER: THANK YOU SO MUCH FOR YOUR PRESENTATION. MY QUESTION, AND YOU MAY HAVE ALREADY ALLUDED TO HIS IN YOUR PRESENTATION, BUT WHAT STEPS HAVE YOU ALL TAKEN OR ARE YOU TAKING TO, I GUESS, DUPLICATE THE FRAMEWORK OF YOUR RESEARCH SO THAT IT CAN BE EXPANDED BEYOND YOUR WORK GROUP COLLABORATION WITH GENETIC COLLABORATIONS AND THEN IMPLEMENTED OR USED TO ADDRESS OTHER HEALTH DISPARITIES OR BE USED BY OTHER INSTITUTIONS TO ADDRESS OTHER RESEARCH QUESTIONS, YOU KNOW, USING YOUR OBJECTIVES AS TRAINING, RESEARCH, AND COLLABORATION? I GUESS, WHAT STEPS ARE YOU ALL TAKING? DR. HERMAN TAYLOR: SO, YOU KNOW, WE HOPE THIS MODEL IS SOMETHING THAT OTHERS WILL FIND USEFUL. WE, YOU KNOW, IN PART, IT WAS THE NIH'S INSPIRATION. IN PART IT HAS BEEN A QUESTION OF NECESSITY BEING THE MOTHER OF INVENTION. YOU KNOW, REACHING OUT THROUGH THE VANGUARD CENTER NETWORK IS PARTLY OUR ACKNOWLEDGEMENT THAT, YOU KNOW, WITH A SMALL GROUP IN ONE LOCATION, THERE'S ONLY SO MUCH YOU CAN DO. SO, YOU'VE GOT TO REACH OUT. I LIKE BLOOD AS COLLABORATION. WE HAVE TO DO THAT. I THINK THERE'S A GENERALIZED APPRECIATION OF THAT GROWING IN THE SCIENTIFIC COMMUNITY, AND WE'RE CERTAINLY TRYING TO GET OUT THERE AND MAKE IT AS EASY AS POSSIBLE WHILE STILL PROTECTING THE COHORT IN TERMS OF THEIR CONFIDENTIALITY, IN TERMS OF HOW FAR THEY WANT THEIR DATA DISSEMINATED. SOME HAVE SPECIFICALLY EXPRESSED THAT WE DON'T WANT IT TO GO ANY FURTHER THAN JACKSON. OTHERS SAY I WANT IT TO GO AS FAR AS IT CAN TO BRING SOME GOOD BACK TO JACKSON AND BACK TO AFRICAN AMERICANS AND OTHERS THREATENED BY THIS DISEASE. SO, IT'S A MODEL THAT I THINK IS STILL EVOLVING. AND WE HOPE TO, YOU KNOW, KEEP IT IN PERPETUITY. THAT WOULD BE NICE. YOU KNOW, FRAMINGHAM'S BEEN GOING ON FOR 68 YEARS, BUT THEY'VE BEEN ADAPTIVE. THEY'VE CHANGED WITH THE TIMES. THEY'VE EMBRACED NEW AREAS OF RESEARCH, NEW APPROACHES. AND WE HAVE THE BENEFIT OF GOOD SUPPORT FROM THE NIH AND SOME PRETTY SMART PEOPLE ON THE GROUND. SO, WE'RE ALWAYS INTERESTED TO SHARE OUR BEST PRACTICES AND LESSONS LEARNED. WE'VE LEARNED A LOT OF LESSONS ALONG THE WAY. FEMALE SPEAKER: HI. THANK YOU VERY MUCH FOR YOUR TALK. I WAS JUST CURIOUS, GIVEN THE ENVIRONMENT THAT YOU DESCRIBED, ABOUT THE DISTRUST IN THE RESEARCH ENVIRONMENT. YOU WERE EXTRAORDINARILY SUCCESSFUL IN RECRUITING AND IN MAINTAINING THAT POPULATION AS TIME WENT ON. I WAS JUST CURIOUS IF YOU COULD DESCRIBE MORE ABOUT WHAT RECRUITMENT STRATEGIES. YOU KNOW, WHAT DID YOU DO TO ESTABLISH THAT TRUST GIVEN THAT BACKGROUND? DR. HERMAN TAYLOR: YOU KNOW, IT'S SUCH A WEB OF ACTIVITY. SO, YOU KNOW, SPECIFICALLY, WE DID THINGS LIKE I MENTIONED IN TERMS OF INTEGRATING COMMUNITY WISDOM INTO WHAT WE WERE DOING. AND THAT WAS FROM THE GROUND UP. WE TALKED TO THEM FIRST. SECOND, I THINK THAT'S IMPORTANT -- IT'S IMPORTANT TO MENTION THAT WE DIDN'T EMBRACE THE CONCEPT OF GIVING BACK. WE EMBRACED THE CONCEPT OF GIVING AS YOU GO. THAT IS, THAT TO THE EXTENT THAT WE KNOW THINGS, TO THE EXTENT THAT WE HAVE INFORMATION THAT SEEMS TO BE NOT PLENTIFUL AND NOT WIDESPREAD. WE, THROUGH OUR COMMUNITY HEALTH ADVISORS, WHICH IS AN ARMY OF ABOUT 90 PEOPLE NOW -- FIRST WE TRAIN THEM IN BASICS ABOUT RISK FACTORS AND, YOU KNOW, COOKING AND WHAT HAVE YOU, TIPS ON STAYING HEALTHY. AND THEN THEY GO OUT AND HOLD SMALL LITTLE GROUP MEETINGS AND SO FORTH. AND WITH THAT EFFORT, WE BEGIN TO DISSEMINATE APPROPRIATE LEVELS OF INFORMATION OF EVIDENCE-BASED INFORMATION THAT PEOPLE CAN EMBRACE AND USE IN PRACTICAL WAYS IN THEIR FAMILY LIFE AND SO ON. SO, THAT ALSO BUILDS A FUND OF GOODWILL. I MEAN, THEY SEE THAT YOU ARE INTERESTED IN THEM. YOU KNOW THE OLD ADAGE: PEOPLE DON'T CARE HOW MUCH YOU KNOW UNTIL THEY KNOW HOW MUCH YOU CARE. I MEAN, THAT'S REAL STUFF, AND YOU'RE DEALING WITH REAL PEOPLE. ALSO, EMBRACING THE HBCUS AS A PART OF THIS EFFORT I THINK WAS HUGE. YOU KNOW, ONE OF THE EARLY MEETINGS I HAD WAS A TOUGALOO MEETING. TOUGALOO IS A SMALL AFRICAN AMERICAN COLLEGE THAT'S A PART OF THE STUDY THROUGH ITS SCHOLARS PROGRAM. I'LL NEVER FORGET -- WE WOULD PURPOSELY HAVE CEREMONIES TO CELEBRATE, SAY, THE HIGH SCHOOL STUDENTS ENDING THEIR SUMMER. AND I REMEMBER A SPONTANEOUS TESTIMONIAL BY ONE OF THE PARENTS WHO JUST STOOD UP AND SAID, "THIS JACKSON HEARTS STUDY IS A WONDERFUL THING." AND HE WENT ON FORZn FIVE MINUTES ABOUT THAT. YOU KNOW, I MEAN, YOU CAN'T BUY THAT KIND OF PR. AND HE GOES AND TALKS TO PEOPLE, HIS CHILDREN TALK TO PEOPLE, AND SO FORTH. SO, YOU BECOME A PART OF THE COMMUNITY, YOU KNOW. I THINK WE ARE VERY MUCH INTERWOVEN WITH THE JACKSON COMMUNITY. THEY KNOW OUR INTENTIONS. THEY KNOW OUR COMMITMENT. THEY KNOW HOW MUCH WE'VE WORKED TO BRING THINGS TO THIS POINT AND WHERE WE WANT TO SEE THINGS GO. THAT TAGLINE OF A LEGACY OF HEALTH WAS BASICALLY COME TO IN COLLABORATION WITH THE COMMUNITY. THAT'S WHAT THEY WANT TO LEAVE. SO, YOU KNOW, AT EVERY LEVEL AND IN EVERY WAY, IT'S NOT JUST ONE DEPARTMENT THAT'S IN CHARGE. ALTHOUGH WE DO HAVE A DEPARTMENT IN CHARGE OF COMMUNITY PARTNERSHIP, IT'S NOT JUST THE ACTIVITIES OF THAT DEPARTMENT. IT'S EVERYTHING WE DO. IT'S THE, YOU KNOW, TRYING TO COLLABORATE EFFECTIVELY ACROSS THE LOCAL INSTITUTIONS, TRAINING THE CHILDREN OF THE COMMUNITY, YOU KNOW, PARTICIPATING IN THE TRAINING OF UNDERREPRESENTED MINORITIES WHO THEN GO OUT AND TALK ABOUT THE JACKSON HEART STUDY OR GO OUT AND VOLUNTEER IN ANY VARIETY OF WAYS. PEOPLE SEE THAT AS BELIEVING IN THE COMMUNITY, INVESTING IN THE COMMUNITY, AND THAT BUYS YOU A DEEP FUND OF GOODWILL. DR. JOYCE HUNTER: OKAY, WE CAN TAKE ONE MORE QUESTION. IF NOT, I THINK WE WANT TO THANK DR. TAYLOR FOR THIS WONDERFUL -- [APPLAUSE] DR. HERMAN TAYLOR: THANK YOU, DR. HUNTER, I APPRECIATE THAT. DR. JOYCE HUNTER: OUR NEXT SEMINAR WILL BE IN MARCH. PLEASE LOOK AT OUR WEBSITE IN ORDER TO GET THE TITLE OF THE SEMINAR AND THE EXACT DATE AND TIME. AND, AS I ALWAYS SAY EACH TIME WE END, PLEASE COME BACK, BRING TWO FRIENDS, AND HAVE THEM BRING TWO FRIENDS. THANK YOU AND HAVE A GOOD EVENING.