I WANT TO
WELCOME YOU ALL AND THANK YOU
FOR JOINING US TODAY AS WE BEGIN
A LARGELY NOVEL RESEARCH
DIRECTION FOR NIDDK
UNDERSTANDING THE BIOLOGICAL
MECHANISMS INFORMATION AND
MECHANISMS OF RACISM,
MARGINALIZATION AND
DISCRIMINATION AND WE HAVE
VIEWERS TUNING IN VIA NIH
VIDEOCAST.
WE HAVE TWO PRIMARY OBJECTIVES
FOR THIS WORKSHOP.
WE AIM FIRST TO IDENTIFY
RESEARCH OPPORTUNITIES TO BETTER
UNDERSTAND THE BIOLOGICAL
PATHWAYS THROUGH WHICH RACISM,
MARGINALIZATION AND
DISCRIMINATION OR RMD, IN THE
GOVERNMENT WE HAVE TO HAVE
ACRONYMS FOR EVERYTHING,
CONTRIBUTE TO NIDDK DISEASES AND
THEN SECONDLY, WE'D LIKE TOE
FOSTER CROSS POLINIZATION AND
LOOKING AT CAREGIVERS AND BASIC
SUNE TESTS, EPIDEMIOLOGISTS,
HEALTH EQUITY RESEARCHERS AND
MANY MANY OTHERS.
WE HOPE THAT MANY MUCH YOU WILL
LEAVE HERE AND LEAVE THIS
MEETING WITH NEW IDEAS AND NEW
COLLABORATIONS TO ADVANCE THIS
TYPE OF SCIENCE WE'LL TAKE A
MOMENT AND MARGINALIZATION AND
DISCRIMINATION BASED ON SOCIALLY
CONSTRUCTED CATEGORIES SUCH AS
RACE AND ETHNICITY, SEXUAL
ORIENTATION AND GENDER PRODUCE
BIOLOGICAL CONSEQUENCES THAT
CONTRIBUTE TO NEGATIVE HEALTH
OUTCOMES AND HEALTH DISPARITIES
IN MANY OF NIDDK'S DISEASES.
KEY PATHWAYS OF COURSE LIKELY
INCLUDING EXPOSURE TO ADVERSE
SOCIAL DETERMINATES OF HEALTH OR
SOCIAL RISK WHICH CAN STRAIN AND
MODIFY HEALTH-RELATED BEHAVIOR
OR AND DIRECT ALTERATIONS OF
BIOLOGY BY TRIGGER FOR EXAMPLE,
STRESS PATHWAYS AND MODIFYING
BIOLOGICAL HOMEOSTASIS AND WHILE
UNDERSTANDING THE
PATHOPHYSIOLOGY IS SOMEWHAT
LIMITED.
AND THIS ALIGNS WITH KEY
RECOMMENDATIONS AND
OPPORTUNITIES FOR ADVANCING
HEALTH DISPARITIES AND HEALTH
EQUITY RESEARCH FROM A RECENT
REPORT PUBLISHED JUST IN MARCH
OF 2023 ENTITLED PATHWAYS TO
HEALTH FOR ALL.
IN PARTICULAR THIS WORKSHOP IS
THE FIRST STEP IN ADVANCING
RECOMMENDATION NUMBER 2, SHOWN
THERE ON THE RIGHT TO ADVANCE
RESEARCH ON THE MECHANISMS BY
WHICH BIOLOGICAL, BEHAVIORAL,
ENVIRONMENTAL AND STRUCTURAL
FACTORS UNTO ACT TO AFFECT
HEALTH, DISEASE AND RESILIENCE.
THIS WORKSHOP DEMONSTRATES
COMMITMENT TO STRENGTHENING
COMMUNITY ENGAGEMENT.
PEOPLE WHO EXPERIENCE
DISCRIMINATION AND LIVE WITH
CONDITIONS HAVE BEEN INVOLVED IN
PLANNING THE WORKSHOP.
IMMEDIATELY AFTER OUR PLENARY
PANEL YOU'LL HERE DIRECTLY FROM
PATIENTS AND THE COMMUNITY
MEMBERS ON THEIR EXPERIENCE AND
TRIN THEIR TOPIC.
AND WE CALL ON ALL OF YOU IN THE
ROOM TODAY TO SEEK MEANINGFUL
RESEARCH COMMUNITY MEMBER
PARTNERSHIPS TO ADVANCE THIS
RESEARCH FIELD.
ALSO, ENHANCING COLLABORATIONS
AS WE BRING TOGETHER THE MANY
RESEARCH PERSPECTIVES TO ADVANCE
THESE DISEASES.
BEFORE I PASS THE MIC BACK OVER
TO OUR STAFF LEAD, I'D LIKE TO
THANK THE EXTERNAL PLANNING
COMMITTEE FOR THEIR THOUGHTFUL
INPUT ON EVERY ASPECT OF THIS
WORKSHOP.
I'D ALSO LIKE TO THANK THE NIH
INSTITUTES, CENTERS AND OFFICES
WHO SUPPORTED THE PLANNING WITH
TIME AND COMMIT.
THEIR PROGRAM STAFF.
IN PARTICULAR, I'D LIKE TO I'D
LIKE TO THANK THE OFFICE OF
BEHAVIORAL AND SOCIAL SCIENCE
RESEARCH, OR OBSSR FOR THE NIH
VIDEOCAST I MENTIONED.
AND ONE ALL THE SINCERE THANKS
I'D LIKE TO PASS IT BACK TO RACK
RAQUEL AND OUR STAFF LEAD.
THANK YOU.
THANK YOU, DR. RODGERS FOR THAT
WONDERFUL INTRODUCTION.
AND SO TO FOLLOW UP ON -- I WANT
TO OUTLINE SOME OF THE SPECIFIC
RESEARCH QUESTIONS WE'LL BE
ADDRESSING DURING TODAY'S
WORKSHOP.
WHAT ARE THE DIRECT MECHANISMS
AND PATHWAYS UNDERLYING THE
RELATIONSHIP BETWEEN RACISM,
MARGINALIZATION AND
DISCRIMINATION AND NIDDK
DISEASES AND CONDITIONS AND
LOOKING AT SEVERAL MECHANISMS OF
INTEREST WHICH ARE LOOKING
INCLUDING AT STRESS, ALLOSTATIC
LOAD AND HOW DO THE MECHANISM OR
PATHWAYS DIFFER OVERLAPPING OVER
POPULATIONS EXPERIENCING RACISM,
MARGINALIZATION AND
DISCRIMINATION AND ACCOUNT FOR
INTERSECTIONALITY.
HOW DO THE BIOLOGICAL MECHANISM
AND PATHWAYS DIFFER OR OVERLAP
IN THE CONTEXT OF STRUCTURAL
VERSUS INTERPERSONAL FORMS OF
DRMD
DEF
ANOTHER QUESTION WE'LL ADDRESS
IS WHAT BIO, SOCIAL FACTORS
MITIGATE DISEASE CREATING
DIFFERENTIAL HEALTH IMPACTS
WITHIN SUBPOPULATIONS DESPITE
EXPOSURE TO RMD.
HOW DO WE IDENTIFY THE
BIOLOGICAL MARKERS TO DESCRIBE
THE EXPERIENCE OF RMD.
DOES RACISM, MARGINALIZATION OR
DISCRIMINATION CONTRIBUTE TO THE
POPULATION LEVEL DIFFERS --
DIFFERENCES AND WHAT TOOLS IS
DEVELOPED TO ASSESS THE IMPACT
OF RMD ON HEALTH OUTCOMES?
SO WE KNOW THAT DISCRIMINATION
CONTRIB,
RACISM AND DISCRIMINATION
CONTRIBUTE TO DISPARATE POVERTY
TRACT TO SOCIAL RISK THAT
CONTRIBUTE TO DIFFERENT SHALL
IMPACT ON DISEASE AND HEALTH
OUTCOMES AND WE KNOW
DISCRIMINATION AND STRUCTURAL
RACISM AND MARGINALIZATION
CONTRIBUTE THROUGH BIOLOGICAL
MECHANISMS TO CONTRIBUTE TO
HEALTH OUTCOMES AND THAT'S THE
GOAL OF WHAT WE WANT TO FOCUS ON
IN TODAY'S WORK SHOP.
AND SO AS DR. RODGERS ALREADY
STARTED TO ALLUDE TO WE'LL HAVE
A PLENARY TALK FROM KEITH NORRIS
EMPHASIZING THE FIND AND
PROJECTING THE FUTURE FOR BIO
MECHANISTIC RESEARCH AND HEAR
FROM OUR PATIENT AND COMMUNITY
PANEL ABOUT THEIR EXPERIENCES
WITH RMD AND WHY THIS THIS
TOPIC IS SO IMPORTANT AND THEN
HAVE A LUNCH BREAK AND HAVE
PANELS DIVING INTO THE BIOLOGIC
MECHANISMS INCLUDING A PANEL ON
TELOMERES AND EPIGENETIC
MECHANISMS, PRENATAL AND FETAL
MECHANISMS AND ALLOSTATIC LOAD
AND INFORMATION AND CLOSING
COMMENTS FROM OUR DEPUTY
DIRECTOR.
ON DAY TWO, SO TOMORROW WE'LL
OPEN UP WITH POSTER SESSIONS AND
WE ENCOURAGE YOU ALL TO ATTEND
SINCE SOME OF THESE POSTERS WILL
BE FROM JUNIOR FACULTY AND
TRAINEES.
WE WANT TO ENCOURAGE TO PURSUE
RESEARCH IN THE SPACE AND THEN
HAVE A PLENARY PANEL FOCUSSED ON
UNDERSTANDING DIFFERENTIAL
IMPACTS ON POPULATIONS AND
FOLLOWED BY A PANEL ON BIO
MECHANISMS AND ANOTHER LUNCH
BREAK AND THE BREAKOUT GROUPS
WHICH IS THE MEAT OF THIS
CONFERENCE MEANT TO GUIDE FUTURE
RESEARCH DIRECTIONS AND THE
OPPORTUNITIES IN THIS AREA AND
WANT TO HEAR FROM YOU AND HOPE
YOU'LL PARTICIPATE IN THOSE
DISCUSSIONS AND THEN WE CLOSE ON
THAT LAST DAY.
BEFORE WE LAUNCH INTO OUR
SESSIONS I WANT TO GO THROUGH
LOGISTICAL SESSION.
WE HAVE A PACKED AGENDA AND
WE'RE ALREADY STARTING LATE DUE
TO TECHNICAL ISSUES AND WANT TO
KEEP THE TALKS ON TIME.
AND WE HAVE THE BIOS.
THERE'S COFFEE AND SNACKS
AVAILABLE FOR PURCHASE FROM THE
HOTEL RESTAURANT AND WE
ENCOURAGE YOU TO SIGN UP FOR
DINNER.
I KNOW MANY OF YOU ARE COMING
FROM AFAR.
WE CERTAINLY WANT TO FOSTER
COLLABORATIONS THROUGH THIS
CONFERENCE AND SO WE ENCOURAGE
TO YOU SIGN UP FOR DIFFERENT AND
IF YOU HAVE NOT SIGNED UP FOR A
BREAKOUT GROUP WE ENCOURAGE YOU
TO.
>> A COUPLE QUESTIONS.
[OFF-MIC]
>> THERE MAY NOT BE -- I'LL
CONFIRM WITH OUR ORGANIZER.
THEY MAY BE AVAILABLE ONLINE AND
IF YOU GO TO THE WEBSITE THE
SPEAKER BIOS ARE LISTED THERE.
WE DID ORGANIZE WITH THE
RESTAURANT IN ADVANCE TO PROVIDE
LUNCH BOXES YOU CAN QUICKLY GRAB
A LUNCH BOX, PAY FOR IT AND
REJOIN.
WE DID TRY TO MAKE IT AS
EFFICIENT AS POSSIBLE.
I THINK IT'S THE ROOM NUMBER AND
THEN I THINK WE'LL I'LL FIGURE
OUT THE ONE FOR THE MEETING
CONFERENCE AND CIRCULATE THAT TO
YOU AND GRAB THE WI-FI.
SO IF YOU GO OUT FRONT, THERE'S
PEOPLE TO DIRECT YOU TO THE
RESTROOMS AND EVERYTHING LIKE
THAT.
ALL RIGHT, ARE WE GOOD?
ALL RIGHT.
SO WITH THAT I'M GOING INVITE
OUR NEXT SPEAKER, KEITH NORRIS
IN THE HEALTH SERVICES RESEARCH
AT UCLA.
THANK YOU.
DEF NOR
>> HI, EVERYBODY.
THANK YOU VERY MUCH, ANY
QUESTION, I'M MORE THAN HAPPY TO
ADDRESS.
I'LL GIVE AN OVERVIEW OF THE
ACTIVITIES FOR THE NEXT TWO DAYS
BUT I WANT TO START OUT FIRST
WITH THIS VIDEO.
>> SO THAT'S REMUNERATION WITH A
BUNCH OF STALLING AND THE
QUESTION IS HOW DO THEY DO THAT
WITHOUT RUNNING INTO EACH OTHER?
ANYBODY.
DO THEY GO TO A PLANNING MEETING
IN THE MORNING?
SOME AWARENESS.
HOW DOES ANYBODY KNOW WHO TO
START AND FOLLOW AND WHEN TO
CHANGE, ETCETERA, ETCETERA?
THIS IS A PHENOMENA.
WE TEND TO CALL IT
SELF-ORGANIZATION BUT WE REALLY
DON'T KNOW.
I THINK THERE'S A LEVEL OF
AWARENESS AND WE THESE TO THINK
ABOUT HOW THAT HAPPENS AND WHAT
LEVEL IT HAPPENS AT.
AS WE TALK OVER THE NEXT COUPLE
DAYS WE NEED TO HAVE A DIFFERENT
LEVEL OF THINKING, A CONCEPTUAL
APPROACH TO SOLVE PROBLEMS TO
TRANSCEND AND WE DO GOOD WORK
AND ARE MAKING SOME LEVEL OF
PROGRESS BUT THE QUESTION IS TO
REALLY TAKE THE NEXT STEP IN
MAKING RESOLUTION
SCIENTIFICALLY, WHAT TYPE OF
APPROACHES DO WE NEED AS
SCIENTISTS TO GET US THERE.
AS WE HEARD EARLIER, THERE'S A
VARIETY OF STRUCTURAL FACTORS
THAT FLOW DOWN STREAM TO THESE
STRUCTURAL FACTORS AND UPSTREAM
FACTORS THAT FLOW DOWN STREAM TO
IMPACT HEALTH OUTCOMES.
IF THOSE ARE NOT EQUITABLY
DISTRIBUTED WE HAVE HEALTH
DISPARITIES.
WHAT WE THINK ABOUT IS NOT ONLY
UP STREAM FACTORS BUT A LITTLE
MORE DETAIL ABOUT THE DOWN
STREAM FACTORS AND WHY WE'RE
LOOKING TO BIOLOGICAL
MECHANISMS.
WE THINK RACISM, MARGINALIZATION
AND DISCRIMINATION ARE STRESSORS
AND THERE'S OTHERS.
SOMETIMES THE STRESS IS NOT GOOD
BUT SOMETIMES THE STRESS CAN
WORK OUT PRETTY WELL.
SO THERE'S BOTH STRESS AND
ADAPTATION TO STRESS.
SO AS WE HEARD EARLIER, TO THE
ONES WE FOCUS ON ARE THOSE THAT
COME FROM THAT WILL SOCIETALLY
GENERATE AND WE THINK THE BIASES
THAT WE HAVE AND STEREOTYPES
PRODUCED, PREJUDICES, PEOPLE
HAVE.
THESE ARE BELIEFS AND THEY CAN
HAVE AN IMPACT AND GREATER
IMPACT WHEN WE HAVE ACTIONS.
MICROAGGRESSIONS AND
DISCRIMINATION THAT OCCURS AND
RACISM IN ITS MULTIPLE FORMS
WE'LL HEAR ABOUT OVER THE NEXT
COUPLE DAYS.
ALL THESE FACTORS LEAD TO STRESS
OR CAN INCREASE STRESS IN THESE
SPACES.
AND WE WANT TO BE AWARE OF
INTERSECTIONALITY.
NONE OF THE STRESSES OCCUR IN
ISOLATION.
WE WANT TO BE THINKING ABOUT
OTHER BIASES AND OTHER
GROUP-LEVEL DISCRIMINATORY
ACTION MAY OCCUR AND THEY'RE ALL
GENERATED BY HAVING THESE
STEREOTYPES OR BIASES AGAINST A
GROUP AND ASSIGNING THAT BIAS TO
EVERY INDIVIDUAL IN THE GROUP.
SO I'VE HIGHLIGHTED A FEW OF
THEM WE WANT TO THINK ABOUT
BECAUSE THIS BECOMES IMPORTANT
WHEN DOING RESEARCH.
HOW DO WE CONTROL FOR THESE AND
ACCOUNT FOR SOME OF THESE.
SO WHAT ABOUT THE CLINICAL
IMPLICATIONS OF RACISM,
MARGINALIZATION AND
DISRIMINATION?
THIS IS FROM THIS IS FROM AND
YOU SEE ALLOSTATIC LOAD AND
OTHERS IMPACTING THE FUNCTION OF
THE KIDNEY AND THE DEVELOPMENT
AND PROGRESSION OF KIDNEY
DISEASE.
AND THERE'S PARALLEL ACTIVITIES
IN OTHER AREAS IN NIDDK IN
DIGESTIVE DISEASES, UROLOGIC AND
METABOLIC DISEASES, ETCETERA.
WHEN I THINK OF THOSE THESE ARE
STRESSES.
AND STRESS IS ONE THING BUT IT'S
THE DESTRESS WHEN IT'S BAD.
YOU GET THE COLD FROM THE
PRESSURE AND THAT LEADS TO POOR
COGNITIVE AND BIOLOGIC
PROCESSING AND MANY OTHER
FACTORS.
SOME OTHER-ISMS, CLASSISM,
POVERTY, SEXISM, ETCETERA, CAN
ALL CONTRIBUTE TO HOW WE AS AN
INDIVIDUAL CAN HANDLE WHATEVER
IT IS WE'RE DOING.
WHATEVER BALLS WE'RE JUGGLING.
WHEN WE THINK ABOUT THE
COGNITIVE PROCESSING AND THE
NEURO LOGIC ASPECTS I THINK
REALIGNMENT OF WHAT'S CALLED THE
GLOBAL WORD SPACE OF THE BRAIN.
WE LACK AT THE IMPACT ON THE
COGNITIVE OR EXECUTIVE FUNCTIONS
AND TWO OF THEM ARE MOST
DRAMATICALLY IMPACTED.
THE ABILITY TO REMEMBER, THE
ABILITY TO IMPLEMENT TASKS.
AND THEN THERE'S BIOLOGICAL
PROCESSING THAT AFFECTS ALL THE
THINGS WE TALKED ABOUT FROM
INFLAMMATION, OXIDATIVE STRESS,
IMMUNE FUNCTION AND MORE.
WE THINK ABOUT PATIENTS AN
STUDENTS AND THINK ABOUT OUR
PATIENTS AND WE TAKE CARE OF A
PATIENT, WE SEE THE PATIENT, WE
WANT OUR PATIENT TO REMEMBER
WHAT WE TOLD THEM AND DO WHAT WE
ASKED THEM DO.
WITH ALL THE STRESSORS, THEY
HAVE AN IMPAIRMENT OF THEIR
COGNITIVE PROCESSING THAT
ACTUALLY IMPACTS THOSE FUNCTIONS
THAT WE WANT THEM TO DO.
WE'RE USUALLY NOT AWARE OF IT.
SO IF WE THINK OF OUR PATIENT,
AND WONDER WHY THEY HAVE
SUBOPTIMAL CLINICAL OUTCOMES AND
INCREASED COMORBIDITIES AND
ADVANCED DISEASE PROGRESSION
THAT MAY BE SUBCLINICAL BECAUSE
OF BOTH THE STRUCTURAL AND
BIOLOGICAL FACTORS THAT ADDRESS
THEIR BIOLOGY AND THEN WE ADD TO
THAT A VARIETY OF FACTORS THAT
WE TYPICALLY SEE IN MARGINALIZED
COMMUNITIES.
INDIVIDUALS WHO HAVE LOWER SOCIO
ECONOMIC STATUS SO THEY'RE
THINKING ABOUT THE COST OF FOOD,
VERSUS THEIR PRESCRIPTIONS AND
OTHER FACTORS.
MISTRUST OF THE PHYSICIAN OF THE
HEALTH SYSTEM, ETCETERA,
ETCETERA.
AND THEN WE ADD TO THAT AN
IMPAIRED ABILITY TO REMEMBER AND
IMPLEMENT TASKS AND WONDER WHY
OUR PATIENT'S OUTCOMES ARE SUB
OPTIMAL.
AND EVERYBODY HERE WILL HEAR HOW
WE ATTENUATE ALL THOSE FACTORS
AND IMPROVE OUR PATIENT
OUTCOMES.
SO ONE ELEMENT THAT WE HEAR
ABOUT OR SORT OF TWO TERMS BUT
ONE IS WEATHERING, THE WEAR AND
TEAR OF EXPOSURES TO STRESS
COINED BY ARLENE GERONOMIS AND
ALLOSTATIC CLOSE WHICH IS THE
CLINICAL AND BIOMARKER
INDICATORS OF CUMULATIVE STRAIN
OR STRESS COINED BY BRUCE
MCEWEN.
THESE FACTORS ARE NOT ONLY
IMPORTANT FOR ALL STRESSES BUT
THERE'S LOTS OF DATA THAT HAVE
SHOWN THEM TO BE ASSOCIATED WITH
VARIOUS FORMS OF DISCRIMINATION
AS SHOWN HERE.
SO WE WANT TO BE COGNIZANT OF
THE FACT THAT DISCRIMINATION SAY
MAJOR MEDIATOR OF THE WEAR AND
TEAR FOR THE WEATHERING OF
ALLOSTATIC LOAD.
THE PAPER THAT LINKED ALLOSTATIC
LOAD TO CLINICAL OUTCOMES WAS BY
THERESA SELMAN WHO LACKED AT A
LITTLE OVER 700 INDIVIDUALS
ABOUT 70 TO 79 YEARS OF AGE AND
FOR THE ED -- FOLLOWED OVER SEVN
YEARS AND HAD A HIGHER RATE OF
MORTALITY IF YOU HAD A HIGHER
ALLOSTATIC LOAD OF 7 TO 10
VERSUS HAVING ONE.
THIS IS 10 MEASURES OF AL OWE
STALT -- ALLOSTATIC LOAD, TOTAL
CHOLESTEROL AND A VARIETY OF
OTHER STRESSORS AND THAT PUT
ALLOSTATIC LOAD FRONT AND CENTER
AS A MEASURE WE CAN USE TO SORT
OF ASSESS PEOPLE'S CLINICAL
STATUS AND RISK.
BUT WHAT ABOUT LOOKING MORE
SPECIFICALLY AT BIO LODGE
PROCESSES?
SO WE HEARD FROM DR. GRIA
THERE'LL BE A PRESENTATION ON
GENERATIONAL AFFECTS OF RACISM,
MARGINALIZATION AND
DISRIMINATION, SO THIS IS A
STRESSOR, POVERTY, COULD BE
MARGINALIZATION NOT
DISCRIMINATION OR RACISM BUT
IT'S A NATURAL EXPERIMENT SO THE
GREAT CHINESE FAMINE OF IN THE
1959-61.
SOME REMEMBER THAT.
THEY FOLLOWED INDIVIDUALS BORN
AT THAT TIME THE F1 GENERATION
AND THEN THEIR CHILDREN.
AND THEY LOOKED AT INDIVIDUALS
IN CHINA WHO WERE IN THAT AREA
WHERE THE FAMINE WAS AND WHERE
IT WASN'T.
SO THEY FOUND THE FIRST
GENERATION THERE WAS A HIGH
INCREASE IN THE PREVALENCE OF
LOW GFR AND AT THE SAME TIME
HIGH INCREASE IN THE PRESENCE OF
METABOLIC SYNDROME.
IN THE SECOND GENERATION, IT'S
ATTENUATED, IT HASN'T GONE AWAY
TOTALLY BUT WASN'T STATISTICALLY
SIGNIFICANT BUT FOUND THERE WAS
A DEFINED EPIGENETIC PROFILE FOR
INDIVIDUALS THAT WERE EXPOSED --
WHOSE PARENTS WERE EXPOSED TO
THE FAMINE.
EITHER THEY WERE EXPOSED WHEN
THEY WERE YOUNG AND THEN THEIR
CHILDREN, THEY ALSO HAD THAT
EPIGENETIC PROFILE.
WE THINK ABOUT THE EPIGENETIC
CHANGES AND THEY CAN BE
TRANSFERRED EPIGENETICALLY AND
RACISM AND MARGINALIZATION AND
DISCRIMINATION CAN AFFECT THAT
CHANGE.
IF WE SHIFT AND THINK OF THE
RELATIONSHIP BETWEEN
DISCRIMINATION AND TELOMERES OR
MARKERS OF AGING, THIS PAPER BY
DAVID SHAY WHO WILL BE TALKING
TOMORROW, IN PARTICULAR, HAVE AN
INCREASED EXPERIENCES OF RACIAL
DISCRIMINATION ASSOCIATED WITH
FASTER 10 YEAR LEUKOCYTE
TELOMERE LENGTH SHORTENING.
INCREASED DISCRIMINATION AND
SHORTENING OF TELOMERES BAD FOR
OUR AGING PROCESS.
THEY LOOKED AT YOUTH AND AFTER
YEARS REPORTING HIGH UNSTABLE
DISCRIMINATION AND THERE'S AN A
MARKED INCREASE IN THE RATE OF
AGING IF THOSE FAMILIES HAD
LOW -- IF THOSE INDIVIDUALS HAD
LOW FAMILY SUPPORT.
AND IF THEY HAD HIGH FAMILY
SUPPORT, IT ATTENUATED THAT
AGING PROCESS.
SO HERE WE CAN SEE THE
ASSOCIATION WITH AGING,
DISCRIMINATION AND WE ALSO SEE
FACTORS THAT MIGHT MITIGATE IT
WHICH IS VERY IMPORTANT.
SIMILARLY IN ANOTHER PAPER THEY
LOOKED AT THE RELATIONSHIP
BETWEEN DISCRIMINATION AND
INFLAMMATION AND WHAT THEY
REPORTED HERE IS AGAIN WITH LOW
LEVELS OF DISCRIMINATION VERSUS
HIGH LEVELS OF DISCRIMINATION,
WHAT YOU SEE IS AFTER SEVERAL
YEARS FOLLOW UP REPORTING HIGH
LEVELS OF EXPOSURE OR EXPERIENCE
WITH DISCRIMINATION A SLIGHT
INCREASE WITH THE GROUP WITH
POSITIVE RACIAL IDENTITY, THEY
HAVE A POSITIVE SELF-IDENTITY
ABOUT BEING A MEMBER OF A
MARGINALIZED RACIAL GROUP VERSUS
THOSE WITH A NEGATIVE
SELF-IDENTITY.
AND THOSE WITH THE NEGATIVE
SELF-IDENTIFY HAVE A MARKED IN
SELF-IDENTIFICATION.
LOOKING AT THE FACTORS THAT MAY
BE PROTECTIVE.
AND AGAIN OTHER FACTORS SUCH AS
PERCEIVED CONTROL HERE HAVE
HIGHLIGHTED THE IMPACT OF
PERCEIVED CONTROL AS ANOTHER
POTENTIAL MODULATOR PARTICULARLY
ON THE EXPRESSION OF CV ACTIVE
PROTEIN AS A DOWN STREAM
MEDIATOR FROM EVERYDAY
DISCRIMINATION.
I WANT TO HIGHLIGHT THIS STUDY
AS WE THINK OF RESEARCH IN THE
FUTURE FROM APRIL THAMES AND
STEVE COLE IN COLLEAGUES IN
INDIVIDUALS WITH HIV, BLACK AND
WHITE AND WHAT'S SHOWN HERE IS
DATA ON THE RELATIVE INCREASE IN
A VARIETY OF OR RELATIVE CHANGE
IN A VARIETY OF MARKERS BETWEEN
BLACK AND WHITE INDIVIDUALS,
PROINFLAMMATORY AT THE TOP WITH
ACTIVATOR PROTEIN ONE NF KAPPA B
A
AND THIS IS IMPORTANT BECAUSE WE
HAVE THE TOTAL ASSOCIATION AND
THE BOTTOM PANEL IS CONTROLLED
FOR DISCRIMINATION.
IF YOU LOOK AT THE
PRO-INFLAMMATORY MARKERS WHICH
ARE INCREASED IN THE BLACK
COHORT, WHEN YOU CONTROL FOR
DISCRIMINATION, THEY NO LONGER
EXIST.
AGAIN, SO EMPHASIZING THAT IT'S
NOT REY RACE PER SE BUT FACTORS
THAT ARE OPERATING THROUGH RACE
AND HERE RACISM THAT MAKES THE
DIFFERENCE.
WHAT'S ALSO IMPORTANT IS WHEN WE
THINK BE THE RESEARCH, WHEN YOU
CONTROL FOR DISCRIMINATION, THAT
DID NOT ACCOUNT FOR THE CHANGES
IN THE STRESS RESPONSIVE
SIGNALLING PATHWAYS.
AND SO THERE'S SOME OTHER
FACTORS THAT ARE HAPPENING
THERE.
WE HAVE TO BE COGNITIVE OF THE
FACT THAT NOT ALL OF AS THE
BIOMARKERS CHANGE THE SAME IN
EVERY SETTING OR RELATED TO
EVERY TYPE OF STRESS
REPRESENTATION.
-- RESPONSE.
SO JUST TO SORT OF SUMMARIZE
THAT SO WE HAVE
INSTITUTIONALIZED, RACISM,
BIASES, DISCRIMINATION, ETCETERA
THAT CAN HAVE AN IMPACT ON
FACTORS LIKE RESIDENTIAL
SEGREGATION, LOW OR UNDER
EMPLOYMENT, HOUSING, INSURANCE
STATUS, WHEN THESE COME TOGETHER
AND CAN LEAD TO STRESS AND
MALADAPTIVE COPING BEHAVIORS AND
THEN THEY ALL COME TOGETHER TO
IMPACT WHERE WE'RE FOCUSSING ON
TODAY ARE THE BIOLOGICAL
CONSEQUENCES.
THE CHRONIC INFLAMMATION AND
DYSFUNCTION, IMMUNE REGULATION,
EPIGENETIC CHANGES AND MORE AND
ULTIMATELY WHAT WE SEE IS THE
INCREASE IN WEATHERING OR
ALLOSTATIC LOAD REDUCED TELOMERE
LENGTH AND POORER OUTCOMES, MORE
DISEASE.
THE KEY FACTORS WE SAW IN THE
PAPER OR SLIDES I SHOWED WAS
POSITIVELY RACIAL IDENTITY OR A
SENSE OF SELF-WORTH CAN HELP
ATTENUATE THE BIOLOGICAL
CONSEQUENCES OF STRESS, RATE OF
FAMILY SUPPORT OR CONNECTEDNESS,
RIGHT, WE TALK ABOUT
CONNECTEDNESS BEING IMPORTANT
FOR HEALTH AND GREATER PERCEIVED
CONTROL.
SO, WE ALSO WANT TO BE THINKING
ABOUT AND COGNITIVE OF THOSE
FACTORS AND HOW THEY'RE BEING
INCLUDED OR ASSESSED WHEN WE ARE
DOING RESEARCH IN THIS SPACE.
SO I WANT TO PROJECT THE FUTURE
OR AT LEAST MY THOUGHTS FOR
THINGS WE NEED TO BE THINK ABOUT
WHEN WE'RE DOING RESEARCH IN
THIS SPACE.
SO AGAIN, I WANT US TO BE THINK
ABOUT HOW WE NEED TO THINK OR
WHERE WE KNENEED TO COME FROM.
WHAT IS THAT A PICTURE OF?
SOME SAY GLASS HALF FULL, SOME
SAY GLASS HALF EMPTY.
WATER IN THE GLASS.
COULD BE A PICTURE OF A GLASS
HALFWAY ON ITS WAY TO BEING FULL
OR EMPTY.
COULD BE WATER AND AIR.
COULD BE ENERGY.
IT'S A PICTURE OF A GLASS.
WE SAY IT'S A GLASS AND IT'S NOT
UNREASONABLE.
WAS THAT ALWAYS A GLASS?
WAS IT ALWAYS A GLASS?
AND WILL IT ALWAYS BE A GLASS?
SO IT'S ON IT'S WAY FROM
SOMEWHERE TO SOMEWHERE ELSE.
WE HAPPEN TO HAVE CAUGHT IT
WHILE IT'S A GLASS.
WE HAVE TO HAVE THAT SAME LEVEL
OF INTROSPECTION WHEN WE THINK
OF THE RESEARCH WE'RE DOING AND
THE INTERPRETATION AND THAT'S
GOING TO BE IMPORTANT IN THE
SPACE AS WE START GETTING DOWN
TO SOME OF THE BIOMARKERS AND
CELL-LEVEL ACTIVITIES, WE WANT
TO BE THINKING ABOUT HOW WE CAN
ADVANCE THE WORK WE'RE DOING TO
HAVE AN EVEN GREATER IMPACT THAN
WHAT WE'VE BEEN DOING TO DATE.
I'LL LET EVERYBODY THINK ABOUT
THAT ALONE UNIN INFLUENCED AND
UNENCUMBERED BY A CONDITION
VOICE AND THAT'S IMPORTANT FOR
RESEARCHERS AND IT WILL BE
IMPORTANT FOR OUR PATIENTS IF WE
WANT THEM TO BE ABLE TO ACHIEVE
THEIR OPTED MALL HEALTH.
-- OPTIMAL HEALTH.
SO SOME THINGS WE WANT TO BE
THINKING ABOUT FOR
INTERVENTIONS.
NUTRITION AND WE FOCUS ON PLEA
-- NUTRITION, LIFESTYLE
CHANGES, PRACTICES.
ARE THERE WAYS WE CAN GIVE
PEOPLE THE TOOLS THAT ARE NOT
EXPENSIVE THAT CAN ATTENUATE OR
MITIGATE THE DOWN STREAM
CONSEQUENCES OF THE STRUCTURAL
AND PSYCHOLOGICAL INSULTS
THEY'RE DEALING WITH.
WE TALKED ABOUT CONNECTEDNESS.
WE'RE SEEING A LOT OF ARTIFICIAL
INTELLIGENCE AND SOCIAL MEDIA.
SOME PEOPLE ARE MOVING TO THAT
FOR THEIR CONNECTIONS.
IS THAT CONNECTEDNESS THE SAME
AS HAVING ACTUAL REAL, PHYSICAL
CONNECTIONS WITH OTHER PEOPLE?
I DON'T KNOW.
SOMEBODY NEEDS TO DO THAT
RESEARCH ON THE PATHWAYS WE SEE
THAT HAVE BECOME ABNORMAL IN THE
SETTING OF MARGINALIZATION AND
DISCRIMINATION.
ANTI-INFLAMMATORY MARKERS FOR
OXIDATIVE STRESS AND CYTOKINE
INHIBITORS, ETCETERA.
THIS IS AN OPPORTUNITY FOR
PHARMACOLOGIC DEVELOPMENT OF
TOOLS THAT CAN BE HELPFUL.
WEARABLE SENSORS FOR STRESS
RESPONSE.
I'LL TALK ABOUT THAT IN A
SECOND.
R&D IN THE MICROBIND.
THERE'S A LOT GOING ON THERE AND
FOR HOW WE INTERPRET THINGS DO
WE EVEN KNOW TALKING ABOUT
DISCRIMINATION AND
MARGINALIZATION WE HAVE TO
UNDERSTAND HOW METHODLOGICALLY
WE SHOULD NOT USE RACE LOOKING
AT DIFFERENCES IN HEALTH SYSTEM
WORK AND PUBLIC HEALTH WORK
VERSUS INDIVIDUAL LEVEL
ALGORITHMS, ETCETERA.
SO, WHEN I THINK OF
MARGINALIZATION I THINK OF
CONDITIONED THOUGHTS.
ALL THE FACTORS CONSPIRE TO
INFLUENCE OUR CONDITION THOUGHTS
AND BEHAVIORS AND ACTIVATION.
THIS HAS RACISM, DISCRIMINATION
IS LINKED TO THE STRUCTURAL
DRIVERS OF HEALTH.
THAT LEADS TO BIOLOGICAL STRESS
PROCESS IMPACT ALL DISEASE
SYSTEMS BUT OF IMPORTANCE TO
DATE, NIDDK RELATED DISEASE
SYSTEMS.
SO WE THINK ABOUT INTERVENTIONS
AND HAVE TO THINK OF SOCIAL
CHANGE BUT FOR THE MORE BIOLOGIC
RELATED PATHWAYS WE THINK
PRECISION NUTRITION AND NOVEL
THERAPEUTICS TO TRY TO ADDRESS
THE PATHWAYS.
EVEN MORE BROADLY, PRECISION
NUTRITION OR MORE SPECIFICALLY
WITH NOVEL THERAPEUTICS.
WHERE ARE THE SENSORS?
OTHERS HAVE WORK COMING OUT OF
WEARABLE SENSORS WHERE THEY CAN
MEASURE C REACTIVE PROTEIN AND
OTHER INFLAMMATORY MARKERS AS
WELL AS OTHER CLINICAL
BIOMARKERS.
SO THOSE ARE ADVANCING AND
COMING ALONG NOW AND WILL BE
WAYS TO MEASURE OVER TIME WHAT'S
GOING ON WITH A PARTICULAR
PATIENT OR COHORT WE'RE LOOKING
AT AND LINK IT MORE SPECIFICALLY
TO EXPERIENCES OR EXPOSURES THEY
MAY HAVE.
THE MICROBIOME AND THEY RECENTLY
PROVIDED A MODEL LINKING THE
BRAIN-GUT MICROBIOME TO
DISCRIMINATION AND CLINICAL
OUTCOMES.
AGAIN, SOMETHING WE WANT TO BE
THINKING ABOUT BECAUSE THERE'S
SO MUCH GOING ON IN THE
MICROBIOME NOW AND BEING
COGNIZANT OF THAT WHEN DOING OUR
WORK OR MAY TAKE THAT AS A
PRIMARY PATH FOR RESEARCH.
A LOT OF TIMES WE TEND TO STUDY
PEOPLE WHOSE POMP -- POPULATIONS
WE LOOK AT WITH THE DISEASE AND
DON'T LOOK ENOUGH AT PEOPLE WHO
ARE WELL DESPITE THE FACT THEY
SHOULD HAVE DISEASE BECAUSE
THERE'S A LOT TO LEARN WHY
SOMEBODY IS DOING SO WELL
DESPITE ALL THE REASONS THEY
SHOULD BE STICK FOR A PARTICULAR
CONDITION.
WE'LL NEED NEW METHODS TO
MEASURE EVERY DAY DISCRIMINATION
TO HAVE SOCIAL MEDIA, CYBER
BULLYING AND MAYBE THINKING
ABOUT INTERSECTIONALITY MORE,
CONNECTEDNESS, SELF-WORTH AND
HOW DO THEY ALL IMPACT THE
STRESS BIOMARKERS AND WHICH ONES
DO THEY ALL IMPACT THE SAME
BIOMARKERS.
WE DON'T KNOW.
INTERSECTIONALITY.
WE WANT TO BE COGNIZANT OF THAT
AND WHAT ARE THE MAJOR/MINOR
PATHWAYS FOR AS POTENTIAL
APPLICANTS OR EXISTING GRANTEES
AT NIDDK FOR WHATEVER ORGAN,
ORGAN SYSTEM OR CELL SYSTEM
YOU'RE FOCUSSING ON OR MIGHT BE
FOCUSSING ON, WHAT ARE THE MAJOR
AND MINOR PATHWAYS THAT MAY BE
IMPORTANT FOR YOUR ORGAN SYSTEM
AND WHAT STRESS MEDIATORS MAY BE
MORE IMPORTANT FOR YOUR SYSTEM
THAN IN OTHER SYSTEMS.
SO WE WANT TO BE THINKING ABOUT
THAT.
SO FOR EVERYBODY HERE, AS YOU
PUT THAT ALL TOGETHER, YOU'RE
GOING TO COME UP WITH YOUR
TAILORED INTERVENTIONS THAT ARE
GOING TO LEAD TO ADVANCES IN
ADDRESSING HEALTH DISPARITIES
AND ACHIEVING HEALTH EQUITY IN
NIDDK SPACES BEFORE ANY OTHER
INSTITUTE.
THAT'S THE GOAL HERE, RIGHT.
WE WANT TO BRING ALL THE OTHER
INSTITUTES ALONG WHERE YOUR GOAL
IS TO BE LEADERS HERE.
SO WHAT ABOUT AT THE CELLULAR
LEVEL.
I DIDN'T MENTION MUCH ABOUT
INSIDE THE CELL.
A LOT OF WORK HAS BEEN DONE ON
MITOCHONDRIAL DYSFUNCTION AND
MITOCHONDRIAL ALLOSTATIC LOAD
AND ALL THE ORGANELLES IN THE
CELL.
WHEN WE LOOK AT CLINICALLY WHEN
WE LOOK AT COMMUNITY-LEVEL
FACTORS, WE DO GEOGRAPHIC
INFORMATION SYSTEMS TO PULL
TOGETHER DIFFERENT STRUCTURAL
SOCIAL FACTOR MAY BE HIGHER OR
LOWER IN PREVALENCE THAN AN
INDIVIDUAL COMMUNITY.
WHO IS DOING G.I.S. WORK WITHIN
A CELL?
DO YOU THINK IF ORGANELLES IN
THE CELL ARE ARRANGED
DIFFERENTLY IT ACTS THE SAME?
THERE'S SOME THAT ARE LINKED TO
EYE DIFFERENTIAL ORGANELLE IN
THE CELL.
THERE'S LIMITED WORK IN THAT
SPACE AND OPEN TO LOOK AT FOR
QUITE A WHILE.
IF WE THINK ABOUT RACE, WE SAW
THE ENUMERATION.
IF WE THINK ABOUT CELLULAR
COMMUNICATION, THERE'S DATA ON
QUANTUM COHERENCE AS IT RELATES
TO LIGHT BUT WE DON'T YEEL DO
MUCH OF THAT IN MEDICINE BUT TO
THINK QUANTUM COHERENCE IN THE
WAY THAT FUNCTIONING WOULD NOT
BE RELEVANT TO WHAT'S HAPPENING
IN OUR CELLS AND BODY I THINK
WE'RE NAIVE TO THINK IT'S NOT
HAPPENING.
SO, I THINK I'LL WIND UP WITH
THIS SLIDE FROM BALMER AND
COLLEAGUES WHICH GIVES A NICE
INTEGRATION HOW WE CAN THINK OF
THINGS.
COMMUNITY-ENGAGED COLLABORATIVE
TEAMS LOOKING AT THE SOCIAL
DETERMINATES OF HEALTH, LOOKING
AT STRESS REDUCTION ELEMENTS,
SLEEP, I DIDN'T MENTION SLEEP.
IF YOU HAVE STRESS OR NOT
SLEEPING THAT'S IMPORTANT FOR
BEING CONTROLLED AND WHAT IMPACT
DOES THAT HAVE AND THEN HOW
THOSE INTERVENTIONS ARE LINKED
TO THESE BIOLOGIC FACTORS.
AND TRANSCRIPTOMICS AND MORE AND
IN CERTAIN INSTANCES WHETHER
PEOPLE CAN LOOK WITHIN THE CELLS
AND LOOK AT CELL RECEPTORS AND
SO RECEPTORS WITH THEIR
MODIFICATIONS IN SOME RESPECT
FOR EXPRESSION AND IS IT DUE TO
NUMBERS OR CO-LOCATION WITH
ORGANELLES.
THINGS WE NEED TO THINK OF AND
END WITH THIS FROM DANIEL BO
BOORSTIN.
THE GREATEST OBSTACLE TO
DISCOVERY IS NOT IG NOERNSZ BUT
THE ILLUSION OF KNOWLEDGE.
IG
>> SEEING NOBODY ELSE LINE UP IN
THE ROOM I GOT SEVERAL QUESTIONS
VIA ZOOM.
>> I WAS GOING TO ASK ABOUT
THAT.
>> I'LL GO AHEAD AND ALLOW YOU
TO ENTERTAIN A FEW OF THESE.
SO THE FIRST QUESTION IS DIRECT.
IF THE STUDY WHICH DEMONSTRATED
ADJUSTING FOR DISCRIMINATION AND
INFLAMMATION AND RACE, HOW WAS
WAS INFORMATION COLLECTED?
BY SELF-REPORT?
>> YES, SELF-REPORT.
>> THAT WAS AN EASY ONE.
THE NEXT ONE IS A LITTLE MORE
COMPLICATE ABOUT MEASUREMENT AND
I'LL COMBINE A COUPLE QUESTIONS.
THERE WERE QUESTIONS ABOUT HOW
WE CAN BEST MEASURE STRUCTURAL
RACISM AND HOW WE CAN QUANTIFY
THE STRESS RESPONSE THAT MIGHT
BE UNIQUE TO EXPERIENCING
RACISM, MARGINALIZATION AND
DISCRIMINATION VERSUS ANY OTHER
CHRONIC STRESSORS SUCH AS FAMINE
OR OTHER CHRONIC STRESSORS AND
IS THAT STRESS EXPERIENCED FROM
RACISM, MARGINALIZATION AND IS
IT MULTIPLICLATIVE.
>> SOME OF THE RESEARCH THAT
COMES FROM THE JUNIOR FACULTY
HERE AND POSTDOCS AND GRADUATE
STUDENTS BECAUSE THOSE ARE
IMPORTANT QUESTIONS.
FIRST, HOW DO WE MEASURE THE
IMPACT OF STRUCTURAL RACISM.
THERE'S MULTIPLE STRUCTURES IN A
GIVEN COMMUNITY THAT IMPACTS
EACH PERSON DIFFERENTLY.
EACH PERSON IS NOT EXPOSED TO
EACH STRUCTURE IN THAT COMMUNITY
EQUALLY.
AND THEN WE HAVE TO THINK ABOUT
DIFFERENT PEOPLE HAVE DIFFERENT
PROTECTIVE FACTORS.
IF YOU THINK ABOUT EARLY ADVERSE
EVENTS IN CHILDREN AND ADVERSE
EVENTS, YOU HAVE A MARKED
INCREASE IN THE RISK OF MANY
CHRONIC DISEASES.
THE ONE MEDIATING FACTOR FOR
THAT IS IF YOU HAVE ONE PERSON
IN YOUR FAMILY LOVED YOU AND
CARED FOR YOU, THAT TENDS TO
HAVE A SIGNIFICANT PROTECTIVE
EFFECT AGAINST ALL THESE OTHER
ADVERSE EVENTS.
SO AND IT'S NOT WELL KNOWN AND
SO THERE'S PEOPLE OUT THERE AND
THEY'RE WAITING FOR THE PAPERS
AND GRANT PROPOSALS.
>> GREAT ANSWER TO THAT QUESTION
AND EXCELLENT TALK WHICH I
PROBABLY SHOULD HAVE STARTED
WITH WHEN I WALKED UP.
I SEE WE'RE A LITTLE BEHIND
TIME.
I THINK IF EVERYBODY COULD JUST
GIVE ONE MORE ROUND OF
APPLAUSE -- THANK YOU.
AND I BELIEVE WE'RE INVITING UP
OUR PATIENT AND COMMUNITY PANEL
TO THE STAGE.
HELLO, I'M PLEASED TO BE
CO-MODERATING TODAY'S SESSION
OUR PATIENT AND COMMUNITY PANEL.
MY NAME IS SHEENA MARTENIES AND
JOINED BY OUR CO-MODERATOR VIA
ZOOM JOINED WITH PHYLLIS HARRIS,
NICOLE WIESEN AND BOBBY HOWARD
AND CLAUDIA CAMACHO.
THE GOALS FOR THE SESSION ARE
T
TWOFOLD.
FIRST IS SET THE STAGE FOR THE
WORKSHOP AND EMPHASIZE THE
IMPORTANCE OF THE TOPIC.
MANY OF US ARE COMING FROM A
RESEARCH AND PRACTICE
PERSPECTIVE AND IT'S IMPORTANT
TO UNDERSTAND THE PATIENT AND
COMMUNITY PERSPECTIVE AS WE
PURSUE OUR WORK.
IT'S ALSO A REMINDER FOR US TO
ALL TAILOR OUR DISCUSSIONS TO BE
INCLUSIVE THE PATIENTS AND
OTHERS AT RISK FOR
NIDDK-FOCUSSED DISEASES WHO ARE
ALSO IN ATTENDANCE IN THE
WORKSHOP TODAY AND TOMORROW.
WITH THAT I'D LOVE OUR PANELISTS
TO INTRODUCE THEMSELVES AND
OFFER INFORMATION ON THE
IDENTITIES AND PERSPECTIVES
YOU'RE BRINGING TO THIS
DISCUSSION AND THEN OUR
COMODERATOR, GLENDA WILL
INTRODUCE HERSELF.
>> MY NAME IS PHYLLIS HARRIS.
I COME FROM CLEVELAND, OHIO.
I HAVE PARTICIPATED IN THE LAST
SEVERAL MONTHS AS AN ORGANIZER.
I THINK THAT'S WHAT I GET CREDIT
FOR.
I FELT EXCITED THOUGH I WAS
ZOOMS ON SCIENTISTS AND A LOT OF
WHAT I WAS HEARING I DIDN'T
QUITE UNDERSTAND.
I KNOW ENOUGH ABOUT MY WORK OF
AN EXECUTIVE DIRECTOR IN TERMS
OF AN LGBTQ DIRECTOR RELATED TO
MINORITY STRESS.
KNOW A LOT ABOUT MY OWN PERSONAL
EXPERIENCE AS A BLACK LESBIAN AS
A MOM AND NON-PROFIT EXECUTIVE
RAISED BY A WORKING CLASS SINGLE
MOM WHO WORKED IN A FACTORY FOR
30 YEARS AND NOW WE'RE DEALING
WITH THE CHALLENGES THAT HAS
BROUGHT AROUND HER HEALTH.
I LOVE THE OPENING REMARKS AND
WHAT I LEARNED THERE I'M HERE
REPRESENTING MYSELF AND I'M
ALMOST 60.
I FIGURED OUT TWO YEARS AGO --
THREE YEARS AGO IF I COULD BE
THE PERSON TO HELP HER REDUCE
THE STRESS IN HER LIFE, I COULD
HELP HER DELAY THE PROGRESSION
OF HER DISEASE.
SO YOU'RE UP HERE TALK TO A ROOM
OF SMART PEOPLE AND SCIENTISTS
AND YOU'RE SPEAKING MY LIFE.
IT DIDN'T TAKE ME BEING HERE TO
UNDERSTAND WHAT YOU WERE SAYING
TO SEE IT PLAY OUT IN REAL TIME
WITH MY MOM AND HOW IT'S WORKING
TO MIKE ENOUGH MONEY TO HELP HER
AND KEEP HER IN HER HOME AND
THAT'S ALL SHE HAS TO SHOW FOR
THE 30 YEARS OF WORK IN A
FACTORY AND TELL ME AND MY
BROTHER I'M DOING THIS SO YOU
DON'T HAVE TO AND BE HERE TO
REPRESENT CHANGES IN THE
NARRATIVE IN TERMS OF WHAT A
WANT TO DO AS A BLACK WOMAN, AS
SOMEONE WHO IS PROUD TO BE
BLACK, PROUD TO BE OUT AND A
LESBIAN AND MOM AND FOR OUR
FAMILIES.
FOR THE GENERATIONAL STRESS AND
WITH THIS AND MORE MY KIDS WILL
BE BETTER.
I THINK THERE'S A WAY TO CHANGE
THE NARRATIVE.
I THINK YOU ARE ALL ARE A PART
OF THAT SO THANK YOU.
>> GOOD MORNING.
MY NAME IS CLAUDIA CAMACHO.
I'M FROM DENVER.
WE CAME TO THE STATES BACK IN
THE LATE '80s.
CAN YOU HEAR ME NOW?
SO I WORK AT THE UNIVERSITY OF
COLORADO RIGHT NOW WITH DR
DR. CERVANTES AS A PATIENT
NAVIGATOR AND DIALYSIS
PATIENTS -- UM, THE REASON WHEN
SHE POSTED THE SHOW I -- THE
FIRST THING I THOUGHT ABOUT WAS
KIDNEY DISEASE.
MY DAD WAS DIAGNOSED END STAGE
KIDNEY DISEASE BACK IN THE EARLY
2000s AND WE TRIED TO NAVIGATE
THE SYSTEM.
IT WAS DIFFICULT.
IF I KNEW WHAT I KNOW NOW IS
AVAILABLE MY DAD WOULD PROBABLY
BE ALIVE AT THIS POINT.
WE WERE NOT OFFERING A LOT OF
STUFF.
I WAS A SPANISH INTERPRETER AT
THAT TIME AND THOUGHT I THROUGH
WHAT WE NEEDED TO DO AT THE END
WE LACKED A LOT OF INFORMATION.
I WANTED TO SAY SOMETHING ABOUT
I WANT TO TALK ABOUT THE
MOTIVATION AND CREATION AND I
KNOW BASED ON THE STUDIES, BASED
ON THE WORK SHE HAS DONE THEY
HAVE KNOWN A LOT OF PEOPLE, A
LOT OF COMMUNITY, LATINO
COMMUNITY THAT STRUGGLE EVERY
DAY WITH RESOURCES ESPECIALLY
WITH THE MIGRANCY SITUATION
WAITING FOR THE PAPERS AND NOT
LEGAL AND SOMETIMES WE'RE IN THE
SHADOWS.
WE DON'T WANT GO TO THE
HOSPITALS BECAUSE WE'RE AFRAID
THEY'RE GOING TO DEPORT US OR
GET SEPARATED FROM OUR KIDS AND
FAMILY.
THAT'S WHAT HAPPENED TO MANY
PATIENTS IN DENVER WHEN THEY
WERE GETTING DIALYSIS.
THEY WENT TO THE HOSPITAL AND
YOU WERE TOLD GO BACK TO YOUR
COUNTRY BECAUSE YOU DON'T HAVE
MEDICAL INSURANCE.
I KNOW IT'S STILL HAPPENING
THOUGH IN COLORADO, EMERGENCY
MEDICAID COVERS IN-CENTER
DIALYSIS I STILL HEAR PEOPLE
SAYING I WENT TO THE HOSPITAL
AND THEY TOLD ME TO GO BACK TO
MY COUNTRY.
THAT'S A GROUP WHERE I'M IN A
PRIVILEGED POSITION BECAUSE I'M
WORKING WITH THE DOCTOR AND
WE'RE TRYING TO DO BETTER SYSTEM
FOR THE LATINO COMMUNITY.
THERE WAS A LOT OF STUFF THAT
RESONATED WITH ME ON YOUR
PRESENTATION.
KIDS CAN, I WANT TO DO THIS FOR
MY KIDS TOO.
LIKE HER.
THERE'S MORE AWARENESS OF WHAT'S
HAPPENING.
SOMETIMES BEING IN THE SHADOWS
OR IN THE COUNTRY BECAUSE WE
DON'T HAVE PAPERS AND AN
EMERGENCY BECAUSE WE'RE GETTING
SICK AND WE THINK THAT'S ENOUGH.
I THINK I DON'T HAVE A RIGHT TO
BE HERE SO WHATEVER THEY'LL GIVE
ME WILL BE ENOUGH.
AND WITH HEALTH CARE WE WORK
HARD, LATINOS WORK HARD.
YOU CAN SEE PEOPLE IN THE FIELDS
AND WITH THE FIRES AND WE WORK
REALLY HARD AND CONTRIBUTE TO
THE ECONOMY.
WE DON'T GET MANY BACK BUT WE
CONTRIBUTE.
WE JUST NEED A LITTLE BIT OF
WORK AND WE'LL BE OKAY.
I WANT PEOPLE TO KNOW LATINOS WE
CAN EXPECT MORE FROM THE SYSTEM
ESPECIALLY KEEPING US HEALTHY.
>> GOOD MORNING, MY NAME IS
BOBBY HOWARD.
I BRING YOU GREETINGS FROM THE
GREAT STATE OF GEORGIA.
I RECEIVED A KIDNEY AND OCTOBER
WILL BE 30 YEAR.
MY BACKGROUND PRIOR TO THAT IS
SMALL.
I WAS A FORMER RUNNING BACK WITH
THE TB BUCCANEERS AND
PHILADELPHIA EAGLES AND THE
GREEN BAY PACKERS AND I
CONTRACTED END STAGE RENAL
DISEASE RIGHT AFTER I RETIRED
FROM THE NFL AND MY WHOLE
JOURNEY WITH THAT AND THE WORK I
DO, I WORK NOW AS A DIRECTOR OF
OUR MULTI-CULTURAL PROGRAM WE
RECOVER ALL THE ORGANS IN THE
STATE FOR TRANSPLANT AND THROUGH
MY JOURNEY I SAW THE NEED FOR MY
VOICE AND WHO I WAS AND MY
DIALYSIS AND TRANSPLANT JOURNEY
WASN'T AS STRINGENT AND TOUGH AS
OTHER PEOPLE I SAW ON DIALYSIS.
SO I WANTED TO USE MY VOICE TO
BE AN ADVOCATE FOR PEOPLE WHO
WERE SUFFERING BECAUSE I FELT MY
BACKGROUND LENDED ME THAT
CREDIBILITY TO SAY I PLAY
FOOTBALL AND I CAN CHANGE THE
SUBJECT MATTER AND TALK ABOUT
WHAT I REALLY WANT TO TALK
ABOUT.
I HAVE REALLY USED THAT IN MY
CAREER NOW TO HELP PEOPLE
NAVIGATE THE SYSTEM AND NAVIGATE
THE COMORBIDITIES AND THE WORK
WITH THE HEALTH CARE SYSTEM TO
SAY BECAUSE YOU'RE DIFFERENT
THEN NORM, YOU CAN STILL HAVE
THE SAME TREATMENT AS THE NORM.
AND WORKING THROUGH THE WHOLE
PROCESS GOES WAY BACK.
MY MOTHER RECEIVED A KIDNEY
TRANSPLANT BUT DIED PASSED WHEN
I WAS 13 YEARS OLD MAKING THE
TRANSITION AND HOPEFULLY WHAT I
CAN BRING IS WITHOUT HAVING
COMMUNITY PARTNERS INVOLVED IN
DECISION MAKING, I TRULY BELIEVE
YOU'RE GOING DOWN THE WRONG ROAD
AND BRINGING COMMUNITY PARTNERS
TO HEAR WHAT THE COMMUNITY NEEDS
WE CAN ALL GO DOWN THE SAME ROAD
AND HOPE TO HAVE BETTER
OUTCOMES.
THANK YOU FOR ALLOWING ME TO BE
HERE AND GIVE SOME INSIGHT FROM
MY PERSPECTIVE.
>> I'D LIKE TO THANK ALL THREE
OF MY PANELISTS.
TO THE WERE VERY MOVING
COMMENTS.
MY NAME IS GLENDA ROBERTS.
I'M AN AFRICAN AMERICAN
HETEROSEXUAL TRANSPLANT
RECIPIENT WITH -- CAN YOU HEAR
ME?
I'M PROUD TO HAVE AN OPPORTUNITY
TO INTERFACE WITH THIS PANEL.
YOU GUYS HAVE DONE A GREAT JOB
OF ADDRESSING OUR PRIMARY
QUESTION WAS TO ASK YOU ABOUT
YOUR EXPERIENCES WITH RACISM,
MARGINALIZATION AND
DISCRIMINATION -- OKAY.
TELL ME WHEN YOU WANT ME TO
START.
YOU CAN HEAR ME ONLINE BUT NOT
IN THE ROOM.
>> YOU CAN HEAR US BUT WE CAN'T
HEAR YOU AND THEY'RE TO FIX THE
AUDIO COMING INTO THE ROOM.
IF YOU CAN CHECK YOUR MIC AND
MAKE SURE -- CAN YOU HEAR ME IN
THE ROOM NOW?
I HAVE A REQUEST -- ARE THOSE
ONLINE ALSO IN THE ROOM, COULD
YOU ASK SHEENA TO GO AHEAD WITH
THE QUESTIONS.
>> THANK YOU, GLENDA.
HOPEFULLY WE CAN HEAR FROM YOU
IN THE RAM.
I'LL PROCEED WITH OUR FIRST
QUESTIONS.
CAN YOU SHARE WITH US WHAT YOU
SEE IN THE COMMUNITY.
>> OKAY.
I JUST WANT TO -- I CAN START.
IS THAT OKAY?
OKAY.
SO THINKING ABOUT THE QUESTIONS
AND WHAT I LEARNED LIKE I SAID
MY DAD WAS DIAGNOSED END STAGE
RENAL DISEASE I THOUGHT WE WERE
PRIVILEGED SITUATION OR PLACE
BECAUSE I KNEW THE SYSTEM,
RIGHT.
I WAS A SPANISH INTERPRETER.
S THEY DIDN'T OFFER US ANYTHING
AND I USED TO ENCOURAGE HIM LIKE
WE SHOULD BE THANKFUL AND YOU
ARE IN THE POSITION YOU CAN GET
BENEFITS AND A CENTER TO GET
DIALYSIS AND INTERPRETING FOR
INDIVIDUALS AT THE HOSPITAL THAT
WERE REAL SICK AND COULDN'T GET
DIALYSIS BECAUSE THEIR POTASSIUM
WAS LOW OR WASN'T HIGH ENOUGH.
I USED TO TELL MY DAD, WE'RE
LUCKY, WE CAN GO TO A CENTER AND
THERE'S PEOPLE THAT CAN'T.
THAT'S WHAT I THINK THEN I START
WORKING WITH THE PATIENTS AFTER
MY DAD PASSED AWAY AND THEY
DECLINED FAST ER AND THE PEOPLE
THAT WAS HERE WORKING TRYING TO
SURVIVE FOR FAMILIES WERE AT THE
HOSPITAL EVERY WEEK AND THEIR
LIFE CHANGES.
AND THERE'S NO SAFETY NET AND
CAN GO TO THE CENTER BUT THEY
DON'T HAVE TRANSPORTATION, THEY
DON'T HAVE A RESOURCES LIKE FOOD
STAMPS.
THERE'S PANTRIES AVAILABLE BUT
DON'T HAVE TRANSPORTATION AND
THE PATIENTS DECLINE.
AND I SAW THE PEOPLE THAT DIDN'T
HAVE AND COMPARED TO PEOPLE THAT
HAVE FAMILY SUPPORT AND HERE
LIVING BY THEMSELVES BECAUSE
THEY CAME HERE FROM THEIR
COUNTRY.
THEY DIDN'T HAVE SUPPORT OR
ANYTHING AND BECAUSE THE
ILLEGALS, THEY DON'T HAVE
PAPERS, I'LL SAY THAT, THEY'RE
NOT ELIGIBLE FOR ANYTHING.
>> I THINK I'LL START WITH
THINKING ABOUT WHEN I FIRST
BECAME ACQUIRE -- AWARE AND
STARTED WITH FIND AS A LESBIAN
IN OUR COMMUNITY WE NEEDED TO
FIND PLACE TO GO AND GET MEDICAL
CARE AND IN MY COMMUNITY THAT
WAS A PLANNED PARENTHOOD.
IT WAS KNOWN AND IN MY EARLY 20s
IT WAS KNOWN AROUND MY NETWORK
OF LESBIAN FEMINISTS IN
CLEVELAND, PLANNED PARENTHOOD IS
A PLACE YOU COULD GO AND BE
RESPECTED AND BE OUT AND SAY I'M
A LESBIAN AND I DON'T HAVE SEX
LIKE THIS BUT LIKE THAT AND I
WAS REFERRED TO ANOTHER
GYNECOLOGIST BECAUSE THE NURSE
TOLD ME I MAY HAVE FIBROIDS.
I DIDN'T KNOW WHAT THEY WERE BUT
SENT ME OVER AND SAID GET
ANOTHER DOCTOR AND GO CHECK
THESE OUT AND A DID AND FOUND
OUT SHE WAS RIGHT AND SO I WAS
HAPPY FOR THAT INTERVENTION AND
I LEARNED ALL ABOUT FIBROIDS.
I WAS PARTNERED AT THE TIME AND
WE HAD PLANS TO HAVE CHILDREN
AND I WAS PLANNING TO BE THE
BIRTH MOM AND I SAW THE
GYNECOLOGIST AND BASICALLY SHE
CAME TO TALK TO US BOTH AND LET
ME KNOW AT 27 I WOULD NEED TO
HAVE A HYSTERECTOMY AND MY THEN
PARTNER WHO WAS WHITE AND THIS
IS ABOUT MY PROXIMITY TO
WHITENESS AND THINK IT SUPPORTED
ME AROUND GETTING BETTER CARE,
SAID, OH, NO, WE DON'T WANT TO
HAVE A HYSTERECTOMY, TALKING
ABOUT ME.
WE DIDN'T BUT WE WANT TO HAVE
CHILDREN AND THE WHITE PHYSICIAN
SAID TO US, THEN YOU HAVE THE
BABY AND POINTED TO HER AND SHE
SAID IT'S NOT GOING TO COME OUT
OF MY BODY, THIS ABOUT HER AND I
LEARNED ABOUT MYOMECTOMY AND I
DON'T THINK IF I HADN'T BEEN
WITH AMY MY CO-PARENTING PARTNER
QUESTIONING IT I THINK IT STARTS
THERE.
FAST FORWARD MY EXPERIENCE WITH
MEDICAL CARE AFTER I HAD A
PREMATURE CHILD BY THIS TIME I'M
32.
BY THE THAT TIME MY SON IS NOW
36 AND GETTING MARRIED IN AUGUST
WAS BORN TWO POUNDS 14 OUNCES IN
A HOSPITAL RIGHT IN THE HOOD AND
LIVED IN A SUBURB BUT THAT'S
WHERE MY DOCTOR PRACTICED OUT OF
AND WHERE I DELIVERED.
THE EXPERIENCE OF ANTI-BLACK
BIAS I KNOW OF NOW, I KNEW TO
CALL IT THERE AND THE MICRO
AGGRESSIONS BUT I WAS FIERCE AND
HAD A BABY COMPLETELY HEALTHY
BUT TINY.
THROUGHOUT MY PREGNANCY I'M A
BIG CURVY WOMAN, I WOULD BE
ASKED IF I MAYBE USED DRUGS
BECAUSE I WAS GAINING WEIGHT AND
I WAS VEGETARIAN AND MY MAMA WAS
BLACK AND SAID EAT SOME MEAT AND
I DEALT WITH THOUGHT OF LITERACY
AND DIDN'T THINK THAT I COULD
READ AND I KNOW THAT IS AN
PROBLEM IN THAT AREA AND IT WAS
INFURIATING AND I HAD THIS KID
AND IN THE HOSPITAL AND THEY'RE
NOT TREATING ME RIGHT AND IT WAS
ANTI-BLACK BIAS AND RACISM.
THAT WAS MY FIRST EXPERIENCE OF
IT.
SO COMING IN INTO THE INTERACIAL
RELATIONSHIP AND LESBIANS AND
OUT AND FAST FORWARD QUICKLY, IF
THAT'S POSSIBLE I GET TO A PLACE
WHERE I'M AN ADULT.
MY KID IS FINE.
I BIRTHED MY SON AND CAUGHT MY
DAUGHTER.
MY CO-PARENTING PARTNER HAD OUR
DAUGHTER AND THEY'RE 26 AND 18.
AND YOU WOULD LOVE INTERACTING
WITH THEM.
I'M DOING MY THING.
I'M NOW 56, 57, SOMETHING LIKE
THAT, CO-PARENTING PARTNER WE
FIGURED IT OUT AND I GET SICK.
FOR THREE MONTHS I'M REALLY SICK
WITH FATIGUE, I'M LOSING WEIGHT.
I CAN BARELY WALK FROM HERE TO
THERE AND DRINKING PROTEIN TO
GIVE ME SOME ENERGY.
I'M CONNECTED TO A HEALTH
SYSTEM.
I'VE GONE THROUGH EVERY
DEPARTMENT LIKE FROM THEY'RE
TESTING EVERYTHING LIKE THEY
THOUGHT I HAD LYME'S DISEASE AND
ASKING ME QUESTIONS AND GET TO
THE GYNECOLOGIST AND I'M IN
THERE.
HE ALREADY DOESN'T THINK THAT
WHATEVER IS GOING ON WITH ME HAS
ANYTHING TO DO HOW HE COULD CARE
FOR ME.
AND I REMEMBER BEING IN THE
DOCTORS OFFICE AND SAYING I
DON'T WANT TO BE I DON'T WANT
YOU TO DISMISS WHAT I'M SAYING
AROUND WHAT'S GOING ON WITH ME.
YOUR NOT LISTENING TO ME.
YOU ALREADY LET ME KNOW BY YOUR
ATTITUDE YOU DON'T THINK I CAN
HELP AND I DON'T UNDERSTAND THAT
AND KNEW HOW TO ADVOCATE FOR
MYSELF AND HAD THE WORSE BIOPSY.
IT WAS THE WORSE EXPERIENCE I'VE
EVER HAD IN TERMS OF A
GYNECOLOGICAL EXPERIENCE AND
CAME OUT OF THERE AND WROTE A
LETTER QUICKLY ON THE MY CHART
SITUATION AND IF THIS PERSON
RESPECTED ME MORE AND GIVEN ME
MORE CARE AND LISTENED TO ME I
THINK SOMETHING BETTER COULD
HAVE HAPPENED.
I BELIEVE THAT SITUATION AND NOW
I'M ON TO ONTOLOGY.
THEY CAN'T FIGURE OUT WHAT'S
GOING ON.
MY WHITE BLOOD COUNT IS CRAZY.
I'M NOT GETTING ANY BETTER.
IT'S THE CANCER STUFF, ONCOLOGY
AND THEY'RE LOOKING AT THAT AND
TAKING MY BLOOD OUT AND PUTTING
IT BACK IN AND DOING ALL THIS
CRAZY STUFF LIKE WILD.
I GO ON SOCIAL MEDIA AND SAY I
NEED HELP AND I HAVE SOME
PRIVILEGE AND GET KNOW SOMEONE
IN A DIFFERENT HOSPITAL SYSTEM
TO CALL SOMEONE IN ANOTHER
HOSPITAL SYSTEM TO SEE IF I CAN
GET IN TO SEE A DIFFERENT
DOCTOR.
LONG STORY SHORT, I HAD I HAD
THE MYOECTOMY AND SIT CALCIFIED
WHEN IT GETS OLD FIBROIDS THAT
WERE MISSED IN ALL OF THE OF ALL
THE X-RAYS AND A TEAM OF WOMEN,
WHICH I LOVE AS A FEMINIST, IF
YOU KNOW, YOU KNOW.
I'M IN THE EMERGENCY ROOM AND
EXHAUSTED AND BARELY BREATHE.
YOU ALL ARE SCIENTISTS.
IT WAS GROSS.
THEY WALK IN AND SHE'S EXHAUSTED
AND SIT ON THE SIDE ON THE
LITTLE STOOL AND THAT'S WHO PAID
ATTENTION TO ME AND LISTENED TO
ME BUT I TOOK ALMOST THREE
MONTHS AND NO ONE WOULD TREAT ME
BECAUSE THEY COULDN'T FIND THE
SOURCE OF MY ILLNESS.
AND PEOPLE DIDN'T BELIEVE HOW
SICK AND WAS IT BECAUSE I WAS
BLACK?
BECAUSE I WAS LESBIAN OR BECAUSE
I CHOSE TO USE THE PUBLIC
HOSPITAL I TRUSTED?
I GOT BETTER CARE THERE THAN THE
OTHER ONES INITIALLY BY SOME
DOCTORS BUT IT WAS MADDENING.
IF I TALK ABOUT IN TODAY'S TERM
AR OR WHEN I TALK ABOUT MY MOM
AND THE CHALLENGES AROUND I'M
THE OLDEST OF GEN X BUT I FEEL
MORE LIKE A BOOMER BECAUSE MY
BROTHER AND MOM ARE BOOMERS AND
RAISED IN A HOUSEHOLD AND SORT
OF HAVE BOOMER VALUES, DON'T
TELL THE YOUNG PEERM.
-- PEOPLE.
I KNOW IT'S IMPORTANT WE
ADVOCATE FOR OURSELVES I KNOW
ABOUT MARGINALIZATION AND
DISCRIMINATION AND ANTI-BLACK
BIAS THAT'S WORLDWIDE AND ALL
THOSE THINGS AND HOW IT'S WITHIN
OUR SYSTEMS AND KNOW ABOUT
INTERNALIZED OPPRESSION AND
THAT'S WHAT I SEE IN MY MOM.
WHEN I'M IN THE ROOM WITH HER,
LETTING FOLKS KNOW SHE HAS
PEOPLE, ME AND MY BROTHER.
SHE HAS FOLKS TO ADVOCATE FOR
HER.
I ARGUE WITH HER ABOUT ALLOWING
ME TO ADVOCATE BECAUSE OF THE
DIFFERENCE OF RESPECTABILITY AND
POLITICS AND DOCTORS KNOW MORE
AND I SAY, MOM, THEY KNOW MORE
ABOUT SCIENCE BUT DON'T KNOW HOW
BLACK PEOPLE ARE TREATED AND HOW
WE EXPERIENCE RACISM AND SEXISM
AND CLASSISM AND WHAT HAPPENS
WHEN YOU HAVE INTERSECTING
IDENTITIES.
I'M FIRED UP ABOUT THIS AND
THINKING BIT IN TERMS OF MYSELF
AND MY OWN EXPERIENCES BUT AS
THAT PERSON WHO WILL BE THERE
FOR MY MOM TO HELP HER LIVE
PASSED 78.
SHE'S 78 THIS YEAR.
>> IN THE STATEMENT OF GEORGIA
THERE'S A LACK OF INFORMATION
AND HEALTH CARE FOR PEOPLE OF
COLOR IN THE STATE.
AND FOR ME PERSONALLY I DON'T
THINK I HAVE TOO MUCH
DISCRIMINATION AND AM VERY VOCAL
AND KNOW HOW TO FIGHT FOR ME BUT
WHEN IT'S DONE TO OTHERS AND SEE
IT HOW CAN YOU SIT AND ALLOW IT
TO HAPPEN?
WHEN I SEE PEOPLE NOT BEING
TREATED FAIRLY IS WHEN I TRY TO
STEP IN AND USE MY ABILITIES AND
MY KNOWLEDGE TO GIVE THEM
INSIGHT ON MAYBE QUESTIONS TO
ASK TELLING THEM DON'T GO TO THE
DOCTOR BY YOURSELF.
TAKE A BUDDY WITH YOU.
SOMETIMES WHEN YOU GET
INFORMATION FROM HEALTH CARE
PROFESSIONALS I BELIEVE IN THE
BLACK COMMUNITY ANYTIME YOU WEAR
A WHITE COAT YOU WEAR
EVERYTHING.
THEY SAY IT'S PRACTICING
MEDICINE BUT I BELIEVE THEY'RE
PRACTICING SO THEY DON'T KNOW
EITHER AND WHEN YOU ASK A LOT OF
QUESTIONS AND HAVE A BUDDY WITH
YOU AND WHEN YOU GET THE
INFORMATION YOU HEAR SOMETHING
NEGATIVE YOU HAVEN'T HEARD
ANYTHING ELSE THE DOCTOR OR
NURSE OR ANYONE SAID BUT WHEN
YOU HAVE A BUDDY TO HELP YOU
UNDERSTAND WHAT WAS STATED BUT
IT'S SO SAD WHEN YOU'RE GIVEN
SOME INFORMATION AND IT'S NOT
CORRECT OR IT'S INFORMATION THAT
YOU'RE GIVE JON JUST TO GET OUT
OUT OF THE WAY.
THAT'S WHAT THE COMMUNITY
BELIEVES.
WHEN YOU LOOK AT DISCRIMINATION
IT ALWAYS SEEM TO BE TO PEOPLE
OF COLOR AND SEE HOSPITALS
CLOSING UP ONLY IN COMMUNITIES
OF COLOR.
WHEN YOU SEE HEALTH CARE SYSTEMS
MOVING OUT AND YOU'RE SAYING IF
SOMETHING HAPPENS YOU HAVE TO
DRIVE OVER AN HOUR TO GET
TREATMENT AND THE MINUTE CLINICS
JUST DON'T DO IT.
WHEN YOU LLOOK YOU LOOK AT THOS
THINGS YOU HAVE TO SEE WHY IT'S
HAPPENING AND THE HISTORY AND
VOLUME OF INEQUITY AND UNFAIR
TREATMENT TO PEOPLE OF COLOR AND
NOW YOU LOOK AT THE HEALTH CARE
SYSTEM AND IT'S THE SAME THING.
YOU JUST HAVE A BIGGER FIGHT
BECAUSE NOW WE'RE FIGHTING ABOUT
MY LIFE, NOT THE SOCIAL NEEDS
BUT MY HEALTH AND MY LIFE.
FORMING GROUPS AND COMMUNITY
VOICES FOR THE VOICELESS IS WHAT
I SEE ON A DAILY BASIS
THROUGHOUT THE STATE OF GEORGIA.
>> THANK YOU.
TO BRING THIS SESSION TO A CLOSE
TO HAVE TIME FOR YOUR RESPONSES,
I WOULD ASK WHAT ADVICE YOU
COULD GIVE TO THE RESEARCH
COMMUNITY HOW DISCRIMINATION
IMPACTS HEALTH?
ARE THERE AREAS OR TOPICS YOU
IDENTIFY AS A PRIORITY IN THE
SPACE FOR RESEARCHERS TO WORK
ON?
>> WHAT A WOULD LIKE TO SEE IS
MORE PEOPLE LIKE US A PART OF
YOUR RESEARCH STUDIES.
I THINK SOMETIMES WHEN THERE'S
GROUPS PUT TOGETHER WE GO FOR
THE HIGH PEOPLE NOT THE MEDIUM
OR LOW PEOPLE AND SOMETIMES
DON'T VALUE OR THINK THEY'RE
PIN -- OPINION IS WHAT WE REALLY
WANT.
IF YOU THINK ABOUT WHO YOU
REALLY NEED AT THE TABLE IT'S
THE PEOPLE WHO YOUR RESEARCH IS
GOING TO AFFECT.
SO YOU MUST HAVE THAT OPINION
FROM THE HEALTHY PEOPLE THEIR
OPINION IS DIFFERENT THAN MINE.
I TELL MY FRIENDS ON A DAILY
BASIS, I SAY YOU GOT TO GO TO
THE DOCTOR AND I SAY I KNOW
WHAT'S WRONG WITH ME BECAUSE GO
TO THE DOCTOR BUT YOU DON'T KNOW
WHAT'S WRONG WITH YOU BECAUSE
YOU DON'T KNOW.
SOMETIMES WE GET OPINIONS
INTEREST PEOPLE WHO WILL JUST
GIVE THEIR OPINION TO BE A PART
OF SOMETHING.
IF THERE'S ANY FIELD OR RESEARCH
THAT I WOULD LIKE TO SEE IT'S
RESEARCH ON WHEN IT COMES TO
HEALTH IS WHAT CAN HAPPEN IF
YOUR COMMUNITY PLAYED A BIGGER
ROLE AND WHAT DOES YOUR
COMMUNITY NEED TO MAKE A
DIFFERENCE IN YOUR OVER ALL
HEALTH THAT'S WHAT I WOULD LIKE
TO SEE HAPPEN BECAUSE DON'T
THINK THE QUESTION'S BEING ASKED
OF THE COMMUNITIES WHO ARE
SUFFERING.
I THINK IF WE DO SOME OF
RESEARCH AND ASK WHAT DOES YOUR
COMMUNITY NEED?
WE THINK WE NEED A LOT OF IT BUT
IT'S THE FINE LINE THINGS WE
DON'T KNOW ABOUT.
THAT'S WHAT I WOULD LIKE TO SEE.
THANK YOU.
>> I HAVE SOME EMPATHY OR WANT
TO GIVE GRACE TO MEDICAL
PROFESSIONALS IN SOME WAYS I
THINK INFORMATION RACISM IS AN
ANTI-BLACK BIAS AND
MARGINALIZATION OF PEOPLE AND
UNDERSTANDING DOMINANT CULTURAL
RULES AROUND POWER IS SOMETHING
IS AN ONGOING JOURNEY OF
LEARNING AND CHALLENGE AND
STRETCHING YOURSELF AND BEING
UNCOMFORTABLE AND THEN I THINK
OF WHAT I IMAGINE THE PACE OF
BEING A MEDICAL PROFESSIONAL, WE
SEE IT IN DOCTOR'S OFFICE WHEN
WE'RE HANDED SOMETHING TO GET US
OUT.
WE'RE NOT DUMB.
WE KNOW.
WE KNOW WHAT'S HAPPENING.
WE SEE THE RUSH.
SOMEBODY -- A DOCTOR WHO WAS
TELLING US AFTER WE WAITED THREE
HOURS FROM MY MOM'S OUT PATIENT
SURGERY TO BE CANCELLED WHEN I
SAID IT'S NOT GOING TO BE HARD
FOR US TO RESCHEDULE BECAUSE I'M
HER PERSON AROUND TRANSPORTATION
AND I'M LEAVING FOR A
CONFERENCE.
HE SAW MY MOM TRYING TO
ACQUIESCE AND ME ADVOCATING AND
PATTING HER ON THE HEAD, Y'ALL.
IN MY CASE IT READ IF THIS
PHYSICIAN DOESN'T KNOW THAT
PLACATING MY MOTHER BY DOING
THAT AND DOESN'T UNDERSTAND THAT
BLACK PEOPLE SPECIFICALLY BLACK
WOMEN ARE NOT BELIEVED ABOUT OUR
PAIN AND HE NEEDS MORE TRAINING.
DON'T FIGHT US.
DON'T DISMISS US ABOUT WHAT
WE'RE SAYING AND NEED.
FIGHT INSURANCE COMPANIES.
FIGHT WHAT YOU ARE HEARING ABOUT
ROLLING BACK TRAINING FOR
DIVERSITY, EQUITY, INCLUSION AND
BELONGING AND ACCESS.
WITH YOUR DIRECT SERVICE AND
RESEARCH AND ALL THAT, WE ALL
SOME HAVE POWERS ABOUT YOU ALL
BEING GREAT AND TAKING CARE OF
ALL TEAM BECAUSE THAT'S WHAT YOU
WANT TO DO.
I SAW A GLASS HALF FULL.
TARGETINGIOR MOTHER OR ADVOCACY
AROUND NOT FIGHTING AGAINST
INSURANCE AND WHAT MAKES YOU
TREAT US LIKE WIDGETS, OPPOSED
TO PEOPLE, FIX IT.
>> I'M GOING MIRROR BOBBY.
WE NEED MORE PEOPLE LIKE US IN
THE RESEARCH SPACE.
DOING RESEARCH MYSELF NOW WITH
DR. CERVANTES I RESONATE WITH
PEOPLE AND WE IDENTIFY.
CULTURALLY HAVE MORE PEOPLE ON
YOUR TEAM CULTURALLY APPROPRIATE
AND LATINOS ARE BIG ON RELIGION
AND GOD AND INFORM YOURSELF.
GET THE CULTURED PIECE ON YOUR
RESEARCH.
THAT'S GOING TO HELP YOU A LOT.
SPEAK THE LANGUAGE.
THAT'S VERY IMPORTANT.
DON'T HAVE SOMEBODY THAT WENT TO
GUATEMALA ONE YEAR AND LEARNED
SPANISH.
SPEAK THE LANGUAGE, THE LANGUAGE
CULTURALLY SO YOU CAN
COMMUNICATE.
IT'S FUNNY, RIGHT NOW WE'RE
DOING SOME INTERVIEWS AND WE'RE
ASKING PATIENTS IN DIALYSIS WHAT
WORKS IN RESEARCH.
RIGHT NOW THEY HAVE NO
EXPERIENCE WITH RESEARCH.
NOBODY'S APPROACHING THEM TO ASK
DO YOU WANT TO BE PART OF THE
STUDY.
IF THEY DO, THEY DON'T DO A GOOD
JOB EXPLAINING.
I HAD A PATIENT IN THE TRIAL AND
IT WAS A NEW MEDICATION FOR
PHOSPHORUS THE POWDER, SHE
DOESN'T KNOW WHAT IT WAS FOR.
AND ANOTHER PATIENT WHO ASKED
EVERY TIME ARE YOU TAKING THE
MEDICINE AND SHE WASN'T TAKING
IT AND SHE COULDN'T ASK.
THE RESEARCH ASSISTANT WASN'T
SPEAKING THE LANGUAGE.
THEY WERE LIKE, HERE, I DON'T
KNOW.
IF YOU WANT TO INCLUDE THE
ATLANTA COMMUNITY HAVE SPANISH
SPEAKERS NATIVES IF YOU CAN.
SPEAK THE LANGUAGE AND GIVING
RESULTS AND I HEARD PEOPLE
SAYING I PARTICIPATED IN THIS
BUT I DON'T KNOW WHAT HAPPENED
AFTER.
WHAT HAPPENED?
DID I HELP SOMEBODY?
GIVE THEM RESULTS.
THINGS TO LOOK FORWARD TO AND WE
HELP WITH THE MISTRUST.
LATINOS DON'T LIKE TO
PARTICIPATE BECAUSE DON'T WANT
TO BE THE GUINEA PIGS, RIGHT.
THAT WILL GIVE YOU MISTRUST AND
INCLUDE PEOPLE.
YOU WILL INCREASE THE FORCE WITH
LATINOS AND PEOPLE LIKE ME THAT
WANT TO DO BETTER IN THE
COMMUNITIES.
>> THANK YOU SO MUCH TO ALL OF
YOU FOR SHARING YOUR
PERSPECTIVES.
>> THANK YOU.
>> THAT WAS FANTASTIC.
THANK YOU.
SINCE WE'RE RUNNING 15 MINUTES
BEHIND SCHEDULE I WANTED TO GIVE
FOLKS A FEW QUICK UPDATES BEFORE
GOING TO LUNCH.
SO WE'RE GOING TO TROUBLE SHOOT
THE AUDIO TO HOPEFULLY HEAR FROM
GLENDA AFTER LUNCH BRIEFLY SINCE
SHE DIDN'T GET TO GIVE COMMENTS.
APOLOGY FOR THE TECHNICAL
DIFFICULTIES AND HOPEFULLY WE'LL
GIVE GLENDA AN OPPORTUNITY TO
SPEAK BRIEFLY WHEN WE COME BACK
FROM LUNCH.
SINCE WE'RE 15 MINUTES BEHIND,
I'M GOING TO CUT FIVE MINUTES
FROM LUNCH AND TRY TO GET US A
LITTLE BIT BACK ON SCHEDULE.
IF WE CAN AIM TO GET BACK HERE
AT 12:20.
THERE'S BOX LUNCHED SO THAT
SHOULD MAKE THE PROCESS QUICKER
AND APOLOGIES FOR SOME OF THE
TECHNICAL DIFFICULTIES.
FIRST I'D LIKE TO THANK THE
PANELISTS.
I THINK YOU DID A FANTASTIC JOB
AND AN APPRECIATE THE
OPPORTUNITY TO MAKE A FEW
COMMENTS.
FOR THOSE WHO KNOW ME KNOW I'M
VERY RESULTS ORIENTED AND THE
QUESTION SHOW CAN WE ACTUALIZE
THE FEEDBACK WE'VE RECEIVED FROM
OUR PANELISTS.
I MADE A FEW NOTES BUT BEFORE I
DO, I'D LIKE TO ENCOURAGE YOU TO
DO AN EXERCISE EITHER TONIGHT OR
THIS EVENING OR WHENEVER YOU
HAVE A CHANCE IN TERMS OF
INTRODUCING YOURSELVES.
THIS EXERCISE IS IMPORTANT
BECAUSE IT GIVES YOU A
PERSPECTIVE ON YOUR POSITION AS
IT RELATES TO RACISM,
MARGINALIZATION AND
DISCRIMINATION IN YOUR
COMMUNITY.
AND I'LL GIVE YOU AN EXAMPLE.
SO WHEN I INTRODUCE MY SELF-I
SAME I'M GLENDA ROBERTS, AFRICAN
AMERICAN I IDENTIFY AS BLACK OF
MIXED RACE AND KIDNEY TRANSPLANT
RECIPIENT AND WORK IN PATIENT
ENGAGEMENT FOR THE KIDNEY
RESEARCH INSTITUTE AT THE
UNIVERSITY OF WASHINGTON'S
CENTER FOR DIALYSIS AND
INNOVATION.
IF YOU LISTEN TO THOSE THINGS
YOU THINK WELL OTHER THAN BEING
BLACK AND HETEROSEXUAL, I
PROBABLY HAVEN'T HAD A LOT OF
EXPERIENCE WITH RACISM.
BUT THE REALITY IS IN MY
PROFESSIONAL LIFE I THINK I'VE
HAD MORE OF AN EXPERIENCE THAN
THE PERSONAL LIFE BECAUSE I MORE
OR LESS CONTROL THIS
ENVIRONMENT.
I ASK YOU TO DO THIS EXERCISE
TONIGHT TO THINK ABOUT YOUR
RELATIONSHIP TO R&D AND HOW TO
IMPACT CHANGE.
AND IN TERMS OF YOUR RESEARCH, I
HAVE SOME SPECIFIC THINGS THAT I
WANTED TO HIGHLIGHT.
I THOUGHT THAT BOBBY AND CLAUDIA
DID A GREAT JOB WHEN THEY
TALKED --
[NO AUDIO]
ONE OF THE THINGS I THINK WE CAN
DO AS RESEARCHERS IS TO MAKE
SURE THAT WE ASK PEOPLE TO
PARTICIPATE.
WE KNOW THAT THE PUGH OF
RESEARCH SAYS AFRICAN AMERICANS,
LATINX ARE ALL INTERESTED IN
RESEARCH AND THINK IT'S A GOOD
THING.
AS A MATTER OF FACT, MORE THAN
65% OF AMERICANS THINK
PARTICIPATION IN RESEARCH SAY
GOOD THING.
THE PROBLEM IS WHEN YOU LOOK AT
THE PARTICIPATION OF BLACK
AMERICANS, LATINX AND OTHER
PEOPLE OF COLOR, WE HAVE A
RELATIVELY LOW PARTICIPATION
RATE.
AND THAT'S BECAUSE NOBODY ASKED
US.
I ENCOURAGE YOU TO ASK PEOPLE TO
PARTICIPATE.
AND WHEN I ASK PEOPLE WELL, WHY
DON'T YOU ASK PEOPLE TO
PARTICIPATE BECAUSE WE KNOW YOU
CAN TALK, THEY GENERALLY SAY,
I'M NOT COMFORTABLE WITH THE
CONVERSATION THAT WILL FOLLOW.
BECAUSE IF I'M ASKING ANYBODY
OTHER THAN YOU, GLENDA, I
PROBABLY HAVE TO HAVE THE
CONVERSATION AROUND TRUST AND
ADVERSE IMPACTS PEOPLE HAVE HAD
HISTORICALLY WITH RACISM.
I WOULD ENCOURAGE EACH OF YOU TO
HAVE THAT CONVERSATION.
YOU KNOW, SHOW SOME EMPATHY BUT
BE OPEN AND HAVE THE
CONVERSATION AND BE PREPARED FOR
SOME DIFFICULT QUESTIONS AND
HAVE IT BE OKAY TO SAY I DON'T
KNOW.
I ENCOURAGE YOU TO TRY TO HAVE
MORE PEOPLE WHO ARE IN THE
RESEARCH ROLES WHETHER WE'RE
TALKING ABOUT RESEARCHERS,
RESEARCH COORDINATORS, BE
REFLECTIVE OF THE PEOPLE THAT
YOU ARE TRYING TO ATTRACT TO THE
TRIALS.
WHEN CLAUDIA WAS TALKING ABOUT
THE IMPORTANCE OF CULTURAL
SENSITIVITY, I CAN TELL YOU JUST
SEEING SOMEBODY IN THE ROOM THAT
LOOKS LIKE ME GIVES ME A GREATER
DEGREE OF COMFORT.
AND THE THIRD AND FINAL THING I
WOULD LIKE TO EMPHASIZE IS I
ENCOURAGE YOU TO RECRUIT PATIENT
ADVISORY BOARDS AND COUNCILS.
SO IN THE CASE OF THE KIDNEY
PRECISION MEDICINE PROJECT, AND
THE APOLLO STUDY WHICH I'M A
PART OF, WE HAVE DIVERSE
POPULATIONS OF PATIENT PARTNER
RESEARCHERS.
WE ARE TREATED AS EQUAL PARTNERS
IN THE RESEARCH AND I THINK THAT
IS SO IMPORTANT BECAUSE WHEN
KWLUR TRYING TO ATTRACT PEOPLE
WHEN YOU TRY TO SHOW A PICTURE
OF PANELISTS THAT LOOK LIKE THE
PEOPLE YOU WANT TO ATTRACT, THAT
GIVES PEOPLE GREATER CONFIDENCE
THAT THEY'RE BEING REPRESENTED
IN THE RESEARCH AND THAT
SOMEBODY IS SPEAKING UP ON THEIR
BEHALF.
I THINK IT WAS CLAUDIA WHO SAID
GIVE PEOPLE AN UPDATE ABOUT
WHAT'S GOING ON.
YOU KNOW, AS PATIENTS AND
PATIENTS PARTICIPANTS AND STUDY
PARTICIPANTS, WE RECOGNIZE THAT
YOU CAN'T GIVE US THE END
RESULT, BUT YOU CAN GIVE US
UPDATES AS YOU'RE GOING ALONG
THE WAY.
YOU CAN TELL US HOW MANY PEOPLE
HAVE SIGNED UP, IF YOU HAVE
PUBLISHED ANY PAPERS.
SO THERE ARE LOTS OF WAYS THAT
YOU CAN BUILD TRUST, ENGAGE
PEOPLE, AND GET GREATER FEEDBACK
FOR PARTICIPATION IN YOUR
STUDIES.
AND I'D LIKE TO THANK YOU FOR
YOUR TIME.
[APPLAUSE]
>> SORRY, GLENDA.
I HAD TO RUN UP TO THE FRONT OF
THE ROOM.
>> NO PROBLEM.
>> THAT WAS FANTASTIC.
THANK YOU FOR THOSE COMMENTS.
SO NEXT UP, WE HAVE OUR PANEL ON
EPIDEMIOLOGY.
SO BEFORE I INVITE THAT PANEL TO
THE STAGE, I JUST WANT TO MAKE
TWO QUICK ANNOUNCEMENTS.
IF YOU DID NOT HAVE A CHANCE TO
ORDER LUNCH, PIZZA IS ON THE
WAY, IT SHOULD BE HERE AROUND
1:00, AND IF YOU ARE STILL
LOOKING FOR THE WIFI CODE, IT IS
417.
THANK YOU.
>> SINCE WE'RE RUNNING TIGHT ON
TIME, CAN I HAVE THE PANELISTS
JUST COME UP HERE AND SIT SO WE
DON'T HAVE TO WAIT IN BETWEEN?
YES, RUN!
[LAUGHTER]
SO THIS IS THE EPIDEMIOLOGY OF
RACISM, MARGINALIZATION AND
DISCRIMINATION IN NIDDK
DISEASES.
WE HAVE THREE PRESENTERS TODAY
AND THEN WE'LL DO QUESTIONS AT
THE END.
OUR FIRST PRESENTER IS TENE
LEWIS, WHO WILL BE TALKING TO US
ABOUT DISCRIMINATORY STRESSORS
IN AFRICAN AMERICAN WOMEN,
IMPLICATIONS FOR CARDIOMETABOLIC
DISEASE AND SYSTEMIC LUPUS.
>> HI, EVERYONE.
IT'S A PLEASURE TO BE HERE.
I AM A PROFESSOR IN THE ROLLINS
SCHOOL OF PUBLIC HEALTH AT EMORY
UNIVERSITY, FULL DISCLOSURE, I'M
CLATRAINED AS A CLINICAL HEALTH
PSYCHOLOGIST, SO YOU'LL SEE
EVIDENCE OF THAT THROUGHOUT MY
WORK.
NEXT SLIDE, PLEASE.
SO I WANT TO GIVE A BRIEF SORT
OF OVERVIEW OF SOME OF THE WORK
I'VE BEEN DOING THIS AREA, IT'S
WHAT I KNOW BEST AND ABLE TO
ANSWER QUESTIONS ABOUT.
SO WHEN I ENTERED THE FIELD, I
THINK IT'S IMPORTANT TO GIVE A
BIT OF A HISTORY OF THE SCIENCE
IN THIS AREA BECAUSE IF YOU'RE
SITTING IN THIS ROOM, IT'S EASY
TO THINK THAT PEOPLE HAVE ALWAYS
BEEN DOING REALLY GREAT,
INTERESTING CUTTING EDGE
RESEARCH, BUT THAT'S NOT
NECESSARILY THE CASE FOR A LOT
OF SYSTEMIC REASONS.
NOT BECAUSE THE INTEREST AND THE
PASSION WASN'T THERE, BUT
BECAUSE THE OPPORTUNITIES WERE
NOT THERE.
SO WHEN I ENTERED THE FIELD,
THERE WAS A LOT OF THEORETICAL
WORK THAT REALLY ARGUED THAT
DISCRIMINATION SHOULD MATTER FOR
HEALTH.
THERE WASN'T A LOT OF EMPIRICAL
WORK, AND WHAT WAS WAS REALLY
FOCUSED ON SMALL LABORATORY
STUDIES OF CARDIOVASCULAR
ACTIVITY AND SELF-REPORTED
OUTCOMES.
JUST TO GIVE YOU ANOTHER BIT OF
CONTEXT, MOST OF MY WORK IS IN
THE FIELD OF CARDIOMETABOLIC
HEALTH.
AND UP UNTIL 20, 30 YEARS AGO,
THERE WAS NOT A LOT OF WORK
LOOKING AT OBJECTIVE CLINICAL --
CLINICALLY RELEVANT MARKERS OF
DISEASE IN TERMS OF OUTCOMES IN
THIS SPACE.
AND THERE'S BEEN JUST A DRAMATIC
EXPLOSION OF RESEARCH OVER THE
PAST TWO DECADES.
MY FIRST STUDY WAS PUBLISHED
LOOKING AT THE ASSOCIATION
BETWEEN EVERYDAY DISCRIMINATION
AND CORONARY ARTERY
CLASSIFICATION, THAT PART I
WON'T GO INTO AS MUCH BUT I DO
WANT TO TALK ABOUT -- WE SAW IT
IN AFRICAN AMERICAN WOMEN, NOT
WHITE WOMEN, MORE DISCRIMINATION
AMONG AFRICAN AMERICAN REPORTED
THE MORE LIKELY THEY WERE TO
HAVE ANY CORONARY ARTERY CALCIUM
IN THEIR ARTERIES.
THESE FINDINGS WERE PUBLISHED
AND PEOPLE SAID THE WORK WAS
GROUNDBREAKING,
THOUGHT-PROVOKING AND THEN
ALMOST MEANINGLESS, WHICH IS NOT
WHAT YOU WANT TO HEAR.
AND SO I GOT A LOT OF FEEDBACK
FROM SENIOR SCHOLARS AND OTHER
RESEARCHERS IN THE FIELD, SENIOR
SCHOLARS OF COLOR WOULD COME UP
TO ME WHISPERING -- I BELIEVE
THIS, AND THIS IS REAL, THEN I
GOT FEEDBACK FROM OTHER PEOPLE,
DON'T DO THIS TYPE OF RESEARCH
BECAUSE IT MAKES PEOPLE
UNCOMFORTABLE.
AND THAT CAME FROM A PROGRAM
OFFICER, OKAY, AT NIH.
SO THIS WAS 20 YEARS AGO, AND
THAT, FOR ME, IS THE SORT OF
FEEDBACK THAT I GOT CONSISTENTLY
AT THAT TIME.
BUT GOING BACK TO THE PANEL THAT
WE JUST HEARD, WHEN YOU LISTEN
TO PEOPLE AND YOU LISTEN TO
PATIENTS, YOU KNOW THIS IS
SOMETHING REAL THAT IMPACTS
PEOPLE'S LIVES, SO I DECIDED TO
STICK WITH IT, AND HAVE A BODY
OF RESEARCH AND HEALTHY COHORTS
WHERE WE FOUND A LOT OF
DOSE-RESPONSE ASSOCIATIONS WITH
A RANGE OF DIFFERENT INDICATORS
FOR CARDIOMETABOLIC DISEASE,
CRP, VISCERAL FAT, INCIDENT CVD,
INCIDENT DIABETES, AND THIS IS
USING THE MOST CONSERVATIVE
METHODOLOGIES BECAUSE REVIEWERS
FORCED US TO DO IT THAT WAY, YOU
CAN'T CONTROL FOR THIS BUT
CONTROL FOR THAT, SO THIS WAS
SOMETHING THAT REALLY MATTERED
AND THERE WAS A NEED FOR AN
EVIDENCE BASE.
SO WE MOVED PAST THAT NOW AND
NOW I'M ACTUALLY LOOKING AT
OTHER SUBGROUPS OF WOMEN
UNIQUELY VULNERABLE TO A RANGE
OF DIFFERENT --
[NO AUDIO]
-- WOMEN WHO ARE BLACK.
AND IT'S IMPORTANT TO NOTE THAT
AFRICAN AMERICAN WOMEN WITH
LUPUS DIE FROM CARDIOVASCULAR
DISEASE 20 YEARS EAR EARLIER THN
WOMEN WITHOUT, SO I HAVE A GRANT
TO REALLY UNDERSTAND TO WHICH
SOCIAL STRESSORS PLAY A ROLE IN
THAT.
HOWEVER, CHRONIC KIDNEY DISEASE
IS ALSO A MAJOR COMPLICATION.
WHEN I WAS ASKED TO PRESENT HERE
BY A COLLEAGUE, THAT PERSON SAID
YOU HAVE THIS COHORT OF WOMEN
WITH LUPUS, COULD YOU LOOK AT
KIDNEY FUNCTION IN THAT GROUP?
I SAID WELL, WE HAVEN'T, BUT WE
COULD.
SO IT ANOTHER MAJOR CONTRIBUTOR
TO MORBIDITY AND MORTALITY IN
THIS GROUP.
SO THIS IS THE NAME OF MYCOHORT,
MYCOHORT, IT'S ACTUALLY FUNDED Y
NIAMS.
YOU HEARD PEOPLE TALK ABOUT
INTERSECTIONALITY, SO WHAT WE'RE
TRYING TO DO IN THIS COHORT IS
REALLY UNDERSTAND HOW ASPECTS OF
THE LIVED EXPERIENCE, RIGHT, SO
WHAT DOES IT MEAN TO BE A BLACK
A WOMAN IN THIS COUNTRY, WE
FOCUSED ON AFRICAN AMERICAN
WOMEN BECAUSE THAT'S THE
CONTEXT -- NOT TO GO INTO A TON
OF DIFFERENT DETAIL, BUT PEOPLE
WHO EMIGRATE TO THIS COUNTRY
HAVE A DIFFERENT EXPERIENCE, SO
THIS IS THE EXPERIENCE WE'RE
REALLY TALKING ABOUT AND HOW IT
MIGHT CONTRIBUTE TO INFLAMMA
INFLAMMATION, WE HAVE WOMEN WITH
LUPUS AND A GROUP OF WOMEN
WITHOUT LUPUS.
SO WE'RE ASSESSING GENERAL
SOCIAL STRESSORS AS WELL AS
THOSE THAT ARE INTERSECTIONAL IN
ORIGIN.
SO THIS IS A BLACK WOMAN'S
DISEASE, WE WANT TO UNDERSTAND
EXPERIENCES THAT MIGHT BE UNIQUE
TO BLACK WOMEN.
ONE OF THOSE IS THIS CONCERN FOR
CHILDREN, SO THIS IS THE MAYOR
OF ATLANTA DURING THE GEORGE
FLOYD MURDER AND UPRISINGS, AND
SHE ACTUALLY ROSE TO PROMINENCE
FOR THIS SPEECH THAT SHE GAVE ON
THE EVE OF WHAT WAS A MAJOR
UPRISING IN ATLANTA, SO SHE CAME
OUT AND BASICALLY SAID, ABOVE
EVERYTHING ELSE, I AM A MOTHER,
I'M A MOTHER TO FOUR BLACK
CHILDREN IN AMERICA, ONE OF WHOM
IS 18 YEARS OLD, AND WHEN I SAW
THE MURDER OF GEORGE FLOYD, I
HURT LIKE A MOTHER WOULD HURT.
AND SHE WENT ON TO SAY, SO YOU
ARE NOT GOING TO OUTCONCERN ME
OR OUTCARE, BECAUSE I WEAR THIS
EACH AND EVERY DAY.
NURU JETER HAS DONE QUALITATIVE
WORK WITH AFRICAN AMERICAN WOMEN
AND THEY TALKED ABOUT FEELING
RESPONSIBLE FOR PROTECTING THEIR
CHILDREN AGAINST RACISM.
SO THIS IS A MAJOR CONCERN THAT
AFRICAN AMERICAN WOMEN HAVE FOR
THEIR CHILDREN AND ALSO WOMEN OF
OTHER RACES, SANDRA BULLOCK HAS
ACTUALLY SPOKEN ABOUT THIS.
SO HOW THEY'RE WORRIED ABOUT
THINGS THAT THEIR CHILDREN MIGHT
FACE.
SO JUST TO GO INTO SOME DETAILS
ABOUT OUR COHORT, WE HAVE 402
AFRICAN AMERICAN WOMEN, 50% OF
THOSE HAVE LUPUS.
WE LIMITED CURRENT ANALYSIS TO
THOSE WHO ARE PARENTS AND THAT'S
70% OF BOTH GROUPS.
WOMEN HAD TO BE FREE OF HEART
DISEASE AND EQUIVALENTS.
PREMENOPAUSAL, HAD AT LEAST ONE
OVARY, AND FREE OF END STAGE
RENAL DISEASE.
AND THEN WOMEN WITHOUT SLE, NO
AUTOIMMUNE DISEASES.
THIS IS OUR PROTOCOL.
WE DO A FASTING PROTOCOL,
FACE-TO-FACE INTERVIEW, WE HAVE
OUR INTERVIEWERS MATCH RACE AND
GENDER FOR OUR PARPTS PANTS, ALL
SORTS OF THINGS.
SO THIS IS THE SALE.
WE ASKED, SELF-REPORTED, HOW
CONCERNED ARE YOU ABOUT YOUR
CHILDREN GETTING POOR
INSTRUCTION OR BEING IGNORED IN
SCHOOL BECAUSE THEY ARE BLACK,
BEING HARMED OR HARASSED BY THE
POLICE BECAUSE THEY ARE BLACK,
GETTING STOPPED IN A
PREDOMINANTLY WHITE AREA BECAUSE
THEY ARE BLACK, BEING DEALT WITH
MORE HARSHLY THAN WHITE STUDENTS
IN SCHOOL BECAUSE THEY ARE
BLACK, BEING DISCOURAGED FROM
TRYING THINGS OR CRITICIZED
BECAUSE THEY ARE BLACK, BEING
CONSIDERED LESS ATTRACTIVE THAN
THEIR WHITE COUNTERPART PAUSE
TBECAUSETHEY ARE BLACK?
A RANGE OF DIFFERENT DOMAINS,
THESE CONCERNS AND FEARS,
HONESTLY, ABOUT YOUR CHILD'S
EXPERIENCE IN THIS COUNTRY.
I'M NOT GOING TO SHARE THIS PART
BECAUSE THESE ARE UNPUBLISHED
DATA SO I ANALYZED THIS JUST FOR
THE PURPOSES OF THIS CONFERENCE.
SO WE'D LOVE TO HERE YOUR ALL'S
FEEDBACK BUT THIS IS RECORDED
BUT WHAT WE BASICALLY FOUND WAS
THAT THIS LEVEL OF CONCERN WAS
ASSOCIATED WITH LOWER EGFR
LEVELS IN WOMEN WITH LUPUS.
WE DID NOT SEE THESE
ASSOCIATIONS IN WOMEN WITHOUT
LUPUS.
AND WE CONTROLLED FOR A RANGE OF
DIFFERENT THINGS.
SO SOCIODEMOGRAPHICS, AGE,
EDUCATION LEVEL, INCOME.
WE DON'T HAVE DIFFERENCES IN
INSURANCE STATUS, WE ADJUSTED
FOR -- WE COLLECT BLOOD PRESSURE
SO WE ADJUSTED FOR HYPERTENSION,
WE ADJUSTED FOR DIABETES SO RISK
FACTORS FOR KIDNEY DISEASE, WE
ALSO ADJUSTED FOR BMI, SMOKING,
ALL OF THOSE KINDS OF THINGS,
AND WE STILL SAW THIS
ASSOCIATION.
BUT IT'S INTERESTING, THE TWO
DIFFERENT DEFINITIONS OF EGFR,
RIGHT?
SO THERE WAS ONE THAT ACTUALLY
INCORPORATED WHAT I WOULD CALL A
BIT OF MEDICAL RACISM.
AND WHAT WE SAW, THE EFFECTS
WERE SLIGHTLY STRONGER IN THE
CONTEXT OF MEDICAL RACISM WHICH
IS INTERESTING.
WE STILL SAW ASSOCIATION WITH
BOTH OUTCOMES BUT THEY WERE A
LITTLE BIT -- THE EFFECT SIZES
WERE A LITTLE BIT SMALLER WHEN
WE USED THE NEW 2021 NORM.
INDEPENDENT OF RELEVANT RISK
FACTORS, THEN ADDITIONAL
ANALYSES TO LOOK AT DAMAGE DUE
TO SEL AND LONG TERM DAMAGE.
THE THOUGHT WAS SLE MIGHT
CONTRIBUTE TO WEATHERING IN
AFRICAN AMERICAN WOMEN, THIS
IDEA THAT THEY'RE RACED IN
GENDER-RELATED -- DEVELOPED IN
THE CONTEXT OF STUDYING BLACK
WOMEN'S REPRODUCTIVE HEALTH, IT
BEEN APPLIED TO A RANGE OF
DIFFERENT OTHER HEALTH OUTCOMES,
BUT IN GENERAL, THIS IDEA THAT
THERE'S SOMETHING ABOUT
UNDERGOING STRESS PROCESSES THAT
IS PHYSIOLOGICALLY -- THAT
ACCELERATES PHYSIOLOGY OF AGING.
SO SOMEHOW SLE IS CAUSATIVE IN
THAT.
LOTS OF POTENTIAL PATHWAYS WE
COULD EXAMINE, THE PLAN IS TO
EXAMINE A RANGE OF DIFFERENT
INFLAMMATORY MARKERS BUT OTHER
PATHWAYS ARE IMPORTANT AS WELL.
THEN ANOTHER THOUGHT IS THAT
THIS CONCERN FOR CHILDREN MIGHT
BE PARTICULARLY PROBLEMATIC IN A
COHORT OF WOMEN WHO HAVE LOW
LIFE EXPECTANCY.
SO WE'RE ALREADY SEEING, WE
ARE -- WE STARTED IN 2017.
SEVEN OF OUR WOMEN IN THE COHORT
WITH LUPUS HAD ALREADY DIED AND
THEY DIED IN THEIR 30s AND
40s, SOME LATE 20s, SO THIS
IS A DISEASE THAT IS
PARTICULARLY -- IT INTERRUPTS
LIFE EXPECTANCY, AND IT
DISPROPORTIONATELY IMPACTS BLACK
WOMEN WHO ARE IN THEIR EARLY
SORT OF LATE REPRODUCTIVE EARLY
MID LIFE YEARS, SO PERHAPS THAT
KIND OF WORRY THAT YOU MAY NOT
BE AROUND TO PROTECT YOUR CHILD
HAD AN EVEN GREATER IMPACT ON
THIS GROUP.
SO I KNOW I ONLY HAVE 10
MINUTES.
I'LL TRY TO STICK TO THAT, SO
I'LL END THERE.
>> NEXT WE HAVE MITCHELL LUNN
WHO WILL BE TALKING TO US ABOUT
KIDNEY DISEASE IN SGM
POPULATIONS.
>> I CAN'T SING, I CAN'T DANCE.
-- MAYBE A LITTLE BIT.
ALL RIGHT.
HI, EVERYBODY.
DELIGHTED TO BE HERE.
THANKS TO THE ORGANIZERS FOR
INVITING ME.
I USE HE/HIM PRONOUNCE, I'M
ASSOCIATE PROFESSOR AT STANFORD
AND DELIGHTED TO BE HERE TODAY.
NO RELEVANT CONFLICTS TO THIS
PRESENTATION.
A LITTLE BIT ABOUT ME.
I'M A WHITE GAY CISGENDER MAN
ORIGINALLY FROM BISMARCK, NORTH
DAKOTA.
I'M A NEPHROLOGIST BY TRAINING.
I CALL MYSELF A NEPHROLOGIST
LIGHT BECAUSE I ONLY DO ABOUT
30% OF MY TIME IS
NEPHROLOGY-RELATED PATIENT CARE
AND 70% OF MY TIME IS
LGBTQ-RELATED HEALTH AND HEALTH
DISPARITIES-RELATED WORK.
I TALK FAST.
I HAVE A LOT OF THINGS TO GO
THROUGH SO HOLD ON TO YOUR
HORSES.
I'LL SEND SLIDES TO ANYBODY WHO
WANTS THEM AFTER AS WELL.
THE BOTTOM LINE UP FRONT, HERE'S
HERE'S -- LGBTQ+ PEOPLE ARE
UNDERSTUDIED, UNDERSERVED AND
VULNERABLE TO POOR HEALTH AND
HEALTHCARE INEQUITIES.
WE HAVE A LOT OF NEGATIVE
EXPERIENCES, A LOT OF
MARGINALIZATION IN THE
HEALTHCARE PROVIDERS' OFFICES
THAT KEEP US OUT OF MEDICAL
SETTINGS AND OUT OF RESEARCH
SETTINGS.
AND LIMITED FEDERAL COLLECTION
OF BOTH SEXUAL ORIENTATION AND
GENDER IDENTITY HAS SEVERELY
LIMITED THE BASIC EPIDEMIOLOGY
OF EVERYTHING, INCLUDING KIDNEY
DISEASE IN LGBTQ+ PEOPLE, AND
THUS THE LIMITATIONS OF
PUBLISHED DATA TYPICALLY ARE
RELATED TO -- OR CONVENIENT
SAMPLES.
WE TEND TO USE THE TERM SEXUAL
AND GENDER MINORITY WITHIN THE
NIH.
WITHIN A ACADEMIA THIS IS MORE
COMMONLY REFERRED TO AS LGBTQIA+
AND YOU CAN ADD AS MANY LETTERS
AS YOU'D LIKE, IT'S COMPLICATED,
BUT TYPICALLY WE TEND TO SAY
SEXUAL MINORITY PEOPLE ARE
PEOPLE WHO ARE NOT STRAIGHT AND
GENDER MINORITY PEOPLE ARE
PEOPLE WHO ARE NOT CISGENDER,
THAT THEY HAVE A GENDER IDENTITY
THAT IS SOMETHING DIFFERENT THAN
WHAT IS COMMONLY ASSOCIATED WITH
THE SEX THEY WERE ASSIGNED AT
BIRTH.
SO JUST A LITTLE BACKGROUND OF
THE POPULATION.
7.6% OF THE UNITED STATES
IDENTIFIES WITH LGBTQ+.
WE KNOW THIS FROM GALLOP, RANDOM
DIGIT DIALING TO ABOUT A
THOUSAND PEOPLE EVERY YEAR, AND
WE DON'T GET THIS FROM ANY OTHER
SOURCE BECAUSE IT WAS EXCLUDED
FROM THE 2020 CENSUS.
WE DO NOT KNOW WHERE LGBTQ
PEOPLE LIVE, WHAT THEIR AGES
ARE, THEIR JOBS ARE, WHO THEY
LIVE WITH, WHAT THEIR FAMILIES
ARE LIKE, ET CETERA, BECAUSE IT
WAS REMOVED UNDER THE TRUMP
ADMINISTRATION.
FINGERS CROSSED IN 2030 THAT WE
WILL HAVE SEXUAL ORIENTATION AND
GENDER IDENTITY INCLUDED TO
ACTUALLY START DOING SOME
APPROPRIATE EPIDEMIOLOGIC
SAMPLING FRAMES.
I'M NOT GOING TO GO THROUGH ALL
THESE DATA ON MARGINALIZATION,
BUT THIS IS I THINK REALLY
ECHOES THE COMMENTS WE HEARD
EARLIER TODAY.
YOU CAN SEE THESE NAVY BLUE OR
LIGHT GREEN BAR, ANYWHERE
BETWEEN 4 AND 20% OF LGBTQ+
PEOPLE HAD A NEGATIVE EXPERIENCE
IN THE HEALTHCARE PROVIDER'S
OFFICE, BEING PHYSICALLY ABUSED,
VERBALLY ABUSED, BLAMED FOR
THEIR HEALTH STATUS, NOT
LISTENED TO.
SIMILARLY, WE HAVE MORE RECENT
DATA FROM THE 2022 TRANSGENDER
SURVEY.
THIS WAS OF MORE THAN 90,000
TRANS PEOPLE ACROSS THE COUNTRY.
I THINK THE BIG ONE IS THE LAST
BULLET POINT, WHICH IS THAT HALF
OF TRANS PEOPLE HAVE HAD A
NEGATIVE EXPERIENCE IN THE LAST
12 MONTHS IN THE HEALTHCARE
PROVIDER'S OFFICE.
THIS HAS PUSHED PEOPLE AWAY FROM
HEALTHCARE AND IT PUSHES PEOPLE
AWAY FROM RESEARCH, BECAUSE IT'S
PRIMARILY WHERE FOLKS GET
RECRUITED TO VARIOUS RESEARCH
STUDIES, ESPECIALLY IN ACADEMIC
MEDICAL CENTERS.
WE ALSO KNOW THAT LGBTQ+ PEOPLE
WITH DISABILITIES, WHICH
INCLUDES MANY FOLKS IN THE NIDDK
UMBRELLA, HAVE DIFFICULTY
ACCESSING CARE OR DECIDED TO
DELAY CARE WITH ODDS RATIOS IN
THE 3s AND 4s DEPENDING ON
THE CLASSIFICATION OF DISABILITY
THAT FOLKS HAVE.
AND SO LET'S ACTUALLY TALK A
LITTLE ABOUT KIDNEY DISEASE,
WHICH IS THAT THERE ARE ABOUT
35, 36 MILLION PEOPLE IN THE
UNITED STATES WITH CHRONIC
KIDNEY DISEASE.
THERE ARE ABOUT 800,000 FOLKS
WITH END STAGE KIDNEY DISEASE,
OF WHICH TWO THIRDS OF THEM ARE
ON DIALYSIS APPROXIMATELY AND
ONE-THIRD HAVE RECEIVED A KIDNEY
TRANSPLANT.
YOU CAN SEE THE GRAPH THERE AT
THE BOTTOM FROM THE UNITED
STATES RENAL DATA SERVICE THAT
THE INCIDENCE OF END STAGE
KIDNEY DISEASE OVER THE PAST TWO
DECADES HAS INCREASED BY ABOUT
35%.
THIS IS PROBABLY DUE TO MANY
THINGS WHICH INCLUDE PEOPLE
LIVING LONGER SO THEIR KIDNEYS
DON'T LIVE AS LONG AS THEY DO,
AND ALSO SOME CHANGES,
LIFESTYLE-WISE AND IMPROVED
SCREENING ON KIDNEY DISEASE.
AMONG SEXUAL AND GENDER MINORITY
PEOPLE, WE HAVE VERY, VERY
LIMITED DATA.
THIS IS DATA PUBLISHED USING THE
RISK FACTOR SURVEILLANCE SYSTEM
LOOKING AT SEXUAL MINORITY OLDER
ADULTS, SURPRISING IT'S ONLY 50
OR OLDER, I'M LIKE, I'M NOW
ALMOST AN OLER ADULT. OLDER ADUS
IT REALLY SHOWED ONLY
SIGNIFICANT EFFECT FOR SEXUAL
MINORITY MEN, AT ABOUT 30% OR
GREATER ODDS OF HAVING INCIDENT
KIDNEY DISEASE IN THEIR LIFETIME
COMPARED TO THEIR HETEROSEXUAL
PEERS.
WE DID NOT SEE THAT IN SEXUAL
MINORITY WOMEN.
WHEN WE LOOK AT KIDNEY DISEASE
AND TRANSGENDER PEOPLE WERE
REALLY LIMITED TO SINGLE CENT
CENTERS, OF ABOUT
275 TRANSGENDER PATIENTS, AND
SURPRISINGLY HAD A CRAZY HIGH
INCIDENCE OF PREVALENT CHRONIC
KIDNEY DISEASE AT 36%, MUCH
HIGHER THAN THE 10, 12, 14% THAT
WE TYPICALLY SEE IN THE GENERAL
POPULATION.
SO UNCLEAR ON THE EXACT REASONS
FOR THIS.
THEN MORE RECENT DATA LOOKING AT
MORE THAN 350,000 PARTICIPANTS
IN THE ALL-OF-US RESEARCH
PROGRAM, OF WHICH NEARLY 31,000
OF THEM WERE SEXUAL OR GENDER
MINORITY PEOPLE.
IN THIS CASE, THE SGM GROUPS HAD
LOWER ODDS OF DIABETES, HEART
DISEASE, HYPERTENSION, AND
CHRONIC KIDNEY DISEASE.
WE THINK THIS IS LIKELY DUE TO
THE POPULATION PARTICIPATING IN
ALL-OF-US AND NOT THE ACTUAL
POPULATION IN THE REAL WORLD,
BUT THIS WAS I THINK ANOTHER
SURPRISING FINDING.
THESE ARE JUST THE PLOT -- I'LL
BE SURE TO SHARE THESE WITH
FOLKS, YOU CAN SEE FOR THE ONE
OUTLINED IN RED FOR
CARDIOVASCULAR DISEASE, MOST OF
THOSE DOTS ARE LESS THAN 1 OR
THEY HAVE ERROR BARS THAT CROSS
OVER 1, SAME THING FOR CHRONIC
KIDNEY DISEASE IN THE PURPLE
BOX, AND THEN HERE THE PURPLE
BOX IS HYPERTENSION AND THE RED
BOX IS DIABETES.
SO WE'RE SEEING LOWER ODDS AMONG
SEXUAL AND GENDER MINORITY
GROUPS COMPARED TO THEIR
CISGENDER HETEROSEXUAL
COUNTERPARTS.
THEN JUST TO WRAP UP, I'M GOING
TO THROW OUT THE CONCEPT OF CYST
STATIN C, SO FOLKS MAY BE
FAMILIAR WITH THIS MUSCLE-BASED
MEASUREMENT, AND RECENT EFFORTS
AS WE JUST HEARD FROM DR. LEWIS
HAVE ALREADY REMOVED THE RACE
COEFFICIENT FROM THE EQUATION
THAT WE WOULD USE TO ESTIMATE
GLO MAYOR YAL FILTRATION OR
ESTIMATE KIDNEY FUNCTION, BUT WE
HAVE SEX-BASED COEFFICIENTS THAT
REMAIN.
SO YOUR EGFR IS ACTUALLY 12%
HIGHER IF YOU ARE FEMALE VERSUS
IF YOU ARE MALE.
SO THE QUESTION BECOMES HERE,
WHAT EQUATION DO WE USE FOR
GENDER MINORITY PEOPLE?
WHAT EQUATION DO WE USE FOR
PEOPLE WHO ARE NON-BINARY?
SHOULD WE STILL BE USING THE SEX
THEY WERE ASSIGNED AT BIRTH OR
THEIR CURRENT GENDER IDENTITY?
WHAT IF THEY'VE BEEN ON
GENDER-AFFIRMING HORMONES FOR
FIVE YEARS AND THEY'RE A TRANS
MAN TAKING SESS TESTOSTERONE FR
YEARS AND YEARS, BUT I DO WONDER
IF CYST STATIN C QUESTIONS -- IF
ONES THAT DON'T USE CREATININE
AT ALL ARE ACTUALLY GOING TO BE
AN ANSWER FOR ACCURATELY
ESTIMATING GFR GOING FORWARD.
SO -- AVAILABLE AT EVERY
LAB.
SO WHEN WE LOOK AT THE RACE
VALUES, WE LOOK ACROSS THE TOP,
FOR FOLKS WHO ARE AFRICAN
AMERICAN, WHEN WE WERE USING THE
OLD EQUATIONS, THEY ACTUALLY
NEEDED HIGHER DOSES OF DRUGS,
THEY GOT WAIT LISTED FOR
TRANSPLANT LATER, THEY GOT
REFERRED TO A NEPHROLOGIST LATER
AND THEY STARTED DIALYSIS LATER.
SO THIS WAS ONE OF THE KEY
REASONS TO GET RID OF THE RACE
MODIFIER IN THE EGFR EQUATION SO
NOW WE NEED TO START LOOKING AT
WHAT WOULD HAPPEN FOR GENDER
MINORITY FOLKS, ESPECIALLY THOSE
ON GENDER-AFFIRMING HORMONES.
SO MY LAST SLIDE TO WRAP UP IS
MOST OF THE THINGS THAT I HOPE I
SHARED WITH YOU IS THAT WE
REALLY REMAIN UNDERSERVED UNTIL
THERE IS IMPROVED SEXUAL
ORIENTATION AND GENDER IDENTITY
COLLECTION THAT'S HAPPENING AT
BOTH THE LOCAL AND THE FEDERAL
LEVEL.
WE NEED MUCH MORE RESEARCH IN
THIS AREA BECAUSE THERE'S VERY,
VERY LITTLE, AND NOW LOOKING
FORWARD, IF NON-CREATININE-BASED
EGFR MEASUREMENTS ARE GOING TO
BE THE SOLUTION TO HELP
DESCRIBING THE KIDNEY DISEASE
BURDEN, ESPECIALLY AMONG GENDER
MINORITY POPULATIONS GOING
FORWARD.
THAO SO MUCH.
HAPPY TO SEND SLIDES TO ANYBODY.
[APPLAUSE]
>> FINALLY WE HAVE DR. LEONARD
EGEDE WHO WILL BE SPEAKING ABOUT
STRUCTURAL RACISM AND DIABETES
OUTCOMES.
>> I KNOW I'M THE LAST ONE SO I
WANT TO START BY THANKING THE
GROUP, COMMUNITY MEMBERS BECAUSE
I THINK WE SOMETIMES DO NOT
APPRECIATE THE LIVED EXPERIENCE,
HOW WE INCORPORATE THAT INTO
RESEARCH, SO I REALLY LIKED THAT
PERSPECTIVE.
WE USE THAT -- SO MY WORK IS
REALLY -- TO THE POINT WHERE THE
MORE YOU LOOK -- YOU REALIZE
EVERYTHING IS UPSTREAM.
YOU STILL FOCUS ON DOWNSTREAM,
WE DON'T PAY ATTENTION TO
STRUCTURES, I'M TRYING TO FIND
OUT HOW DO WE DO THIS AT A
LARGER SCALE AS OPPOSED TO THE
INDIVIDUAL PATIENT.
DISCLOSURES, A LOT OF SOCIAL
ISSUES TIED TO IT, A LOT OF --
AND IT -- A VERY NICE MODEL TO
REALLY UNDERSTAND HOW SOME OF
THIS STUFF IS BUILT.
WHAT YOU SEE HERE IS RACIAL
DISPARITIES IN DIABETES, IF YOU
LOOK AT THE AVERAGE, ABOUT 15%
IN THE U.S., BY RACE.
BY GENDER YOU ACTUALLY SEE SOME
DIFFERENCES ESPECIALLY FOR
MINORITY GROUPS.
SO THERE IS A MINORITY-DRIVEN
DIFFERENCE IN SOME OF THESE
FACTORS.
SO I'LL GO RIGHT INTO
DEFINITIONS MOST PEOPLE USE.
WE USE ONE OF THEM EQUALLY,
SO -- BUT KEY THING TO
UNDERSTAND IS THIS IS ABOUT
POWER.
IT DOESN'T MATTER HOW YOU DEFINE
IT, IT'S REALLY -- I THINK IT'S
JUST -- TWO CONCEPTS I REALLY
WANT YOU TO APPRECIATE, SO ONE
IS THE CONCEPT AND THIS IS WORK
OF -- WHICH I THINK IS REALLY
SESEMINAL IN HELPING US UNDERSTD
THE SPECIES.
ONE IS DE FACTO, TRUE IN FACT
BUT NOT OFFICIALLY SANCTIONED,
RESULT OF PRIVATE PRACTICE AND
PERSONAL PREFERENCE OR
INDIVIDUAL CHOICE, NOT THE
RESULT OF GOVERNMENT POLICY.
THE OTHER IS DE JURE, SANCTIONED
BY LAW AND PUBLIC POLICY.
I THINK WHAT IS IMPORTANT IS
THAT WITHOUT GOVERNMENT AND LAW,
PREJUDICE HAS LESS OPPORTUNITY
FOR EXPRESSION.
SO AS WE -- WE HAVE TO
UNDERSTAND INDIVIDUAL
PREFERENCES AND -- WHEN IT'S
ACTUALLY SANCTIONED BY LAW, IT
BECOMES A BIGGER ISSUE.
THESE ARE EXAMPLES MANY OF YOU
ARE FAMILIAR WITH THIS.
HOUSING AND RESIDENTIAL
SEGREGATION DUE TO HISTORIC RED
LINING, THE IDEA THAT EDUCATION
BASED ON HOUSING IN THE TAX
BASE, WHEN YOU DO THAT YOU
REALLY PERPETRATE DISCRIMINATION
AND -- BECAUSE OF THAT.
AND THEN STATE SANCTIONED
VIOLENCE, IT'S A JUDICIAL SYSTEM
THAT'S JUST NOT FAIR.
ACTUALLY FACTORS THAT LED TO
SOME OF THESE DIFFERENCES.
SO I WANT TO SPEND SOME TIME
TALKING ABOUT RED LINING.
SOME PEOPLE -- WE RECOGNIZE THAT
REDLINING IS AN EXPRESSION OF
STRUCTURAL RACISM.
IT'S NOT -- ALLOWS US TO
ACTUALLY IDENTIFY THE EXPRESSION
OF STRUCTURAL RACISM AND HOW IT
ACTUALLY IMPACTS HEALTH AND
HEALTH OUTCOMES.
SO THIS IS SOMETHING THAT WAS
FORMALIZED IN 1934 BY THE
FEDERAL HOUSING ADMINISTRATION,
IT WAS LATER PROHIBITED IN THE
FAIR HOUSING ACT OF 1968.
AT THAT TIME, A WAS COLORED
GREEN, B WAS STILL DESIRABLE,
COLOR BLUE.
C WAS DECLINING, COLORED YELLOW,
AND D WAS HAZARDOUS, COLORED
RED, THE TERM REDLINING.
SO WHAT WE HAVE TRIED TO DO IS
TO UNDERSTAND HOW DOES THIS
HISTORIC EVENT REALLY PLAY OUT
TODAY.
IT'S NOT JUST ABOUT HOUSING.
IT'S ABOUT CREDIT, IT'S ABOUT
HOSPITALS.
IT'S ABOUT -- IT'S ABOUT
EDUCATION.
SO IT'S VERY MUCH INTEGRAL TO SO
MANY FACTORS WE TALK ABOUT IN
TERMS OF PUBLIC POLICY, IT'S
ALSO ABOUT POWER -- INFORMATION.
SO TO LOOK AT THE RELATIONSHIP
BETWEEN REDLINING AND PRESENT
DAY DIABETES.
-- TH CREATED -- WE LOOKED AT -
FIVE YEARS OF DATA.
THIS IS SOMETHING THAT'S
IMPORTANT, THIS IS -- WHAT YOU
FIND IS THAT IF YOU LOOK AT 1990
TO 2014 IN TERMS OF -- AS YOU GO
FROM GREEN TO RED, YOUR
MORTALITY INCREASES AND YEARS OF
LIFE LOSS INCREASES.
WHAT WAS ACTUALLY MORE
CONCERNING WAS -- 2014, YOU SEE
IT AFFECTS - -- ACTUALLY SUSTAID
OVER TIME, SO PERSISTENT OVER
TIME -- YOU SEE THE EFFECTS OF
REDLINING.
AND THEN WE NEXT -- LOOKING AT
WHAT'S OUT THERE IN THE
LITERATURE IN TERMS OF
STRUCTURAL RACISM AND DIABETES
OUTCOMES.
SO CYST TI MATIC REVIEW, USING
THE -- MODEL TO ACTUALLY ASK THE
QUESTION CAN WE CLASSIFY SOME OF
THESE -- WHAT WE FOUND WAS THAT
STRUCTURAL RACISM AS YOU DEFINE
IT -- WAS -- LOWER STANDARDS OF
CARE AND HIGHER MORTALITY AND
YEARS OF LIFE LOST.
WHAT WAS MISSING AND WHAT'S
STILL MISSING IS THE PATHWAYS.
BECAUSE WITHOUT PATHWAYS, WE
CANNOT TALK ABOUT INTERVENTION.
SO WHAT WE TRIED TO DO WAS TO
FIND OUT COULD WE ACCESS AT THE
NATIONAL LEVEL -- SO WE USED A
LOT OF CENSUS DATA, ALMOST 3,000
CENSUS TRACTS ACROSS THE UNITED
STATES -- REDLINING AND WE
ACTUALLY USED STRUCTURED MODEL
TO IDENTIFY DIRECT AND INDIRECT
PATHWAYS.
PUBLISHED IN DIABETES CARE.
THIS IS WHAT WE FOUND.
SO WHAT'S INTERESTING IS THAT,
YOU KNOW, THIS IS A PATH
ANALYSIS, ALL OF THE PATHWAYS,
INCARCERATION, POVERTY,
DISCRIMINATION, SUBSTANCE ABUSE
OR SUBSTANCE USE DISORDER,
HOUSING INSTABILITY, EDUCATION,
UNEMPLOYMENT, REDLINING HAD A
NEGATIVE EFFECT ON THOSE
FACTORS.
AND THOSE FACTORS HAD AN EFFECT
ON PREVALENCE OF DIABETES.
SO IT WASN'T JUST REDLINING THAT
WAS THE ISSUE.
IT WAS WHAT REDLINING ACTUALLY
LED TO THAT DROVE SOME OF THOSE
OUTCOMES.
SO THIS IS GETTING US ANOTHER
CHANCE TO ASK REAL SCIENTIFIC
QUESTIONS BECAUSE ONE OF THE
THINGS I HEAR IS THIS IS SO --
BECAUSE THIS IS REAL -- TO BRING
ABOUT CHANGE.
SO THIS JUST CAME OUT, AND SO
NOW WE HAVE TWO NIH GRANTS, AND
WE ACTUALLY LOOK AT THIS FROM
THE STANDPOINT OF WHAT CAN WE
DO.
IT'S NOT JUST ENOUGH TO -- SO
THE FIRST GRANT IS LOOKING AT --
CONVERSATION ABOUT -- ONE WAS
LOOKING AT PATHWAYS, SOCIAL
RISK, HUMAN CAPITAL, HEALTHCARE
RESOURCES, AND THE GOAL OF THIS
STUDY IS TO ACTUALLY IDENTIFY
THE RELATIONSHIP OF REGIONAL
EXPOSURE TO STRUCTURAL RACISM.
AND TO IDENTIFY -- USING -- OF
THE LITERATURE, ONE OF THE KEY
THINGS -- TO IDENTIFY AND
PRIORITIZE STRATEGIES.
WHAT SHOULD WE PRIORITIZE, WHAT
SHOULD WE BE DOING, WHAT TYPES
OF INTERVENTIONS AT THE POLICY
LEVEL WILL HAVE THE MOST IMPACT.
SO AS WE DO THIS WORK -- THAT
PEOPLE CAN ACTUALLY WORK ON AT A
NATIONAL LEVEL.
THE SECOND ONE IS TIED TO --
MORE POSSIBILITIES -- SOME OF
THE EFFECTS OF CREDIT AND
REDLINING AND -- IN COMMUNITIES
WHERE THERE'S NO BENEFIT FOR
THOSE WHO ARE INVESTING.
SO -- HOSPITALS -- IT'S NOT
FINANCIALLY VIABLE FOR THEM TO
STAY INTEREST.
STAY THERE SO WE ARE TRYING TO
UNDERSTAND WHAT'S HAPPENING TO
THESE, HOW DO -- FACTORS PLAY A
ROLE, WHAT ARE SOME
INTERVENTIONS THAT CAN BE PUT IN
PLACE, WHAT ARE COMMUNITIES
DOING, HOW DO YOU ADVOCATE, AND
WHAT EVIDENCE DO YOU NEED TO
HAVE TO ADVOCATE -- ISSUE.
SO I'M GOING TO SUMMARIZE AND
JUST SAY WHEN WE TALK ABOUT
HISTORIC REDLINING -- STILL
PRESENT TODAY.
WE DON'T HAVE A PERFECT -- FOR
STRUCTURAL -- BUT WE'VE HAD
ENOUGH.
WE KNOW ENOUGH TO ACTUALLY START
ACTING.
WE CAN'T KEEP WAITING FOR MORE
MEASURES TO DO SOMETHING, SO --
GIVE US INFORMATION, WE NEED TO
ACT ON WHAT WE KNOW AND WHAT WE
CAN DO TODAY.
THANK YOU.
[APPLAUSE]
>> THANK YOU TO OUR PANELISTS.
NOW WE HAVE TIME FOR QUESTIONS,
COMMENTS, CONCERNS, QUERIES,
COMPLIMENTS.
>> HI.
I'M DEBBIE, COMPLIMENTS TO ALL
OF YOU.
QUESTION FOR DR. LEWIS.
I'M CURIOUS ABOUT WHETHER OR NOT
THERE'S ASSOCIATIONS WITH OTHER
TYPES OF AUTOIMMUNE DISEASE
OTHER THAN SLE AND WHAT THAT
MIGHT -- [INAUDIBLE]
>> ARE THERE ASSOCIATIONS
BETWEEN OTHER AUTOIMMUNE DISEASE
AND CARDIOVASCULAR DISEASE OR --
OKAY.
SO I THINK THERE ARE
ASSOCIATIONS BETWEEN, FOR
EXAMPLE, RHEUMATOID ARTHRITIS
AND A FEW OTHERS, AND A LOT OF
IT IS AUTOIMMUNITY IS USUALLY AN
INFLAMMATORY PROCESS, AND
INFLAMMATORY MARKERS ARE KNOWN
CONTRIBUTORS TO PLAQUE AND ALL
SORTS OF OTHER SORT OF PATHWAYS
THAT LEAD TO ATHEROGENESIS AND
ALL SORTS OF POOR OUTCOMES, SO
NOT JUST CARDIOVASCULAR OUTCOMES
BUT PROBABLY ALSO KIDNEY
OUTCOMES AS WELL.
I THINK WHAT IS UNIQUE ABOUT SLE
IS THE MULTI-SYSTEMIC NATURE OF
IT, AND IT MANIFESTS DIFFERENTLY
FOR DIFFERENT PEOPLE, AND IT
INTERESTING AS YOU WERE
TALKING -- MY MY CO-PANELIST WAS
TALKING ABOUT NEEDING TO REMOVE
THE SEX-SPECIFIC WEIGHT TO EGFR,
I WAS THINKING PERHAPS FOR SLE,
WE WOULD NOT DO THAT, BECAUSE IT
IS A DISEASE THAT IS
PREDOMINANTLY -- ONSET IS OFTEN
AROUND PUBERTY, WE KNOW THERE'S
A HORMONAL COMPONENT.
THERE IS SOMETHING -- AUTOIMMUNE
DISEASES IN GENERAL ARE MORE
AREPREVALENT AMONG WOMEN.
THAT IS PARTICULARLY TREUL FOR
SLE AND IT IS PARTICULARLY A
BLACK WOMAN'S DISEASE.
FOR REASONS THAT I THINK WE'RE
STILL GRA PEPPING WELL, I DON'T
THINK THERE'S AS MUCH ATTENTION
GIVEN TO THAT DISEASE BECAUSE OF
THE POPULATION THAT IT IMPACTS,
QUITE FRANKLY.
BUT I HAVE A NEPHROLOGY
COLLEAGUE IN THE FRONT LOW WHO
IS LOOKING PENSIVE WHO MAY HAVE
MORE ABOUT THAT, I DON'T KNOW.
>> -- THAT WE NEED TO SORT OF
FOLLOW UP WITH IN ADDITION TO
HORMONES AND PUBERTAL ONSET
IS -- I WANT TO GIVE A SHOUT OUT
TO THE CHROMOSOMES X AND Y, AND
THERE'S SO MUCH IMMUNE-RELATED
GENES, WE DON'T REALLY
UNDERSTAND A LOT OF THE
EPIGENETIC INTERACTION OF LIFE
EXPERIENCES, CHRONIC ADVERSITY,
TRAUMA, THAT MAY ALSO PLAY A LOT
INTO THE RISK, IN ADDITION TO
THE HORMONES.
>> I'LL JUST MAKE A COMMENT
ABOUT THE SEX OR GENDER MODIFIER
IN EGFR.
SO IT'S SOMETHING WE'RE GOING TO
NEED TO LOOK AT VERY CLOSELY.
THE FORMULAS WE HAVE SAY THAT AT
A GROUP LEVEL, THERE ARE SOME
DIFFERENCES AMONGST THE GROUPS.
THE VARIATION COULD BE VERY
SUBSTANTIAL.
AND PROBABLY OVER TIME, A LOT OF
IT EARLY ON MAY HAVE BEEN DUE TO
MAJOR DIFFERENCES IN BODY MASS
BETWEEN WOMEN AND MEN.
SO THAT'S CHANGING, AND WE HAVE
SEXUAL GENDER MINORITIES.
SO THE QUESTION IS, IS THAT AN
APPROPRIATE METHODOLOGIC
APPROACH TO ASSIGN THE GROUP
LEVEL DIFFERENCES EQUALLY TO
EACH INDIVIDUAL OF THE GROUP?
YOU CAN ONLY DO THAT
METHODOLOGICALLY IF THE VARIABLE
MEETS THREE QUALITY FIXES: IT'.
IT IS CONSISTENTLY MEASURED,
WHICH IS GOING TO BE A
CHALLENGE, IT IS ORDERED, THERE
IS AN ORDER DIFFERENCE BETWEEN
IT, AND IT IS CAUSALLY RELATED
TO THE OUTCOME OF INTEREST.
SO A LOT OF TIMES, THERE MAY BE
SOME DIFFERENCES, THERE COULD BE
AN ORDER, THERE COULD BE SOME
DIFFERENCES BETWEEN MEN AND
WOMEN IN DIFFERENT DISEASE
CONDITIONS BECAUSE OF SEX
HORMONES, BECAUSE OF DIFFERENT
LEVELS OF ESTROGEN,
TESTOSTERONE, ET CETERA, YET
THERE ARE MANY OTHER INSTANCES
WHERE IT WILL BE DUE TO SOCIETAL
DIFFERENCES THAT LEAD TO THE
CHANGES IN THE OUTCOME, AND
THOSE CANNOT BE ASSIGNED TO
INDIVIDUALS.
METHODOLOGICALLY.
SO I THINK IT'S SOMETHING THAT
WE HAVE TO WATCH CAREFULLY, AND
WE NEED TO REALLY THINK ABOUT
WHETHER OR NOT THAT MODIFIER IS
APPROPRIATE, AND SO I THINK
WE'RE GOING TO BE MOVING CLOSER
AND CLOSER TO THE USE OF
CYSTATIN PARTICULARLY FOR SEXUAL
AND GENDER MINORITIES, WHERE
OVER TIME I THINK WE HAVE TO
RELOOK AT THESE FORMULAS IN
GENERAL WHERE WE'RE GIVING
INDIVIDUAL LEVEL MODIFIERS FOR
WOMEN BECAUSE, AGAIN, FROM
SEXISM, THERE'S BEEN THIS
INHERENT SENSE THAT MEN AND
WOMEN ARE JUST DIFFERENT FOR
EVERYTHING, AND THAT -- WHILE
THERE ARE MAJOR DIFFERENCES, IT
MAY OR MAY NOT BE CAUSALLY
LINKED TO CERTAIN DISEASE
PROCESSES.
>> SO A QUICK ANNOUNCEMENT --
>> COMPLIMENTS TO THE GROUP.
GREAT TALKS.
>> FIRST I SHOULD SAY EXCELLENT
SERIES OF TALKS, THANK YOU VERY
MUCH.
I WANTED TO BRING FORWARD A
QUESTION FROM THE ZOOM, BUT
BEFORE I DO, I ALSO WANT TO LET
FOLKS KNOW IF YOU HAVEN'T
SMELLED IT ALREADY, THERE IS
PIZZA NOW IN THE HALLWAY FOR
THOSE WHO DIDN'T HAVE TIME TO
GRAB LUNCH SO FEEL FREE TO SLIP
OUT A FEW AT A TIME AND GRAB A
SLICE.
THEN AS FOR THE QUESTION, THE
QUESTION -- I'M GOING TO
PARAPHRASE A LITTLE BIT, YOU
GUYS EACH PRESENTED ON SORT OF
DIFFERENT POPULATIONS AND
DIFFERENT OUTCOMES, DIFFERENT
DISEASE AREAS.
TO WHAT DEGREE DO YOU THINK SOME
OF THESE MECHANISMS ARE
ACTING -- ARE COMMON ACROSS
THESE DIFFERENT DISEASE AREAS?
>> SO I THINK FROM THE WORK
WE'RE DOING, LIKE I SAID, WE'RE
USING DIABETES AS A SIGNATURE
DISEASE, IT COULD EQUALLY APPLY
TO HYPERTENSION, TO KIDNEY
DISEASE, SO WE DON'T THINK THESE
FACTORS ARE GENERALLY DIFFERENT
AT A DISEASE LEVEL, WE THINK
IT'S MORE A SOCIETAL ISSUE THAT
HAS IMPACT, SO WE'RE NOT
EXPECTING TO SEE DIFFERENCES
ACROSS DISEASE GROUPS.
IT JUST HAPPENS TO BE WE CAN
ACTUALLY MEASURE THIS IN
DIABETES BECAUSE IT'S EASIER TO
HAVE AN A1C MEASURE, AN OUTCOME
MEASURE AND ESTABLISHED COHORTS
TO WORK WITH.
>> YEAH, I THINK I WOULD ADD, I
WOULD AGREE THAT THERE'S
PROBABLY MULTIPLE
STRESS/INFLAMMATION PATHWAYS
THAT SOME OF WHICH WE KNOW,
PROBABLY MANY OF WHICH WE ALSO
DON'T KNOW, AND THEN ALSO, YOU
KNOW, WE DON'T TYPICALLY MEASURE
A LOT OF THESE DIRECT MARKERS OF
INFLAMMATION, THINGS LIKE CRP
FOR THE CLINICIANS IN THE ROOM.
I THINK I'VE ORDERED, YOU KNOW,
FIVE CRPs TOTAL IN MY LIFE
BECAUSE IT'S NONSPECIFIC AND
RELATIVELY NOT USEFUL, YOU KNOW,
AND SO AT THE SAME TIME, I THINK
THERE'S LOTS OF OTHER PATHWAYS
WHICH ARE BEING RESEARCHED,
THINGS LIKE, YOU KNOW, DNA
METHYLATION AND OTHER EPIGENOMIC
CHANGES THAT ARE OBVIOUSLY ONLY
IN A RESEARCH SETTING, BUT I
WONDER IF, YOU KNOW, TWO, THREE,
FIVE, 10 YEARS FROM NOW, WHOLE
GENOME SEQUENCING PLUS, YOU
KNOW, THE METHYLOME AND OTHER
THINGS WILL BE PART OF OUR
STANDARD PRIMARY OF CARE FOR
EVERYBODY AND BETTER WAYS OF
ASSESSING THE STRESS THEY'VE
RECEIVED, WHETHER THAT'S FROM
RACISM, FROM SEXISM, FROM
HOMOPHOBIA, FROM TRANSPHOBIA,
FROM ANY OF THE OTHER WAYS THAT
PEOPLE GET MARGINALIZED OR
DISCRIMINATED AGAINST.
>> I REALLY APPRECIATE THAT
QUESTION BECAUSE I DO THINK
THERE'S A LOT OF EMPHASIS ON THE
MECHANISMS AND YOU HAVE PEOPLE
SAY, WELL, MAYBE THIS KIND OF
STRESS LEADS TO ALLOSTATIC LOAD
AND THIS ONE DOESN'T OR FOR THIS
GROUP OR THAT GROUP AND THERE
ARE BIOMARKERS THAT ARE A LITTLE
MORE RELEVANT DEPENDING ON WHICH
OUT COME YOU'RE USING SO IT
DEPENDS ON, I THINK, WHAT LEVEL
OF ANALYSIS THAT YOU'RE AT.
BUT I ALSO THINK THAT WHAT THE
LITERATURE HAS SHOWN IS THAT
THERE ARE CERTAIN KINDS OF
STRESSORS THAT ARE WORSE FOR
HEALTH AND THOSE ARE THE KINDS
OF STRESSORS THAT MARGINALIZED
GROUPS TEND TO EXPERIENCE.
SO THE THOUGHT IS THAT THESE
STRESSORS THAT INVOLVE SOCIAL
REJECTION, LIKE WE ARE DESIGNED
TO BE COMMUNAL PEOPLE, YOU SAW
WHAT HAPPENED DURING THE
PANDEMIC WHEN OUR SOCIAL FABRIC
FELL APART AND YOU SEE THESE
INCREDIBLY HIGH RATES OF
DEPRESSION AND SUICIDE AND
LONELINESS AND SO ON.
WE'RE DESIGNED TO BE TOGETHER
WITH ONE ANOTHER.
SO THE THOUGHT IS, AND THERE'S
LITERATURE THAT SUPPORTS THIS,
YOU KNOW, FROM ANIMAL MODELS,
WHEN PEOPLE FEEL REJECTED AND
THEY ARE EXCLUDED, THAT THAT IN
PARTICULAR IS A LOT WORSE FOR
PHYSIOLOGY THAN OTHER KINDS OF
STRESSORS.
AND WE KNOW MINORITIZED
POPULATIONS DEAL WITH A RANGE OF
DIFFERENT THINGS, SO THERE'S
THIS THEORY AND THERE'S SOME,
YOU KNOW, AGAIN, EVIDENCE FOR
THAT, BUT THAT WOULD BE WHAT I
WOULD SAY.
AND YOU'RE GOING TO SEE THAT
WHETHER IT'S IN REDLINED
NEIGHBORHOODS OR SEXUAL GENDER
MINORITIES OR BLACK WOMEN
DEALING WITH LUPUS, AND IT WILL
MANIFEST DIFFERENTLY BECAUSE
SOMETIMES PEOPLE LIVING IN
PREDOMINANTLY -- I'M JUST
THINKING FOR THE ANTI-BLACK
LITERATURE, WE SEE A LOT OF THE
EFFECTS OF INDIVIDUAL EXPOSURE
TO RACISM OR WE SEE THE GROUPS
THAT REPORT THAT MOST BEING THE
HIGHER SES GROUPS, BECAUSE LOWER
SES INDIVIDUALS TEND TO BE MORE
SEGREGATED AND SO THEY'RE
WORKING AND LIVING AND PLAYING
AROUND PEOPLE WHO SORT OF LOOK
LIKE THEM.
BUT THEN PEOPLE LIKE ME ARE
MOVING THROUGH SPACES WHERE I
MAY BE ONE OF THE ONLY ONES.
SO JUST SORT OF ADDING A BIT OF
THAT NUANCE AND CONTEXT TO THE
LITERATURE.
>> I JUST WANTED TO ADD, I THINK
IT'S IMPORTANT FOR US TO PAY
ATTENTION TO THIS PROCESS OF
MULTIPLE PATHWAYS, BECAUSE I
THINK WE LIKE TO HAVE A VERY
SIMPLE ANSWER, AND THIS IS VERY
COMPLEX.
AND SO WE NEED TO DO MORE WORK
ON INCORPORATING ALL OF THESE
MEASURES, BIOLOGY, SOCIAL
ENVIRONMENT, AND ALL OF THESE
FACTORS COMING TOGETHER TO
UNDERSTAND HOW THEY ACTUALLY
INTERACT.
SO I THINK THE MORE WE DO THAT,
THE MORE WE'RE GOING TO GET
BETTER ANSWERS THAN JUST BEING
VERY SIMPLISTIC AND
STRAIGHTFORWARD ABOUT IT.
>> ANOTHER QUESTION FROM THE
ZOOM, PARAPHRASING FROM VALERIE,
SHE IS ASKING ABOUT A POTENTIAL
CONNECTION WITH INTERPERSONAL
VIOLENCE AND COMMUNITY VIOLENCE,
AND WHETHER YOU'VE LOOKED AT
THAT AT ALL IN YOUR RESEARCH ON
SLE AND OUTCOMES IN WOMEN.
>> SO WE HAVE MEASURES OF
INTERPERSONAL VIOLENCE.
WE ARE JUST NOW STARTING TO
CLEAN THOSE DATA AND LOOK AT
THOSE DATA.
BUT I THINK JUST ANECDOTALLY AT
BASELINE, BECAUSE OF HOW IT WAS
FUNDED AND I ASKED A LOT OF
QUESTIONS ABOUT RACE, AND THEN
AT 12 MONTHS, I WAS LIKE I
DIDN'T ASK AS MANY QUESTIONS
AROUND GENDER, SO THAT'S WHEN WE
BEGAN TO GET INTO -- WE HAVE A
LOT OF THINGS ABOUT PEOPLE BEING
STALKED AND FINANCIAL CONTROL,
SO NOT JUST PHYSICAL OR SEXUAL
VIOLENCE, BUT OTHER FORMS OF
EMOTIONAL CONTROL THAT YOU SEE
AND PSYCHOLOGICAL CONTROL THAT
YOU SEE IN INTERPERSONAL
RELATIONSHIPS, THINGS AROUND
SELF-SILENCING.
SO WE HAVE ALL OF THAT AND IT'S
JUST A MATTER OF LACKING LOOKIN.
>> I'LL KEEP THE FINAL QUESTION
FOR THE PANEL.
>> JUST FOR THE PANEL IN
GENERAL.
SO ONE THING THAT'S VERY
INTERESTING, AND I LIKE THE WORK
ON THE REDLINING WHERE YOU HAVE
HIGHER RATES OF DIABETES, OTHER
CHRONIC DISEASES IN REDLINED
COMMUNITIES.
HAVE YOU HAD AN OPPORTUNITY TO
LOOK MORE DEEPLY WITHIN THOSE
COMMUNITIES, SO ONE THING
THAT -- TENE IS ASKING THESE
QUESTIONS ABOUT HOW COMFORTABLE
DO YOU FEEL AND ARE YOU
CONCERNED ABOUT BEING
DISCRIMINATED AGAINST AND
PROBLEMS AT SCHOOL, ET CETERA,
ET CETERA, ET CETERA.
SOME RED LINED COMMUNITIES ARE
LIKE 99% BLACK.
SO IN THAT SPACE, THERE COULD BE
MORE DISCRIMINATION AS IT
RELATES TO SOCIAL STRUCTURES
THAT ARE THERE TO BE SUPPORTED,
BUT THEN ON THE OTHER SIDE,
THERE COULD BE MORE
CONNECTEDNESS AND SENSE OF
SELF-WORTH, AND SO DO YOU KNOW
IF THERE'S ANY DATA OR YOUR TEAM
HAD A CHANCE TO LOOK YET IF
WITHIN THAT -- WITHIN THE
REDLINED COMMUNITIES, IF THE
PERCENT OF RACIAL GROUP WITHIN
THERE THEN EXPRESSES HIGHER OR
LOWER AMOUNTS OF --
>> THAT'S A VERY IMPORTANT
COMPONENT OF THE NEXT PHASE OF
RESEARCH.
SO WHAT WE HAVE RIGHT NOW, WE
KNOW THERE IS -- WITHIN STATE,
THERE'S GREAT VARIABILITY WITHIN
STATES.
AND BETWEEN STATES, THERE ARE
DIFFERENCES.
SO YOU SEE EXPRESSION OF EFFECT,
EFFECTS VARY ACROSS STATES, AND
ACTUALLY DIVE DEEP INTO
DIFFERENT -- DEPENDING ON --
PROPORTION BLACK IN THAT
ENVIRONMENT, OR PROPORTION
HISPANIC, YOU CAN ACTUALLY SEE
THAT THAT EXPRESSION AS YOU LOOK
AT SOCIAL CONNECTIVITY, THOSE
RELATIONSHIPS ARE DIFFERENT.
AND SO THAT'S ONE OF THE -- THE
FIRST PROJECT WE'RE TALKING
ABOUT, WE'RE GOING TO ACTUALLY
BE ABLE TO DO THAT AT A CENSUS
TRACT LEVEL ACROSS ALL STATES,
AND TEASE APART WHAT'S REALLY
DRIVING SOME OF THESE
DIFFERENCES AND WHICH OF THESE
APPROACHES ARE ACTUALLY
PROTECTIVE.
IF YOU LIVE IN AN ENVIRONMENT
WHERE EVERYONE LOOKS LIKE YOU,
YOU HAVE THAT SOCIAL
CONNECTEDNESS, YOU MAY HAVE A
VERY DIFFERENT EXPERIENCE
COMPARED TO SOMEONE WHO ACTUALLY
LIVES -- SO WE'RE TRYING TO
ACTUALLY ISOLATE SOME OF THOSE
RELATIONSHIPS OVER TIME.
>> YOU'LL ACTUALLY JUST ADD, THE
MEASURES WE HAVE AROUND -- I
WANT TO DISTINGUISH BETWEEN THE
EXPERIENCES THAT PEOPLE REPORT
AND THE CONCERNS OR THE WORRY
THAT THEY HAVE OR THE FORM OF
VIGILANCE, RIGHT, SO THIS IS
REALLY LIKE A FORM OF VIGILANCE
THAT BLACK WOMEN HAVE AROUND
THINGS HAPPENING TO THEIR
CHILDREN.
AND WE SEE SO LITTLE VAIRNL ON
THAT SCALE.
I MEAN, LIKE SO MANY -- AND WE
HAVE ONE THE MY OTHER COHORTS WE
HAVE WOMEN ACROSS 200 DIFFERENT
CENSUS TRACTS OR 190-SOMETHING,
RIGHT, AND THEY'RE ALL VERY
CONCERNED.
SO SOME OF THAT, WHAT WE SEE IN
THE LITERATURE ON EXPOSURE IS A
LOT OF IT IS MEDIATED THROUGH
SEGREGATION.
SO WOMEN WHO LIVE IN SEGREGATED
AREAS JUST REPORT LESS EXPOSURE.
BUT THE CONCERN, AND, YOU KNOW,
BECAUSE YOU HAVE THIS CHILD WHO
MIGHT LEAVE THAT NEIGHBORHOOD
AND NEED TO GO A LOT OF
DIFFERENT PLACES AND THEY ARE
REPORTING OFF THE CHART -- I
MEAN, LIKE VERY, VERY HIGH
LEVELS OF CONCERN ABOUT THINGS
HAPPENING TO THEIR CHILDREN
BECAUSE THEY'RE BLACK.
>> COULD WE GET ANOTHER ROUND OF
APPLAUSE FOR THE PANEL?
[APPLAUSE]
AND AT THIS TIME, I WILL INVITE
UP THE NEXT PANEL.
>> SO WE ARE READY TO START THE
NEXT SERIES OF PANELS.
WE WILL HAVE A SERIES OF PANELS
THAT WILL FOCUS ON SPECIFIC
BIOLOGICAL MECHANISMS THAT
[INAUDIBLE] THE FIRST PANEL WILL
BE ON EPIGENETICS AND TELOMERES.
I'D LIKE TO INVITE OUR FIRST
SPEAKER, DR. SHAKIRA SUGLIA, TO
SPEAK ABOUT SOCIAL STRESSORS AND
EPIGENETIC AGING AMONG HISPANIC
AND LATINO ADULTS.
DR. SUGLIA.
>> THANK YOU.
GOOD AFTERNOON, EVERYONE.
I WILL SHARE SOME OF MY WORK
FOCUSING ON SOCIAL STRESSORS AND
EPIGENETIC AGING IN LATINO
ADULTS IN THE U.S.
AS A MOTIVATION FOR THIS WORK
AND WHY WE'RE FOCUSING ON THE
LATINO POPULATION IN THE UNITED
STATES.
WHEN IT COMES TO CARDIOVASCULAR,
CARDIOMETABOLIC DISEASES,
LATINOS HAVE A HIGH PREVALENCE
OF THESE DISEASES IN THE U.S
U.S., -- I'LL GIVE YOU A FEW
MORE DETAILS OF THAT STUDY IN A
SECOND.
HAS SHOWN THAT THE MULTIPLE
GROUPS OF LATINOS ACROSS THE
U.S. HAVE REALLY HIGH PREVALENCE
OF THESE CONDITIONS.
AS AN EXAMPLE -- MEN AND WOMEN
IN THIS COHORT ACTUALLY HAVE THE
HIGHEST PREVALENCE OF DEVELOPING
THESE FACTORS, INCLUDING
DIABETES, OVER 40% PREVALENCE OF
DIABETES, AROUND 60 AND ALMOST
20% IN THIS GROUP.
THE OTHER SORT OF KNOW VAITING G
FACTOR TO FOCUS ON THE LATINO
POPULATION IS MULTILEVEL
EXPERIENCES OF FACTORS THAT CAN
IMPACT STRUCTURAL RACISM,
INDIVIDUAL LEVEL EXPERIENCES OF
DISCRIMINATION ACROSS THESE
MULTIPLE INDIVIDUAL FAMILY
COMMUNITY NEIGHBORHOOD LEVELS,
POLICY LEVELS, AND THE LATINO
POPULATION IN PARTICULAR WE'RE
ALSO THINKING ABOUT THE ROLE OF
DIFFERENT LIVED EXPERIENCES,
COUNTRIES OF ORIGIN, IMMIGRA
IMMIGRATION, DIFFERING LANGUAGE
BARRIERS THAT CAN PRESENT
THEMSELVES AS ADDITIONAL
STRESSORS AND ADDITIONAL
MEASURES OF DISCRIMINATION AND
RACISM.
THESE FACTORS ALL DIFFER AS THIS
POPULATION IS IN THE UNITED
STATES, SO -- WITH TIME IN THE
U.S. -- HOW MUCH OF THESE
EXPERIENCES WE MAY ENCOUNTER,
THEN ALSO WE RECOGNIZE THERE IS
INTERSECTIONALITY SO LATINOS ARE
ALL DIFFERENT RACES, IT'S AN
ETHNIC GROUP, COUNTRY OF ORIGIN,
NOT NECESSARILY -- SO YOU HAVE
THAT SORT OF ADDITIONAL
DIMENSION OF NOT JUST LATINO
IDENTITY BUT RACIAL IDENTITY
ALSO.
SO CONCEPTUALLY IT LOOKS AT THE
IMPACT OF DIFFERENT SOCIAL AND
ECONOMIC STRESSORS IN THE LATINO
POPULATION, HOW IT MAY BE -- HOW
IMPACT -- AGE AND HOW THAT IN
TURN AFFECTS CARDIOMETABOLIC
HEALTH.
THERE ARE SOCIOCULTURAL FACTORS,
ACCULTURATION AND -- NEGATIVE
FACTOR, THE IMPACT OF THE
STRESSORS ON EPIGENETIC MARKERS
AND CARDIOMETABOLIC HEALTH.
FOR THOSE THAT ARE NOT FAMILIAR,
I'VE THROWN AROUND THE TERM A
COUPLE TIMES BUT THE GENES ARE
YOUR GENES, EPIGENETICS IS HOW
THE GENES ARE EXPRESSION, THE
EXPRESSION CAN CHANGE WHEN
EXPOSED TO SOCIAL AND
ENVIRONMENTAL STRESSORS.
DNA METHYLATION IS THE MOST WELL
STUDIED EPIGENETIC MARKER AND
THAT'S WHAT THIS WORK FOCUSES
ON.
DNA METHYLATION MARKERS, WE CAN
OBTAIN -- AGING OR A MEASURE OF
BIOLOGICAL AGE -- IN THE ABSENCE
OF DISEASE.
AND IT'S A WAY TO CAPTURE THE
IMPACT OF STRESS -- HOW MUCH
WE'RE AGING.
SO WE COMPARE THE CHRONOLOGICAL
AGE TO YOUR BIOLOGICAL AGE, --
ACCELERATES THE AGING PROCESS
AND HAVE AN IMPACT ON BU BIOLOGL
AGE.
THESE CLOCKS -- WE HAVE A NUMBER
OF DIFFERENT CLOCKS AND I'LL
SHOW YOU RESULTS FROM A COUPLE
OF THEM.
FIRST OF ALL HORVATH, THE SECOND
GENERATION CLOCKS HAVE BEEN
SHOWN TO PREDICT CHRONIC
DISEASES IN THE ABSENCE OF SORT
OF OUR TRADITIONAL RISK FACTORS.
-- LATINO ADULTS IN THE UNITED
STATES.
SAMPLE LATINOS -- DIFFERENT U.S.
SITES WHICH LARGE -- LATINO
POPULATIONS.
RECOGNIZING HETEROJA NATE OF THE
POPULATION, WE ACTUALLY HAVE
LARGE NUMBERS OF PARTICULAR
GROUPS OF LATINOS THAT WE CAN
LOOK AT THAT ACROSS LATINO
POPULATION BECAUSE OF COUNTRY OF
ORIGIN.
AND IT'S BEEN ONGOING FOR A
NUMBER OF YEARS NOW, I'M GOING
TO SHOW YOU DATA THAT'S BEEN
DLBEENCOLLECTED AT BASELINE ANDD
TIME ASSESSMENT.
THERE'S A NUMBER OF DIFFERENT
ANCILLARY STUDIES TO THIS WHOLE
COHORT.
THE HCHS/SOL INCLUDED A HOST OF
MEASURES -- SOCIAL MEASURES.
AS WELL AS MENTAL HEALTH
MEASURES, AND SORT OF THE
PROJECT THAT I DEVELOPED FOCUSED
ON -- OF THAT POPULATION WHO HAD
ALSO COMPLETED SECOND VISIT AND
PROVIDED BLOOD SAMPLE AND AGREED
THAT WE COULD LOOK AT THEIR
SAMPLES FOR DNA ANALYSIS.
SO THE IDEA WE HAVE TWO TIME
POINTS OF EPIGENETIC AGE, -- WE
CAN LOOK AT THESE STRESSORS THAT
OCCUR -- THAT WE CAN LOOK AT
STRESSORS AND HOW ARE WE GOING
TO -- EPIGENETIC AGE IS
POTENTIALLY CONNECTED TO
CARDIOMETABOLIC HEALTH.
JUST TO GIVE YOU AN IDEA OF THE
SAMPLE FOR THE STUDY, WE HAVE
JUST UNDER A THOUSAND
PARTICIPANTS.
IF IT'S REPRESENTATIVE OF THE
ORIGINAL -- COHORT WHERE 20% OF
THE POPULATION IS U.S.-BORN, SO
THIS IS LARGELY FOREIGN-BORN
POPULATION, AND WE HAVE AVERAGE
AGE OF 45, AT BASELINE WITH AS I
MENTIONED LARGE GROUPS OF --
DISTINCT GROUPS OF HISPANIC AND
LATINOS -- MEXICAN, CUBAN AND
PUERTO RICAN GROUPS IN THIS
POPULATION.
SO ONE OF THE FIRST ANALYSIS
THAT WE FOCUSED ON IS LOOKING AT
WHAT IS THE -- POTENTIALLY
RELATE TO EPIGENETIC AGING,
KNOWING THE ACCULTURATION
PROCESS IS A STRESSFUL
EXPERIENCE THAT THEY
ENCOMPASS -- LOOK AT A NUMBER OF
DIFFERENT FACTORS, IN RELATION
TO EPIGENETIC AGING, WHETHER
THERE WAS A DIFFERENCE THERE.
SO WE LOOKED AT A COUPLE
DIFFERENT CLOCKS, SHOWING -- WE
HAVEN'T PUBLISHED THESE FINDINGS
YET.
LOOKING AT JETT AGE IS ONE TYPEE
TYPE OF INDEX -- THE RATE OF
AGING.
SO WHEN WE COMPARE FOREIGN BORN
AND WE CHARACTERIZE PEOPLE AT
U.S. BORN OR ARRIVING IN THE
UNITED STATES AS A CHILD OR
ARRIVING IN THE UNITED STATES AS
AN ADULT, BECAUSE WE KNOW
THERE'S A DIFFERENCE OF LIVED
EXPERIENCE WHEN YOU COME IN TO
THE U.S. AS A CHILD VERSUS AN
ADULT, WE SEE THAT THE
COMBINATION THAT ARE NOT U.S.
BORN, YOU HAVE A LOWER AGE OR A
DECELERATION OF AGE, IF YOU
WILL, A PROTECTIVE EFFECT OF NOT
BEING BORN IN THE UNITED STATES,
COMING TO THIS COUNTRY AS AN
ADULT.
IT'S NOT STATISTICALLY
SIGNIFICANT -- LIVED IN A
POPULATION ARRIVING AS A CHILD,
SO THIS SORT OF LIKE KIND OF
REPRESENTS A LOT OF WHAT WE SEE
IN THE LITERATURE, AND THE
IMPACT OF ACCULTURATION,
HISPANIC PARADOX, WE KNOW THAT
IMMIGRANT POPULATIONS ARE COMING
IN POTENTIALLY HEALTHIER AND
THAT HEALTH STARTS TO WANE AS
THE POPULATION SPENDS MORE TIME
IN THE UNITED STATES.
WE HAVE PROTECTIVE FACTORS --
PRO TENSIONALLY WPOTENTIALLY WEE
CONTEXT OF POTENTIALLY
DISCRIMINATION AND OTHER FACTORS
HAVE A WEARING EFFECT ON THE
AGING OF THIS POPULATION.
WE HAVE CHARACTERIZED AN
ACTIVITY TWO DIFFERENT WAYS IN
THE COHORT BECAUSE IF YOU ARE
BORN -- FOR EXAMPLE, IF YOU'RE
BORN IN U.S. MAINLAND OR
TERRITORY, -- INCLUDING THE U.S.
TERRITORIES.
SO WHEN WE CONSIDER U.S. NATIVES
BORN IN THE MAINLAND UNITED
STATES OR IN THE TERRITORIES WE
SEE A SLIGHTLY STRONGER EFFECT,
BUT WE SORT OF ISOLATE THIS
FOREIGN BORN POPULATION TO BEING
BORN COMPLETELY OUTSIDE OF THE
U.S. AND U.S. TERRITORIES.
ANOTHER WAY WE LOOKED AT SOME OF
THE IMPACT OF STRESSORS ON THIS
POPULATION IS REALLY THINKING
ABOUT -- SO IT'S NOT JUST -- BUT
WE ACTUALLY HAVE MEASURES OF
WHAT POTENTIALLY THOSE
FACTORS -- THESE GROUPS.
SO NUMBER OF MEASURES ON SES,
ALL THESE OTHER FACTORS, SO WE
CONDUCTED ANALYSIS LOOKING AT
HOW THE ACCUMULATION OF
DIFFERENT FACTORS BOTH SOCIAL
STRESSORS AS WELL AS SOCIAL
SUPPORT -- POTENTIALLY -- SO IT
MAY IN PART DIFFERENTIAL EFFECT
ON EPIGENETIC AGING.
SO THIS IS -- TRADITIONALLY A
METHOD THAT'S USED IN
EPIDEMIOLOGY FOR DIFFERENT
MIXTURES -- TO SEE HOW IT
CLUSTERED.
SO WE'VE LOOKED AT OUR DATA, AND
WE CAN CHARACTERIZE OUR
POPULATION AS ABOUT BELONGING OR
SORT OF BEING -- SORT OF
CLUSTERS.
CLUSTER ONE IS A CLUSTER THAT
HAS HIGH EXPOSURE TO EVERYTHING
WE LOOKED AT, SO IMMIGRATION
STRESS, DEPRESSIVE SYMPTOMS,
ANXIETY, PERCEIVED STRESS --
SUPPORT AND A NUMBER OF
DIFFERENT FACTORS.
CLUSTER FOUR IS THE OTHER
EXTREME WHERE THEY JUST DID NOT
EXPERIENCE ANY OF THESE MARKERS,
AND CLUSTER 2 AND 3 ARE
SOMEWHERE IN BETWEEN.
CLUSTER 2 IS MORE CHARACTERIZED
BY HIGH TRAUMA, HIGH ACES, HYPER
RECEIVED STRESS, AND CLUSTER
THREE IS MORE CHARACTERIZED BY
HIGH LEVELS OF DEPRESSION,
ANXIETY AND PERCEIVED STRESS.
AND WHAT WE SEE IS THAT CLUSTER
1, 2 AND 3 ARE ALSO SEEING
INCREASED AGE ACCELERATION.
SO -- ASSOCIATED WITH INCREASING
ACCELERATION IN -- AGE AND PACE
OF AGING COMPARED TO CLUSTER 4,
WITH DIFFERENT LEVELS OF --
ASSOCIATION DEPENDING ON HOW
MUCH PEOPLE WHO WANT TO.
SO CLUSTER ONE IS SORT OF
EXPOSED TO OTHER FACTORS AND YOU
WOULD EXPECT -- SITUATION.
BUT THE INTERESTING THING HERE
IS THAT WHETHER PEOPLE ARE
REPORTING HIGH LEVELS OF TRAUMA
POTENTIALLY WITHOUT MENTAL
HEALTH SYMPTOMATOLOGY OR THEY'RE
EXPERIENCING HIGH LEVELS OF
THESE MENTAL HEALTH
SYMPTOMATOLOGY WITHOUT -- OF
TRAUMA, WE STILL SEE THIS IMPACT
ON THE --.
I'LL JUST END BY GIVING A LITTLE
BIT OF WHERE WE FOCUSED ON JUST
ONE OF THESE STRESSORS, SO WE DO
A LOT OF WORK ON ACES AND THEIR
IMPACT ON -- ACROSS THE LIFE
COURSE, SO WE ALSO DO WORK JUST
FOCUSING ON ONE TYPE OF
STRESSOR, SO AGES IN RELATION TO
EPIGENETIC AGING.
THIS IS WORK BY -- THE DOCTORAL
STUDENT ALSO -- WORKING WITH ME,
AND WE DO SEE HIGHER LEVELS OF
ACE EXPOSURE -- THAT ARE
ASSOCIATED WITH AGE ACCELERATION
AND WE'RE ALSO LOOKING AT TIME
WHEN -- AS WE HAVE MULTIPLE
MEASURES OF -- AND NOT THE RATE
OF AGING.
IT WAS REALLY INTERESTING, WE
LOOK AT SORT OF THE -- POTENTIAL
MODIFIER OF THE AGES ON
EPIGENETIC AGING AND IN FACT WE
DO SEE THE U.S. -- POPULATION
WHERE WE SEE -- EPIGENETIC AGING
SO SORT OF THAT POTENTIAL SORT
OF EXACERBATING FACT -- EARLY
CHILD EXPERIENCES AND THEN THE
IMPACT OF WHAT BEING A LATINO IN
THE UNITED STATES REPRESENTS.
THAT EXACERBATES EPIGENETIC
AGING IN OUR SAMPLE.
SO I'LL END THERE.
THESE FINDINGS ARE SORT OF
ADJUSTED FOR A NUMBER OF
DIFFERENT FACTORS AND THEY'RE
ROBUST --.
WE -- THE NEXT STEPS FOR THIS
WORK IS TO -- AGING AND
CARDIOVASCULAR HEALTH
MEASURES -- OVERALL CONCEPTUAL
FRAMEWORK.
I WILL STOP THERE.
>> THANK YOU.
NEXT WE HAVE DR. SYLVIE MRUG WHO
WILL TALK ABOUT THE ROLE OF DNA
METHYLATION IN THE CONNECTIONS
BETWEEN EARLY LIFE STRESS,
PROTECTIVE FACTORS AND HEALTH
DISPARITIES IN EARLY MARKERS OF
CHRONIC DISEASE.
>> SO GOOD AFTERNOON, EVERYBODY.
JUST TO INTRODUCE MYSELF A
LITTLE BIT, AS YOU CAN HEAR, I'M
NOT A NATIVE -- I CAME TO THIS
COUNTRY -- YEARS AGO FROM
EASTERN EUROPE WITH $200 AND
THIS MUCH ENGLISH, SO I LIKE I
CAN SPEAK BETTER.
MOST OF THE TIME I'VE BEEN IN
THE U.S., I HAVE LIVED IN
ALABAMA, WHERE WE HAVE -- AND --
[INAUDIBLE].
TODAY I WILL TELL YOU A LITTLE
BIT ABOUT OUR WORK ON THE ROLE
OF DNA METHYLATION AND THE
CONNECTIONS -- PROTECTIVE
FACTORS AND HEALTH DISPARITIES
IN EARLY MARKERS OF CHRONIC
DISEASE.
[INAUDIBLE].
>> WONDERFUL.
SO -- SUBSTANTIAL -- EVIDENCE
SHOWING THAT THERE ARE --
DISPARITIES BETWEEN BLACK AND
WHITE AMERICANS, I LIVE AND WORK
IN ALABAMA -- DISEASE
DISPARITIES AND OVERALL -- OF
CHRONIC -- CONDITIONS INCLUDING
OBESITY, DIABETES, HYPERTENSION,
CARDIOVASCULAR DISEASE, KIDNEY
DISEASE, AS WELL AS LIFE
EXPECTANCY.
AND INTERESTING -- DISPARITY
BETWEEN BLACK AND WHITE
AMERICANS ARE MUCH MORE
EXTENSIVE AND -- COMPARED TO
OTHER REGIONS IN THE COUNTRY.
WE ALSO KNOW THAT THESE
DISPARITIES EMERGE QUITE EARLY,
SO SOME OF THAT CAN BE SEEN IN
CHILDHOOD, YOUNG ADULTHOOD SUCH
AS OBESITY, HYPERTENSION,
GLYCATED HEMOGLOBIN OR
INFLAMMATION.
WE ALSO KNOW THAT THESE EARLY
METABOLIC INDICATORS CONTRIBUTE
TO LATER CHRONIC DISEASE AND
HEALTH DISPARITIES IN LATER
CHRONIC DISEASE.
NEXT, WE KNOW THAT EARLY LIFE
STRESS HAS PROFOUND EFFECTS ON
HEALTH, SO -- LIVING IN POVERTY,
DISADVANTAGED NEIGHBORHOODS,
EXPERIENCING DISCRIMINATION, ALL
OF THESE FACTORS LEAD TO CHRONIC
HEALTH DISORDERS.
AND BLACK AMERICANS CARRY A
DISPROPORTIONATE BURDEN OF THESE
EARLY LIFE STRESSORS.
THESE CHRONIC PSYCHOSOCIAL
STRESS AFFECTS -- BIOLOGICAL AND
PSYCHOLOGICAL AND BEHAVIORAL
PROCESSES INCLUDING DNA
METHYLATION, WHICH IN TURN
ALTERED STRESS REACTIVITY,
METABOLISM AND INFLAMMATION.
SO THERE ARE A NUMBER OF
RESEARCH GAPS -- WORK.
THE QUESTION IS DEVELOPMENTAL
TIMING OF LINKS BETWEEN EARLY
LIFE STRESS AND DNA METHYLATION.
THIS -- TIMING OF THE STRESS
EXPOSURE -- FOR EXPOSURE TO
EARLY LIFE STRESS THIS IS
ESPECIALLY IMPACTFUL.
SECOND, WHAT IS THE TIMING OF
DNA METHYLATION -- AND -- FOCUS
ON IN TERMS OF DEVELOPMENT
INCLUDING CHILDHOOD, ADOLESCENCE
AND YOUNG ADULTHOOD.
AND -- PROCESSES SO THEY CAN
BE -- INTERVENTIONS BEFORE
PEOPLE DEVELOP CHRONIC DISEASE.
WE ALSO HAVE RACIAL DIFFERENCES
IN THESE LINKS BETWEEN EARLY
LIFE STRESS, DNA METHYLATION AND
EARLY CARDIOMETABOLIC
INDICATORS, AND PROTECTIVE
FACTORS THAT MAY REDUCE THE
EFFECTS OF EARLY LIFE STRESS ON
ADA METHYLATION AND HEALTH
OUTCOMES.
THESE PROTECTIVE FACTORS --
INCLUDING INDIVIDUAL, FAMILY AND
COMMUNITY.
SO I'LL FOCUS ON DNA METHYLATION
HAS BEEN PRIMARILY ON EPIGENETIC
AGING, SO AS WE GET OLDER, OUR
DNA METHYLATION GENERALLY
DECREASES.
BUT THERE ARE SUBSTANTIAL
INDIVIDUAL DIFFERENCES IN DNA
METHYLATION WHICH HAVE BEEN --
IN THESE EPIGENETIC CLOCKS WHICH
PROVIDE INFORMATION ON DNA
METHYLATION [INAUDIBLE] ON THE
GENOME AND INDICATE HOW FASTER
OR SLOWER YOUR BIOLOGICAL AGING
IS COMPARED TO YOUR
CHRONOLOGICAL AGE.
SO FIRST I WOULD LIKE TO PRESENT
SOME FINDINGS FROM THE HEALTHY
PASSAGES STUDY WHERE WE HAVE
OVER 1200 INDIVIDUALS FROM
CHILDHOOD TO YOUNG ADULTHOOD,
60% BLACK, 35% WHITE, AND AROUND
[INAUDIBLE].
SO AT AGES 11, 13, 16 AND 19, WE
ASSESSED SEVERAL DIFFERENT EARLY
LIFE STRESSORS INCLUDING FAMILY
INCOME AND WITNESSING VIOLENCE
AND VICTIMIZATION.
AT AGE 11 -- PEOPLE'S ADDRESSES
AND LINKED THEM WITH INFORMATION
FROM THE U.S. CENSUS ON POVERTY,
LEVEL OF EDUCATION,
UNEMPLOYMENT.
AT AGE 19, WE ALSO ASKED ARE
PARTICIPANTS LIFETIME EXPOSURE
TO DISCRIMINATION.
AND -- SALIVA -- SECOND AND
THIRD GENERATION EPIGENETIC
CLOCKS AND PHENOAGE, GRIMAGE AND
DUNEDINPO AM -- ARE BETTER AT
PREDICTING HEALTHSPAN AND --
DISEASE -- CHRONOLOGICAL AGING.
-- INCLUDING AGE, SEX, RACE,
BMI, SMOKING AND CELL --.
SO -- THE QUESTION OF RACIAL
DISPARITIES IN EPIGENETIC AGING.
SO AGAIN ADJUSTING FOR -- BEING
BLACK PREDICTED ACCELERATED
HIGHER GRIMAGE, THIS IS AGE 19
METHYLATION DATA, AS WELL AS
HIGHER -- OF EPIGENETIC AGING.
THIS IS ONLY -- PERCEPT OF THE
SAMPLE BUT IT STILL PREDICTED
HIGHER -- AGING.
INTERESTING -- DIFFERENCES ON
THE -- AGE.
[INAUDIBLE] DIFFERENT MEDIATORS
SO I'M JUST GOING TO SHOW IT
PIECE BY PIECE BUT IT WAS ALL
ANALYZED TOGETHER.
WHEN YOU COME HERE --
DIFFERENCES IN ACCELERATED -- BY
GREATER NEIGHBORHOOD
DISADVANTAGE AND -- AS WELL AS
VIOLENCE -- [INAUDIBLE].
DIFFERENCES IN THE -- OF AGI
AGING -- FAMILY INCOME
EXPERIENCED BY THE BLACK YOUTH
IN OUR STUDY, AND SAME FOR THE
OTHER RACIAL GROUPS ALSO
EXPLAINED BY FAMILY INCOME AND
INTERESTINGLY ALTHOUGH THERE
WERE NO RACIAL DIFFERENCES ON --
AGE -- MODEL, THERE WAS A
SIGNIFICANT MEDIATED EFFECT
BETWEEN BLACK AND WHITE
INDIVIDUALS, AGAIN FASTER
EPIGENETIC AGING -- FEMALE AGE
AND EXPLAINED BY HIGHER EXPOSURE
TO VIOLENCE.
SO NEXT WE TACKLED THE QUESTION
OF DEVELOPMENTAL TIMING FOCUSING
ON VIOLENCE EXPOSURE.
YOU CAN SEE THEY HAVE COLLECTED
AGE 11, 13, 16 AND 19 AND WE
WERE ALSO INTERESTED IN THE
DIFFERENCES BETWEEN WITNESSING
AND VICTIMIZATION.
-- FOR THE LAST 12 MONTHS, YOU
CAN SEE -- VIOLENCE -- HIGH FOR
WHAT WE WOULD LIKE TO SEE.
SO OVER 70% OF YOUTH REPORTED --
VIOLENCE AND BETWEEN 20 AND
50% -- VI VICTIMIZATION.
ALSO NOTICE -- SO PREDICTED
EPIGENETIC AGING -- VIOLENCE AT
THE DIFFERENT AGES WHAT WE FOUND
WAS THAT AGE 11 -- PREDICTED
HIGHER AGE.
AGE 13 AND AGE 16 WITNESSING
VIOLENCE PREDICTED HIGHER -- AGE
AND HIGHER DUNEDIN DB OF AGING,
AND AGE 19 DID NOT PREDICT ANY
EPIGENETIC AGING VARIABLES.
THE -- WERE PRETTY SMALL BUT
THEY WERE ROBUST ACROSS
DIFFERENT OUTCOMES AND THERE
WERE NO SEX DIFFERENCES IN -- SO
THESE RESULTS SUGGEST THAT --
MAY BE A CRITICAL PERIOD FOR
EXPOSURE -- VIOLENCE.
NOW FOR VICTIMIZATION,
INTERESTINGLY THERE WERE NO
EFFECTS WHATSOEVER VICTIMIZATION
AT ANY AGE DID NOT PREDICT
ACCELERATED AGING --
DIFFERENCES.
IN THE NEXT PROJECT THAT I'LL
PRESENT, THE QUESTION OF
PROTECTIVE FACTORS, SPECIFICALLY
FOCUSED ON -- COMING FROM
NEIGHBORHOODS, NEIGHBORHOOD
DISADVANTAGE AND [INAUDIBLE]
EFFECTS.
FOR THIS STUDY, DATA FROM --
PROJECT THE BIRMINGHAM -- OVER
304 CHILDREN WHO WERE POLLED
FROM AGE 11 TO AGE 27.
61% FEMALE, 82% BLACK, 18%
WHITE.
AND AGE 11, WE GATHERED
INFORMATION ON NEIGHBORHOOD
POVERTY FROM U.S. CENSUS DATA
AND -- DISORDER AND DISORDER
INCLUDED THINGS LIKE -- FEELING
UNSAFE IN THE NEIGHBORHOOD.
AND WE ALSO ASKED CHILDREN AND
PARENTS ABOUT -- EXPERIENCES
INCLUDING SUPPORTIVE PARENTING
AS WELL AS HARSH AND
INCONSISTENT PARENTING, YELLING,
SPANKING THE CHILD --
CONSEQUENCES BUT NOT FOLLOWING
THROUGH OR JUST USING DIFFERENT
PUNISHMENT AND -- [INAUDIBLE].
-- YEARS LATER AT AGE 27 27 --
INCLUDING BMI, CORTISOL, CRP --
FROM THE BLOOD AS WELL AS DNA
METHYLATION THAT HAS BEEN
RELATED TO INFORMATION -- PRIOR
RESEARCH.
AND THE -- PAPER WE FOCUSED ON
THE EPIGENETIC CLOCKS AND
EPIGENETIC MORTALITY INDEX.
SO WHAT WE FOUND WAS THAT
NEIGHBORHOOD POVERTY, THIS WAS
FROM CENSUS DATA, EXPERIENCED
AGING LEVEL PREDICTED LOWER
LEVELS OF CORTISOL 16 YEARS
LATER.
AND -- AS REPORTED BY PARENTS AT
AGE 11 PREDICTED HIGHER
METHYLATION RELATED
INFLAMMATION, 16 YEARS LATER.
WE ALSO OBTAINED A NUMBER OF
INTERACTIVE -- BETWEEN PARENTING
AND [INAUDIBLE].
ALL OF THEM ARE IN THE DIRECTION
OF NEIGHBORHOOD DIVERSITY ONLY
BE ASSOCIATED FO WITH POOR OU
OUTCOMES -- AND HIGH
INCONSISTENT DISCIPLINE.
SO HERE YOU CAN SEE -- ON THE
BOTTOM YOU CAN SEE THAT
NEIGHBORHOOD POVERTY IS ALL
ASSOCIATED WITH INFLAMMATION.
-- FOR INCONSISTENT DISCIPLINE,
AND LAST ONE IS FOR THE --
METHYLATION.
ALSO YOU -- ASSOCIATION THAN --
INCONSISTENT DISCIPLINE.
PAPER FOCUSING ON EPIGENETIC
OUTCOMES WE DID NOT OBSERVE
ANY -- OF NEIGHBORHOOD POVERTY
OR NEIGHBORHOOD DISORDER -- BUT
AGAIN, WE HAD A NUMBER OF
SIGNIFICANT INTERACTIONS BETWEEN
NEIGHBORHOOD -- SO THESE ARE T
THE -- THE SHADED AREA IS NOT
SIGNIFICANT, THE WHITE AREA IS
SIGNIFICANT.
WHAT THESE TWO GRAPHS ARE SHOW
SOMETHING WHEN THE CHILD WAS
REPORTING LOW LEVELS OF PAREN
PARENTAL -- PARENTAL SUPPORT WE
SAW POSITIVE ASSOCIATION
BETWEEN -- AND EPIGENETIC
MORTALITIES AND -- EPIGENETIC
AGING.
ON THE BOTTOM IS OUR PARENT
REPORTED -- CONSISTENT
DISCIPLINE, SO WHEN THE PARENTS
REPORTED BEING MORE HARSH, BEING
MORE INCONSISTENT, AGAIN WE SEE
A POSITIVE ASSOCIATION BETWEEN
NEIGHBORHOOD POVERTY AND
DISORDER AND ACCELERATED
EPIGENETIC --.
OUR CURRENT PROJECT, WE ARE
EXAMINING THESE SAME QUESTIONS
IN -- COHORT.
SO USING THE OFFSPRING, THE
CHILDREN OF OUR ADULT
PARTICIPANTS, SO WE HAVE -- SO
THE CHILDREN RANGE FROM LITTLE
BABIES TO 14 YEARS OLD WITH A
MEAN OF 4, 4 YEARS.
WHAT WE FOUND WAS THAT
NEIGHBORHOOD POVERTY, AND THIS
IS NEIGHBORHOOD POVERTY OF --
WAS ASSOCIATED WITH HIGHER
EPIGENETIC AGING USING PEDBE
CLOCK IN CHILDREN AGES 7 OR
ABOVE, WHICH IS CONSISTENT WITH
THE PAST EPIGENETIC AGING BEING
NEGATIVE --.
ON THE OTHER HAND, WE SAW
NEIGHBORHOOD -- ASSOCIATED WITH
LOWER EPIGENETIC AGING --
2 YEARS OF AGE WHICH ACTUALLY IS
CONSISTENT WITH -- SO -- LOARP R
EPIGENETIC AGING IS A -- BETWEEN
NEIGHBORHOOD DISORDER AND
PARENTING.
SO NEIGHBORHOOD DISORDER WAS
RELATED TO LOWER EPIGENETIC
AGING AT LOW INCONSISTENT
DISCIPLINE SUCH AS NO PROTECTIVE
EFFECT OF CONSISTENT DISCIPLINE,
AND WE SAW LOWER NEIGHBORHOOD
DISORDER BEING ASSOCIATED WITH
LOWER METHYLATION RELATED TO
OBESITY AGAIN SUGGESTING
PROTECTIVE IMPACT OF
[INAUDIBLE].
THE FINAL PROJECT I WANT TO SHOW
YOU IS WHERE WE ASKED ABOUT
ALTERNATIVE FACTORS TO -- FROM
COMMUNITY VIOLENCE IMPACTS ON
EPIGENETIC OUTCOMES.
WE MEASURED EXPOSURE -- VIOLENCE
AT AGE 11 AND AT THE SAME TIME,
ASSESSED THE NUMBER OF
PROTECTIVE FACTORS.
THESE FACTORS ALL COME FROM
RESEARCH AND THEY HAVE WELL
ESTABLISHED AS PROTECTIVE FOR --
MORE OU OUTCOMES.
THEY INCLUDE INDULGENCE -- TO
SCHOOL, HAVING GOOD EMOTIONAL
BEHAVIORAL ADJUSTMENT, POSITIVE
PARENTING, AS WELL AS
COMMUNITY -- AND OUR OUTCOME WAS
EPIGENETIC MORTALITY INDEX --
AGE 7.
WE SAW THAT -- HIGHER EXPOSURE
TO COMMUNITY VIOLENCE AND HIGHER
EPIGENETIC MORTALITY RISK 16
YEARS LATER.
HOWEVER, -- PROTECTIVE
FACTORS -- ASSOCIATION AT A
CONVENTIONAL P VALUE AT .05.
THERE WAS MARGINAL INTERACTION
WITH COMMUNITY SOCIAL
CONNECTEDNESS, JUST -- WE MAY
NEED TO LOOK MORE INTO THIS
VARIABLE, BUT I THINK THIS IS
SHOWING, BECAUSE I REALIZE --
PROTECTIVE FACTORS -- THERE MAY
BE -- WHICH -- CONNECTED FACT
FACTORS -- SO TO SUMMARIZE THE
KEY FINDINGS.
WE SEE RACIAL DISPARITIES IN
EPIGENETIC AGING EMERGING QUITE
EARLY, DEFINITELY IN PLACE BY
AGE 19.
THEY ARE PARTLY EXPLAINED BY
EARLY LIFE STRESS FACTORS, SUCH
AS FAMILY POVERTY, NEGATIVE
DISADVANTAGE AND VIOLENCE --
PERIOD FOR STRESS EFFECTS ON
EPIGENETIC OUTCOMES, SUPPORTIVE
AND CONSISTENT PARENTING
MITIGATES THE LONG TERM EFFECTS
OF NEIGHBORHOOD DIVERSITY.
OF NEIGHBORHOOD ADVERSITY.
AS WELL AS EPIGENETIC AGING AND
OBESITY RELATED METHYLATION IN
CHILDHOOD.
WE OBSERVED NO PROTECTIVE
FACTORS FOR EXPOSURE TO
COMMUNITY VIOLENCE AND -- SO IN
TERMS OF FUTURE DIRECTIONS, WE
DON'T -- THESE DIFFERENTIAL
EFFECTS OF EARLY LIFE STRESS AND
PROTECTIVE FACTORS AS WELL AS --
EXPOSURE AND EPIGENETIC
OUTCOMES.
NOW WE ARE COLLECTING DATA ON
THE SAME -- THE FIRST COHORT --
SO WE WILL BE ABLE TO PREDICT
THE CHANGES IN EPIGENETIC
AGING -- TO YOUNG ADULTHOOD FROM
EARLY AND LATER LIFE STRESS AND
PROTECTIVE FACTORS.
SINCE WE ARE COLLECTING DATA --
AND -- TO INVESTIGATE THOSE
GENERATIONAL EFFECTS OF EARLY
AND LATER LIFE STRESS AS WELL AS
IDENTIFY PROTECTIVE FACTORS
THAT -- OF HEALTH DISPARITIES.
AND FINALLY, INTERSECTIONALITY,
WE NEED TO FOCUS MORE ON THE
INTERSECTION OF SEX AND RACIAL
AND SES DIFFERENCES IN THE --
EPIGENETIC MARKERS.
AND SHOUT OUT TO OUR TEAM AND --
THIS WORK.
>> THANK YOU.
NEXT WE HAVE DR. LUDMILA
PAWLIKOWSKA WHO WILL TALK ABOUT
[INAUDIBLE].
>> THANK YOU.
THANK YOU FOR HAVING ME HERE.
IT'S REALLY WONDERFUL TALKS SO
FAR TODAY AND I'M HERE TO HELP
US UNDERSTAND POTENTIALLY HOW WE
CAN USE ANIMAL MODELS -- TO
UNDERSTAND SOME OF THE
MECHANISMS LINKING THE ADVERSE
EFFECTS OF RACISM AND
MARGINALIZATION -- AND HOW
THOSE -- MIGHT IMPACT HEALTH,
DISEASE AND SURVIVAL.
[INAUDIBLE] THERE ARE HUGE
DISPARITIES IN HEALTH THAT SPAN
SOCIAL -- -- MORTALITY ACROSS
THE GLOBE, IN PARTICULAR IN THE
U.S. -- SO THIS IS SOMETHING
THAT'S VERY, VERY WELL
ESTABLISHED -- ABOUT HOW THAT
MIGHT IMPACT OR ACCELERATE
THE -- PROCESS FROM --
PERSPECTIVE MEANS IT WOULD
INCREASE THE RISK OF -- RISK AND
ONSET OF MANY DISEASES OF
WHICH -- OTHER -- [INAUDIBLE].
SO WE CAN -- SOCIAL DETERMINANTS
OF HEALTH FOR SURE --
MARGINALIZATION AND
DISCRIMINATION -- PATTERNS
HEALTH AND WELL-BEING --
INCREASES IN STROKE AND
MORTALITY DAW TO CARDIOVASCULAR
DISEASE IS MUCH HIGHER THAN ANY
OTHER RACIAL AND ETHNIC
BACKGROUND.
BUT WHAT WE MAY NOT ALL KNOW IN
THIS ROOM -- IN SOCIAL
ENVIRONMENTS AND FACE SOME OF
THESE -- SOME SIMILAR SOCIAL
ADVERSITIES.
NOW I'M NOT SAYING THAT -- THESE
SAME SORTS OF THINGS -- RACISM,
MARGINALIZATION AND
DISCRIMINATION OR OTHER SOCIAL
DETERMINANTS OF HEALTH THAT ARE
BASED ON OUR BUILT ENVIRONMENTS,
BUT THEY DO INCUR SOME OF THESE
SAME RESPONSES OR PHYSIOLOGICAL
RESPONSES TO CHRONIC ADVERS Y
ADVERSITY -- PAPER YEARS AGO
WHERE WE BROUGHT TOGETHER --
MORE CROSSTALK WITH
SOCIOLOGISTS, EPIDEMIOLOGISTS --
AS WELL AS THOSE WHO ARE DOING
MORE BIOMEDICALLY RELEVANT
RESEARCH TO TRY AND UNDERSTAND
HOW -- ARE THESE RESPONSES TO --
ACROSS THE ANIMAL KINGDOM AND
HOW CAN WE SORT OF LEVERAGE THAT
NATURAL VARIATION TO DESIGN SOME
EXPERIMENTS TO UNDERSTAND WHAT
ARE SOME OF THE MECHANISMS THAT
MIGHT BE DRIVING THIS
ASSOCIATION.
ALSO TO UNDERSTAND WHAT ARE SOME
OF THE ASPECTS OF THE -- THAT --
MOST FAMILY -- SURVIVAL.
SO I MIGHT GIVE YOU ONE EXAMPLE
TO GET US A LITTLE BIT BACK ON
TIME TODAY, BUT ONE STUDY WHE
WHERE -- TO TRY TO UNDERSTAND
SORT OF WHAT'S GOING ON UNDER
THE HOOD, HOW DOES SOCIAL
ADVERSITY ALTER MOLECULAR
FUNCTION OR OUR IMMUNE CELLS --
AND WHAT DOES THAT MEAN FOR DUNN
STREAM HEALTH AND U. SURVIVAL.
THIS LINK IS REALLY DIFFICULT TO
STUDY IN HUMANS.
WE ARE VERY, VERY CHALLENGING
AND COMPLEX MODEL ORGANISMS, WE
LIVE REALLY LONG LIVES, WE LIVE
IN VERY COMPLEX SOCIAL
ENVIRONMENTS.
WE ALL HAVE VARIABLE ACCESS TO
HEALTHCARE, WE ALL HAVE VARIABLE
ACCESS TO -- NUTRITION AND --
BUT -- ACTUALLY CONTROL MANY OF
THOSE THINGS AND TRY AND
MANIPULATE ASPECTS OF THE SOCIAL
ENVIRONMENT TO GET AT CAUSALITY
BETWEEN YOUR EXPOSURES TO
ADVERSITY, SOCIAL EXPERIENCES
AND HOW THAT MIGHT AFFECT YOUR
CELLS AND YOUR WELL-BEING -- VUR
VIEFL.
SO WE CAN CONTROL THINGS LIKE
VARIABLE ACCESS TO HEALTHCARE,
GETTING ALL THE MONKEYS THE SAME
ACCESS TO HEALTHCARE, THE SAME
NUTRITION, MAKING SURE THEY'RE
NOT SMOKING, THEY'RE NOT
DRINKING, [INAUDIBLE].
WE CAN ALSO DO SOMETHING
EXPERIMENTAL MANIPULATIONS THAT
ALLOW US TO AVOID THIS REVERSE
CAUSALITY WHICH IS OFTEN THE
CASE AND IS HARD TO SORT OF --
PARTICULARLY CROSS-SECTION
STUDIES OF HUMAN COHORTS WHICH
IS THOSE INDIVIDUALS WHO ARE --
WHO ARE IN POORER HEALTH MAY
ACTUALLY FIND THEMSELVES --
SITUATION SO [INAUDIBLE].
SO ANIMALS ARE REALLY RELEVANT
HERE IN THAT WE CAN CONTROL SOME
OF THESE THINGS, CARRY OUT
MANIPULATIONS THAT MIGHT
ACTUALLY ALLOW US TO GET AT
CAUSALITY HERE.
SO I'M GOING TO TELL BUT ONE
STUDY THAT WE DID ALMOST A
DECADE AGO, WHICH IS A VERY LONG
TIME, ON THIS SPECIES, RHESUS
MACAQUES, SPECIFICALLY FEMALE
RHESUS MACAQUES.
SO THEY ARE EVOLUTIONARY
COUSINS, I GUESS, WE SHARE ABOUT
94% OF OUR DNA WITH THEM, THEY
HAVE VERY SIMILAR CELLS, ORGAN
SYSTEMS, BRAINS, AND THEY ARE
SOCIALLY COMPLEX AND FORM VERY
INTERESTING KIND OF -- VERY
STRONG SOCIAL RELATIONSHIPS, AND
VERY STRICT SOCIAL -- BASICALLY
THE FEMALES HERE WERE EASIER TO
STUDY SO WE CAN SORT OF HIJACK
THEIR NATURAL HISTORY TO CHANGE
THEIR SOCIAL STATUS,
SPECIFICALLY LOOKING AT WHETHER
OR NOT THE HIGH VERSUS LOW
SOCIAL STATUS ALTERED SORT OF
THE MOLECULAR MACHINERY OF THE
IMMUNE CELLS IN THESE ANIMALS.
SO THIS WORK WAS DONE, POSTDOC
MENTOR JENNY TUNG -- WITH RHESUS
MACAQUES.
SO WHAT WE DID IS WE MANIPULATED
THEIR SOCIAL LINE, THEIR SOCIAL
STATUS, BASICALLY BY INTRODUCING
THEM TO SOCIAL GROUPS.
STRONGLY PREDICTED THEIR
SUBSEQUENT SOCIAL STATUS OR
DOMINANCE -- FIRST FEMALE THAT
WENT INTO THE CAGE, BEING THE
DOMINANT FEMALE, SECOND -- SO
ON, SO FORTH.
WE CREATED NINE DIFFERENT GROWPS
OF THESE FEMALES.
AND MOST OF THE TIME, -- ALMOST
PERFECTLY PREDICTED -- THAT
SOCIAL GROUP.
SO I'LL SHOW YOU ONE EXAMPLE
HERE WHICH IS EVERY TIME YOU SEE
ONE OF THESE LINES MOVE, SO EACH
OF THESE LINES HAS A FEMALE --
THE ORDER IN WHICH THEY
RETRIEVE -- SO THE FIRST FEMALE
IS ONE, THE SECOND IS -- TWO
FEMALES ARE INTERACTING,
ENGAGING IN SOME SORT OF --
INTERACTION AND -- INDIVIDUAL
ONE INCREASED IN THEIR RANK AND
THEY LOST THE INCREASE
[INAUDIBLE] ALL SORTS OF OTHER
THINGS.
GAMING AND -- ANYWAY.
SO YOU CAN SEE THIS GROUP VERY
QUICKLY.
THEY ESTABLISHED STRICT LINE
LINEAR -- COURSE OF THE STUD
STUDY, -- BUT THIS ALLOWS US TO
ACTUALLY TAKE OUT INDIVIDUAL
DIFFERENCES THAT MIGHT BE
DRIVING -- THAT MIGHT EXPLAIN
VARIATION IN SOCIAL STATUS HERE.
ACTUALLY MANY BELIEVE -- YOU'RE
GOING TO BE -- THEN SEE WHAT
HAPPENS TO THEIR CELLS.
SO -- VERY SIMPLE FIGURE HERE --
WHICH IS WE EXTRACTED --
MULTIPLE TIMES THROUGHOUT THE
EXPERIMENT.
THESE ARE -- LYMPHOCYTES,
MONOCYTES, WHAT WE DID IS WE
CARRIED OUT RNA SEQUENCING ON
INDIVIDUALS THAT SORTED AND
ISOLATED CELL -- SINGLE CELL
SEQUENCING, AND JUST SORT OF
INITY INFANCY, TO MEASURE GENE
EXPRESSION IN INDIVIDUAL CELL
TYPES, SPECIFICALLY -- CELL
TYPES.
LARGELY WHAT WE FOUND IS THAT
OUR EXPERIMENTAL MANIPULATION,
THOSE FEMALES WHO WERE OF LOWER
STATUS WHO WEREN'T -- EXHIBITED
HIGHER LEVELS OF -- RELATED GENE
EXPRESSION -- RELATIVE TO THOSE
FEMALES WHO WERE OF HIGHER
SOCIAL STATUS.
FURTHER, WE COULD DO SOME EX
VIVO STIMULATIONS WITH
POLYSACCHARIDE, WHICH IS
BASICALLY LIKE SIMULATING A
BACTERIAL INFECTION IN THE CELL,
WE EXTRACTED IT -- OUTSIDE AND
WE -- HIGHER BASELINE -- THAT
ACTUALLY HAD AN EXACERBATED
RESULTS, OVERREACTED -- RESPONSE
TO EXPOSURE TO THIS STIMULUS.
AND WE -- SINCE THIS SESSION IS
ALSO ABOUT THE EPIGENOME, I'M
GOING TO TELL YOU ABOUT ONE
OTHER COMPONENT OF THE EPIGENOME
WE LOOKED AT, -- HOW OPEN OR
CLOSED ARE PARTS OF THE GENOME
SO THAT SORT OF TRAN JIPTION
FACTOR IS -- TURN ON -- I'M
TELLING YOU ALL THIS BECAUSE
WE'RE ABLE TO SORT OF FOCUS ON
AND BEEN DOING THIS TO LOOK AT
HOW DIFFERENT CORTICOIDS,
PARTICULARLY THE GEU COCORTICOID
RECEPTOR, BUT IT BINDS TO THE
GLU COCORTICOID RECEPTOR, IT
ENTERS INTO THE NUCLEUS, IT
FINDS -- GENE, TURNS IT ON OR
TURNS IT OFF.
WE KNOW WHEN WE ARE STRESSED,
LIKE MAYBE I WAS GETTING UP HERE
NOT KNOWING HOW THIS TALK WOULD
GO, OUR CORTISOL INCREASES, THAT
IS USEFUL -- CONDITIONS.
HOWEVER, WHAT WE KNOW IS THAT
WHEN PEOPLE ARE TREATED
CHRONICALLY WITH STEROIDS AND/OR
WHEN PEOPLE ARE CHRONICALLY
STRESSED, THIS PATHWAY BECOMES
DESENSITIZED.
WHICH LEADS TO DYSREGULATION OF
THE INFLAMMATORY RESPONSE AND
CHRONIC LEVELS OF INCREASED
INFLAMMATION.
SO WE CALL THIS GLUCOCORTICOID
RESISTANCE.
SO USING THIS EX VIVO MODEL AS
WELL -- ACCESSIBILITY, AND GENE
EXPRESSION, QUICKLY SHOWING THE
TREATMENTS THAT WE DID WORKED.
WE WERE ABLE TO END GUY THAT
THEREOF WERE LIT TOURS IN THE
LOW STATUS SIGNALS SUCH AS THEY
WERE NOT AS RESPONSIVE TO THE
DEXAMETHASONE TREATMENT AS
OPPOSED TO LESS ADVERSITY.
-- THAT MIGHT BE LEADING TO
THIS CHRONIC SOCIAL ADVERSITY
AND DOWNSTREAM HEALTH OUTCOMES
HERE SORT OF ACUTELY LOOKING AT
THEIR IMMUNE CELL GENE
REGULATION.
SO AFTER ONE YEAR IN THESE
SOCIAL GROUPS, GIVEN THIS
EXPERIMENTAL MODEL, WE COULD
MANIPULATE THEIR SOCIAL STATUS.
WE COULD ACTUALLY SAY WHAT
HAPPENS IF WE TAKE THIS
HIGH-RANKING -- MAKE THEM HIGH
STATUS, RIGHT?
HOW STICKY WAS YOUR PRIOR SOCIAL
ENVIRONMENT?
IS THIS REVERSIBLE -- SUGGEST
THAT WE CAN IMPROVE SOCIAL
CONDITIONS, SOCIAL
ENVIRONMENTS -- SHORT TERM.
WE CAN HOPEFULLY -- GOOD HEALTH
LONG TERM.
SO WHAT WE DID IS WE TOOK ALL
HUMANS -- HAVE TO CHANGE -- SO
IT'S ALL -- VICE VERSA.
SAME SORT OF THING, THIS IS
SHOWING HOW MANIPULATION WORKS,
[INAUDIBLE] LARGELY WE FOCUSED
HERE AGAIN OVER -- WE'RE LOOKING
SPECIFICALLY GENE EXPRESSION
PROGRAM -- RELATED -- PROGRAM,
MORE HIGHLY EXPRESSED WHEN
EXPOSED TO ADVERSITY AND LOW --
STATUS -- YOU'RE EXPOSED TO MORE
ADVERSITY, WE SHOULD SEE AN
INCREASE IN THE EXPRESSION OF
GENES RELATED TO --.
THE UNIVERSE FOR -- THAT'S
EXACTLY WHAT WE SAW WHEN WE LOOK
AT SORT OF AVERAGES OF THESE
GENE REGULATORY PROGRAMS, WE SAW
INCREASE IN SOCIAL -- DECREASE
IN SOCIAL STATUS, YOU SAW AN
INCREASE IN YOUR INFLAMMATORY
GENE -- PATTERN -- CELLS AND ON
THE FLIP SIDE OF THAT, IF WE
IMPROVED YOUR SOCIAL -- INCREASE
YOUR SOCIAL STATUS, PREVIOUSLY
LOWER SOCIAL STATUS, WE SAW A
DECREASE IN THE EXPRESSION OF
THOSE -- RELATED GENES.
SO -- YOUR GENES REALLY DON'T
MATTER THAT MUCH, YOUR
ENVIRONMENTAL EXPERIENCES DO.
RIGHT?
AND WHAT I WANT TAKE HOMES TO
BE -- THERE IS NOTHING ABOUT
THESE INDIVIDUAL ANIMALS THAT
DDICTATED WHETHER OR NOT THEY
WERE GOING TO BE EXPOSED TO --
IT WAS PURELY US PLAYING GOD AND
MANIPULATING THEIR EXPERIENCE,
RIGHT?
WHICH SUGGESTS THAT OUR
ENVIRONMENT IS LARGELY -- MUCH
OF WHAT HAPPENS IN -- NOW THIS
IS OVER SIMPLIFIED BECAUSE WE
ARE CONTROLLED FOR MANY THINGS
THAT WE ALSO KNOW ARE STRONGLY
CORRELATED WITH EXPOSURES TO
ADVERSITY SUCH AS ACCESS TO ANY
RESOURCES AND PREDICTABLE
FUTURE.
BUT THIS ALLOWS US TO AT
LEAST -- SOME OF THESE APART AND
UNDERSTAND -- IDENTIFY MESM
NISMS -- HOW WILL I BE ABLE TO
INTERVENE [INAUDIBLE].
SO WITH -- I THINK WE'LL HAVE
SOME DISCUSSION ON ANIMAL MODELS
TOMORROW DURING -- TALK ABOUT
WHAT WE CAN AND -- SO I WON'T
GET INTO THAT NOW.
BUT I DO WANT TO THANK ALL THE
COLLABORATORS FOR PART OF THIS
WORKING GROUP THAT WE BUILT --
POSTDOC THAT WAS BRINGING
TOGETHER LOTS OF SOCIOLOGISTS
AND -- AND ANIMAL -- NON-HUMAN
ANIMAL RESEARCHERS.
AND THEN THANK YOU FROM THE LAB,
THANK YOU TO ALL OF YOU, HAPPY
TO ANSWER ANY QUESTIONS LATER
ON.
>> THANK YOU.
AND NOW FOR THE FINAL TALK IN
THIS SESSION, IT'S DR. IDAN
SHALEV TALKING ABOUT THE
POTENTIAL ROLE OF RACISM,
MARGINALIZATION AND
DISCRIMINATION IN SYSTEMIC
DYSFUNCTION AND BIOLOGICAL
AGING.
I KNOW WE'RE A LITTLE LOW ON
TIME SO I'LL TRY TO TALK FOR
LESS AND ALLOW A LOT OF TIME.
I FIRST WANT TO START BY
THANKING THE ORGANIZERS FOR BE
INVITING ME TO THIS REALLY
IMPORTANT AND INTERESTING
WORKSHOP.
I'M EXCITED TO BE HERE AND SHARE
WITH YOU SOME OF THE INSIGHTS IN
RELATION TO R & D, THEIR
POTENTIAL ROLE OF R & D IN
SYSTEMIC DYSFUNCTION AND
BIOLOGICAL AGING.
AS THE TITLE IND INDICATES, WE
FOCUS IN THE LAB ON -- MORE
BROADLY BUT I WILL TRY TO --
CONTEXT FOR FUTURE RESEARCH.
SO I WANT TO START WITH THE BIG
QUESTION, TO GENERATE
VARIABILITY IN HEALTH AND AGING.
THERE ARE TWO IMPORTANT
QUESTIONS HERE.
FIRST HOW EARLY LIFE PROCESSES
WOULD HELP -- THAT IS OBSERVED
DECADES LATER, AND SECOND, WHY
SHOULD WE EVEN CARE ABOUT AGING
IN OUR LIFE, CAN WE EVEN MEASURE
AGING -- WE ALREADY KNOW THE
ANSWER IS YES.
SHOULD WE CALL IT AGING, SHOULD
WE CALL IT DEVELOPMENT, SHOULD
WE CALL IT SOMETHING DIFFERENT,
SO WE'LL TRY TO ANSWER THAT
QUESTION IN THE NEXT FEW SLIDES.
IF YOU WILL JUST EXCUSE ME FOR A
MINUTE BECAUSE I DIDN'T TAKE MY
GLASSES AND I WON'T BE ABLE TO
SEE.
ALL RIGHT.
SO THIS IS THE CONCEPTUAL
FRAMEWORK THAT WE USE IN OUR
RESEARCH.
SO -- THOUGHT TO BE MEDIATED BY
ACCUMULATION OF -- WE CONSIDER
THESE MOMENT BY MOMENT
VARIATIONS INCLUDING -- AS WELL
AS MORE DYNAMIC CHANGES AT A
CELLULAR LEVEL TO CAPTURE
BIOLOGICAL AGING OVER TIME.
AND THESE CHANGES MOMENT BY
MOMENT CHANGES BY HOURS, BY
DAYS, BY WEEKS, CAN COMPOUND
OVER TIME TO GENERATE THIS
VARIABILITY IN SYSTEMIC
DYSFUNCTION, AGING AND DISEASE
THAT IS OBSERVED DECADES LATER.
SO IN TAKING THESE LAST --
INCLUDING BIOPSYCHOSOCIAL
ASPECTS INCLUDING -- OUR NEXT
SESSION IS GOING TO FOCUS ON
PRENATAL FACTORS AND I'M LOOKING
FORWARD TO THAT SESSION AS WELL,
BUT HERE -- AND DEVELOPMENT.
SO EVEN THOUGH GERENTOLOGICAL
RESEARCH IS STARTING TO -- AGING
EARLY IN LIFE PRIOR TO THE ONSET
OF AGE-RELATED DISEASES, MUCH OF
THIS WORK IS STILL RELATED TO
ADULTS BUT THIS -- NEEDS TO
START EARLY IN LIFE AND WE'VE
ALREADY HEARD SOME EXAMPLES OF
MEASURING -- IN CHILDREN AND
THIS IS WHAT WE ARE TRYING TO --
THIS -- ARTICLE THAT WAS
PUBLISHED RECENTLY, AND
SPECIFICALLY WE WERE OUT OF --
THAT AGING AND DEVELOPMENT ARE
TWO SIDES OF THE SA SAME COIN AD
THAT DEVELOPING A COMPREHENSIVE
UNDERSTANDING OF HEALTH AND
DISEASE RISK REQUIRES EXAMINING
AGE-RE LATED PROCESSES OCCURRING
THROUGHOUT THE EARLIEST YEARS OF
LIFE.
SO THIS IS THE OPPOSITE OF WHAT
WE SEE -- WEAR AND TEAR,
BIOLOGICALLY CHILDREN ARE AGING
AND ARE ACTUALLY -- THAN WHAT WE
SEE LATER IN LIFE.
-- WHAT YOU SEE HERE AT THE
TOP, THIS IS THE -- AND BOTTOM
PANEL IS JUST BIOLOGICAL AGE --
EXPOSURE ACCELERATED TRAJECTORY
OF BIOLOGICAL AGING WHICH
THERE'S ALREADY A LOT OF
EVIDENCE OUT THERE SHOWING THAT
IT CAN ACCELERATE AGING DURING
CHILDHOOD AND ADOLESCENCE, YOU
WANT TO ALSO HIGHLIGHT THE
POTENTIAL ROLE FOR POST EXPOSURE
DIMENSION, ESPECIALLY IF
IMPLEMENTED EARLY IN LIFE,
GETTING THIS TRAJECTORY OF --
AGING AND DELAYING ONSET OF
AGE-RELATED DISEASES.
SO IN SHORT -- TRYING TO SUPPORT
MORE OF THIS WORK OF BIOLOGICAL
AGING THAT WILL START ALREADY IN
UTERO ACROSS CHILDHOOD AND INTO
ADOLESCENCE.
AND TO PROVIDE -- TO ILLUSTRATE
THIS WITH MORE EMPIRICAL EXAM
EXAMPLE, THIS -- CHRONOLOGICAL
AGE ACROSS THE LIFESPAN.
SO WITH TELOMERES, WE KNOW -- AS
WE GROW OLDER, OUR -- WILL GET
SHORTER ON AVERAGE -- BUT IT'S
NOT LINEAR.
SO THIS IS ONE OF THE MAIN
FIGURES FROM THIS META-ANALYSIS.
WHAT YOU SEE HERE, THE Y AXIS IS
THE CORRECTED CORRELATION
BETWEEN TELOMERES AND
CHRONOLOGICAL AGE AND THEY
PLOTTED ACROSS MULTIPLE AGE AND
AGE ACROSS THE LIFESPAN.
THIS IS USING -- T LENGTH.
-- OF THIS FIGURE IS THE
STRENGTH OF THE CORRELATION IS
STRONGER IN THE OPENING YEARS OF
LIFE.
SO IF YOU ARE MEASURING -- YOU
HAVE THE WIDER AGE RANGE -- THIS
IS INDEPENDENT OF STRESS AND
INDEPENDENT OF ANY OTHER --
EXPOSURES.
THIS HAS ALWAYS BEEN A VERY
SENSITIVE DEVELOPMENT -- THAT IF
WE EXPERIENCE ADVERSITIES, WE
WILL EXPECT TO SEE HIGHER
ACCELERATED AGING.
THAT WILL IMPACT HEALTH DISEASE
LATER IN LIFE.
SO THESE ARE SOME OF THE REAS
REASONS -- SOME ARE ASKING,
SO -- MECHANISMS -- HOW DOES
STRESS GET UNDER THE SKIN.
BUT I CAN REPLACE THIS QUESTION
WITH WHAT ARE THE BIOLOGICAL
MECHANISMS UNDERLYING THE
RMD-DISEASE RELATION OR HOW DOES
RMD GET UNDER THE SKIN, THINKING
ABOUT RMD AS A STRESSOR.
HOW DO I MENTION TSH WE'RE ME
SEEING -- TO CAPTURE BIOLOGICAL
AGING, AND WHAT FACTORS CAN
PROMOTE SUCCESSFUL ADAPTATION
AND/OR RESI RESILIENCY TO ADVER?
SO THERE'S ALSO A LOT OF
INTEREST TO TRY TO UNDERSTAND
RESILIENCY AND HOW WE CAN
MITIGATE THE FIRST CONSEQUENCES
LATER IN LIFE.
-- SO AS I MENTIONED WE FOCUS A
LOT ON TELOMERES, USING QVCR,
NOT THE MOST PRECISE METHOD BUT
IT'S -- FOR A LARGE PROPORTION
OF THESE STUDIES.
WE ALSO USE DNA METHYLATION AS
YOU'VE HEARD BEFORE IN PREVIOUS
TALKS.
THERE'S OBVIOUSLY A LOT OF
INTEREST WITH THESE -- WE'RE
CURRENTLY DEVELOPED -- THERE
WILL BE MORE OF THESE DEVELOPED
IN THE FUTURE -- TO BE DEVELOPED
SPECIFICALLY -- EVEN THOUGH --
IN CHILDREN.
TO CAPTURE THE MORE DYNAMIC
MOMENT BY MOMENT VARIATION, WE
ALSO MEASURE GENE EXPRESSION
THRETHROUGH RNA SEQUENCING,
SPECIFICALLY TAPPING THE IMMUNE,
ENDOCRINE AND METABOLIC SYSTEMS,
AS WELL AS METABOLOMICS IN NMR,
IN BLOOD OR URINE, TO TRY TO GET
THIS COMPREHENSIVE UNDERSTANDING
OF MULTIPLE BA BIOLOGICAL FACTOS
AND -- TO UNDERSTAND DISEASE
RELATIONSHIPS.
-- METHODS -- BIOLOGICAL AGE IS
A METHOD DEFINED TO PREDICT AGE
IN YEARS OF A SUBJECT OR --
SYMBOL, SO TELOMERE HAS PROBABLY
BEEN STUDIED IN MOST -- CONTEXT
BUT EPIGENETIC AGING PLOTS ARE
REALLY -- A LOT OF PEOPLE AREN'T
USING THOSE MEASURES, THEY'RE
MORE ACCURATE THAN TELOMERES BUT
LIST -- THE M M MECHANISMS --
CAPTURING GENE EXPRESSION --
MEASURING MULTIPLE AGE --
TELOMERES -- DNA METHYLATION
WHICH IS MORE AGE SIMILAR LEVEL.
SPEAKING OF TELOMERE LENGTH --
SHOUT OUT TO NIH FOR SUPPORTING
THE TELOMERE RESEARCH NETWORK.
SO I WAS SUPPOSED TO READ TO
YOU -- BUT I CAN'T EVEN READ --
THIS IS FROM THE WEBSITE, YOU
CAN GO TO JUST TELOMERE RESEARCH
NETWORK, YOU WILL GO THERE AND
SEE WHAT THIS RESEARCH IS REALLY
ABOUT.
THE BOTTOM LINE, THIS IS A
NETWORK THAT STARTED IN 2019.
AND WE'RE REALLY TRYING TO
INCREASE THE RIGOR AND
REPRODUCIBILITY OF TELOMERE
LENGTH AND MEASUREMENT --
STUDIES AND COHORTS, AND THIS
NETWORK IS STILL ACTIVE AND
GENERATES A LOT OF REALLY
INTERESTING AND IMPORTANT
RESEARCH AND PAPERS.
SO YOU CAN CHECK IT OUT ALSO ON
THEIR WEBSITE.
BUT ONE OF THE REASONS -- IS
BECAUSE THE -- WAS REALLY
INITIATED IN 2017 BY A WORKSHOP
ORGANIZED BY NIH -- TO THIS
WORKSHOP THAT INVITED A LOT OF
EXPERTS AND IN THE FIELD TO
DISCUSS ALL THESE QUESTIONS
ABOUT TELOMERE SCIENCE.
THIS WAS THE TITLE FOR THAT
WORKSHOP, TELOMERES AND
SENTINELS FOR ENVIRONMENTAL
EXPOSURES, PSYCHOSOCIAL STRESS
AND DISEASE SUSCEPTIBILITY.
THESE ARE SOME OF THE POINTS
FROM THE EXECUTIVE SUMMARY AT
THE END OF THIS WORKSHOP.
SO DEVELOP CONSENSUS GUIDELINES,
WHICH WE ALREADY DID, CONDUCT
ROBUST METHODS COMPARISON STUDY,
STILL A WORK IN PROCESS.
FOCUS -- DEVELOPING BETTER
MEASURES OF STRESS EXPOSURE,
FOSTER INTERDISCIPLINARY
COLLABORATION.
SO A LOT OF REALLY IMPORTANT
POINTS THAT CAN BE IMPLEMENTED
IN RMD HA-RELATED RESEARCH.
SO -- FOR FUTURE DISCUSSIONS,
BUT THIS WORKSHOP WAS REALLY --
WAS INITIATED BY THE TELOMERE
RESEARCH NETWORK.
SO -- THE LIFESPAN INFLUENCES ON
TELOMERE, THIS IS FOR A REVIEW
PAPER -- 10 YEARS AGO BUT THIS
IS STILL RELEVANT CONCEPTUALLY
TODAY.
WHAT YOU SEE HERE IS
BIOLOGICAL -- AGE IN PARALLEL
WITH MULTIPLE AGE.
ON THE LEFT YOU CAN SEE THE
IMENT FER IMPACT -- CHILDHOOD
TRAUMA THAT CAN ACCELERATE OR
EPIGENETIC AGING CLOCKS.
THIS GENERATIONAL -- SUPPOSED TO
CAPTURE THE CAUSAL DIRECTION,
SO -- BUT ADULT MENTAL
DISORDERS, DEPRESSION, ANXIETY
HAVE BEEN STUDIED A LOT,
AGE-RELATED DISEASES INCLU INCLG
CARDIOVASCULAR DECEMB DISEASE --
PLAYING A ROLE IN CAUSAL PATHWAY
LEADING TO -- DISEASE.
THEN ON THE TOP WE HAVE ALL TH
THE -- EFFECT ON -- AGING
INCLUDING DIET, SLEEP, STRESS
REDUCTION, ALL OF THESE FACTORS
ARE DB TO CONSIDER AND THEN,
GETTING -- ACROSS THE LIFESPAN,
INCLUDING INTEGER TRANSMISSION
GAUZE RIGHT.
SO IN TERMS OF THE MECHANISMS,
THIS IS STILL ONE OF THOSE --
ADVERSITY AND STRESS MAY LEAD TO
OUR INCREASED RISK FOR
AGE-RELATED DISEASES.
SO IF WE THINK ABOUT TELOMERES
OR EPIGENETIC AGING CLOCKS, --
ESPECIALLY, AGAIN, SPEAR THAT ME
THE MASTER INTEGRATOR OR -- AND
ACCELERATES -- AGING --
INDICATES INCREASED RISK OF
AGE-RELATED DISEASES, BUT AGAIN
THE QUESTION IS, HOW DOES STRESS
AFFECT -- TELOMERES TO GET
SHORTER ACTUALLY -- INCREASED
RISK OF -- THAT, WE STILL DON'T
KNOW, BUT IT'S A COMPLICATED
PROCESSPROCESS, EPIGENETIC REGU,
TAP IN -- INFLAMMATION -- ARE
ALSO VERY IMPORTANT.
MITOCHONDRIAL REGULATION WILL BE
IMPORTANT AS WELL.
IT'S VERY -- TO CONSIDER TO
INTERACT, SO WE REALLY NEED TO
UNDERSTAND THIS MECHANISM TO BE
ABLE TO INTERVENE BETTER IN THE
FUTURE.
AND I WAS -- THERE'S NOT A LOT
OF PAPERS, THERE ARE SOME BUT
NOT A LOT IN CHILDHOOD.
THIS IS A RECENT -- I WAS NOT
INVOLVED WITH THIS STUDY BUT I
THOUGHT IT WAS A NICE PAPER TO
SHOWCASE.
FOR SPECIFICALLY FOR THIS
MEETING, AND THEY FOCUSED ON
EPIGENETIC AGING CLOCKS, SO THE
SAME AGING CLOCKS AS YOU'VE
HEARD BEFORE.
I DID AN -- SPECIFICALLY IN A
SCHOOL CONTEXT.
SO THEY HAVE LEFT THREE AGING --
BLACK YOUTH AND ON THE RIGHT --
IN WHITE YOUTH.
AND SPECIFICALLY THE FINDING
HERE WAS THAT BLACK YOUTH IN
SEGREGATED AND HIGHLY
DISADVANTAGED SCHOOLS
EXPERIENCED INCREASING SPEED OF
EPIGENETIC AGING OVER TIME, SO
THEY'RE MEASURED OVER SIX YEARS.
THAT WAS NOT THE CASE FOR BLACK
OR -- SO THERE'S MORE NUANCED --
EXAMPLE TO SHOW RELATIONSHIP
OF -- AGING IN RELATION TO RMD
IN EARLY LIFE.
SO I'LL FINISH WITH THIS, I JUST
WANTED TO ACKNOWLEDGE ALL THE
COLLEAGUES AND COOPERATOR OVER
THE YEARS THAT HUNDREDED THE
WORK WE'RE DOING -- SUPPORT, AND
I'LL BE HAPPY TO TAKE ANY
QUESTIONS.
>> THANK YOU VERY MUCH.
THIS PANEL IS NOW OPEN FOR
QUESTIONS, BOTH FROM THE
AUDIENCE AND FROM REMOTE
PARTICIPANTS.
I CAN START US UP.
OH, GO AHEAD.
>> THANK YOU VERY MUCH.
GREAT PRESENTATIONS.
SO SOME INSIGHTS -- I THINK
ABOUT EPIGENETIC AGING AND
POVERTY AND VIOLENCE, ET CETERA,
ET CETERA. ARE THERE -- DO
DIFFERENT GROUPS INTERPRET
VIOLENCE DIFFERENTLY AND
INTERPRET POVERTY DIFFERENTLY
BASED ON WHO THEY ARE AND WHERE
THEY ARE?
I GAVE MY FIRST EULOGY AND 16 --
ACROSS THE STREET FROM ME DIED
IN POLICE CUSTODY.
I HEARD OTHER NEIGHBORHOODS THAT
WERE MORE VIOLENT.
AND SO I DON'T KNOW HOW THAT
PLAYS INTO THE SAME THING FOR
POVERTY, PEOPLE MAY -- IF THEY
DON'T SEE WHAT THEY HAVE IN
RELATION TO OTHER THINGS, THEY
MAY FEEL COMFORTABLE AND GOOD
WHERE THEY ARE.
BUT THEN FROM MANHATTAN, HE WAS
WALKING DOWN THE STREET WITH HIS
FRIEND, WHERE IS THIS PLACE THEY
CALL THE GHETTO?
HE'S LIVING IN HARLEM.
SO -- A LOT DEPENDS ON YOUR
PERSPECTIVE.
DO YOU SEE THAT IN THE DATA,
DOES IT SHOW OR HOW DOES THAT --
OR HOW DO YOU TRY TO THINK ABOUT
THAT?
>> I CAN SAY A LITTLE BIT ABOUT
IT.
SO ONE, IN OUR RESEARCH, WE SEE
EFFECTS OF OBJECTIVELY MEASURED
NEIGHBORHOOD DISADVANTAGE, WHICH
IS REALLY NOT TAINTED BY
PEOPLE'S PERCEPTIONS BECAUSE
IT'S JUST -- POVERTY,
UNEMPLOYMENT, LOW INDICATION
INDEX BASE.
I THINK SOMEONE WITH -- SO IN
OUR RESEARCH WE ASK OUR
PARTICIPANTS, HAVE YOU SEEN
PEOPLE THREATEN EACH OTHER, HAVE
YOU SEEN PEOPLE BEAT EACH OTHER,
HAVE YOU SEEN PEOPLE COMMITTING
VIOLENCE WITH WEAPONS.
SO THERE COULD BE SOME
PERCEPTION, SOME BIAS IN THAT,
IF YOU THINK IT'S NORMAL, MAYBE
YOU UNDERREPORT, MAYBE YOUR
THRESHOLD FOR WHAT'S THE THREAT,
WHAT'S THE LEVEL OF VIE L VIOLES
IN A DIFFERENT PLACE.
I'M NOT SURE HOW EXACTLY WE
WOULD INVESTIGATE IT.
HAVE YOU -- HAS YOUR RESEARCH --
>> IN RELATION TO EPIGENETIC
AGING, WE HAVE NOT LOOKED
SEPARATELY AT THE PERCEPTIONS OF
EXPERIENCES VERSUS JUST
OBJECTIVELY MEASURED EXPERIENCES
SO I CAN'T REALLY -- WE DO HAVE
WHAT WE CATEGORIZE AS STRESSORS
AND THEN WE HAVE THE PERCEPTION
OF STRESS, SO WE DO HAVE THOSE
MEASURES WHICH THEY BOTH KNOWED
IN TERMS OF CLUSTERS OF HIGH
LEVELS OF THESE EXPERIENCES THAT
ARE ASSOCIATED WITH EPIGENETIC
AGING REGARDLESS OF WHETHER
YOU'RE HIGH ON PERCEPTION MENTAL
HEALTH OR HIGH ON THE OBJECTIVE
MEASURES LIKE YOU STILL SEE A
LEVEL OF IMPACT ON EPIGENETIC
AGING, BUT WE HAVEN'T
SPECIFICALLY ANALYZED
PERCEPTIONS OF A PARTICULAR TYPE
OF STRESS COMPARED TO ANOTHER
PARTICULAR TYPE OF STRESS.
>> THERE WAS AN INTERESTING
CONCEPT THAT JOON BRODY, GREG
MILLER, EDITH CHAN, THE SKIN
DEEP RESILIENCE, IF YOU HEARD
ABOUT IT.
SO I THINK THIS IS A MODEL THAT
CAN ASCRIBE HOW PEOPLE CAN BE
RESILIENT IN THE FACE OF A
DISCRIMINATION AND ADVERSITY,
BUT STILL UNDER THE SKIN IF
YOU'RE LOOKING AT SOME
BIOMARKERS YOU CAN SEE THAT THEY
ACTUALLY AREN'T DOING AS WELL,
SO I THINK THIS MAY BE A MODEL
THAT'S RELATED TO YOUR QUESTION.
>> AND ACTUALLY THAT MODEL IS
SUPPORTED BY SOME OF OUR DATA.
>> THANK YOU.
>> THANK YOU ALL FOR YOUR TALKS.
EXCELLENT TALKS.
DR. NOAH, AT THE END, I THOUGHT
IT WAS LIKE REALLY, LIKE --
BECAUSE YOU WERE ABLE TO REVERSE
THESE ISSUES THAT THEY HAD WHEN
YOU REORDERED YOUR -- THE
SPECIES, RIGHT, AND SO I WAS
WONDERING ABOUT POST-TRAUMATIC
SLEEP SYNDROME, AND HOW THAT
IMPACTED OUR -- GENERATION BY
GENERATION OVER TIME, DO OUR
JEANS STILL MATTER IN THAT
SPENCE.
THINKING ABOUT OTHER
ENVIRONMENTAL STRESSORS OR EVEN
IF I'M A HEALTHY INDIVIDUAL --
PEEKING OF EARLIER, AND I'M
FACED WITH ADVERSITY AND WORK
SUCH AS MICRO AGGRESSIONS, AND
IF YOU LOOK AT -- ALMOST EVERY
CHRONIC ILLNESS IS -- AFRICAN
AMERICANS ARE AT THE HIGHEST
RATE, SO I'M WONDERING HOW ALL
OF THAT KIND OF FITS TOGETHER
AND EPIGENETICS AND HOW THEY
EXPRESS THAT IN OUR GENES.
>> THAT'S A REALLY GREAT
QUESTION.
I WAS BEING A LITTLE GLIB IN
TERMS OF SAYING THAT GENES DON'T
MATTER, RIGHT?
I THINK THE RELATIVE IMPORTANCE
OF THEM IS MUCH SMALLER THAN
IT'S BEEN MADE OUT TO BE, WHEN
THE HUMAN GENOME CAME OUT,
CLINTON GOT UP THERE AND SAID
ANSWCANCER IS GOING TO BE GONE ,
10 YEARS, WHICH WAS NOT CORRECT,
RIGHT, BECAUSE THIS PERSONALIZED
MEDICINE, EVEN POLYGENIC RISK
SCORES AND THINGS LIKE THAT ARE
NOT THAT PREDICTIVE AT THE
INDIVIDUAL LEVEL AS WELL, RIGHT?
AND WE KNOW THAT OUR EXPOSURES
AND EXPERIENCES HAVE SHORT OF AN
UTESIZEED EFFECT AND WELL-BEING.
YOU MENTIONED SORT OF TRANS
GENERATIONAL EFFECTS OF THESE
AND WHETHER THAT'S PASSED DOWN
THROUGH YOUR EPIGENOME, WHICH IS
NOT SPECIFICALLY YOUR DNA
SEQUENCE BUT, YOU KNOW,
MOLECULAR MODIFIER MARKS -- I
WOULDN'T CALL THAT OUR GENES, SO
WOT COULD BE TRUE AND SORT OF
THE TRANS GENERATIONAL
TRANSMISSION OF THESE TRAUMAS,
RIGHT, THAT YOU MENTIONED.
I MEAN, COULD ALSO BE DUE TO
SORT OF THE TRANSMISSION OF
THOSE TRAUMAS DURING DEVELOPMENT
AND GROWING UP.
THESE EXPERIENCES AND EXPOSURE,
THEY MAY NOT NECESSARILY BE
MOLECULAR MARKS THAT ARE PASSED
DOWN THROUGH GENERATION IN
UTERO, BUT THEY CAN BE PASSED
DOWN THROUGH LIVED EXPERIENCES
AND CONTINUED MARGINALIZATION,
DISCRIMINATION ANDAS WELL.
ONE COMMENT I WANT TO MAKE ABOUT
THE STUDY WE DID, IT'S REALLY,
REALLY CAL T COOL THAT IT'S REVE
BUT STILL, WE DON'T NECESSARILY
KNOW HOW LONG TERM THE EXPOSURE
WOULD NEED TO BE IN TERMS OF
WHETHER OR NOT IT COULD BE
REVERSED VERSUS NOT OR HOW WE
COULD REVERSE THIS EFFECT.
AND I THINK THAT'S PROBABLY ONE
OF THE -- THE STRENGTHS OF
ANIMAL MODELS IS THAT THEY LIVE
SHORTER LIVES THAN US SO WE CAN
CONDUCT THESE LONGITUDAL
STUDIES, RIGHT, THAT CAPTURE ALL
ASPECTS OF DEVELOPMENT, ALL
ASPECTS OF AGING BECAUSE AGING
IS A DEVELOPMENTAL PROCESS TO
TRY AND SEE WHEN THIS MATTERS
AND HOW LONG IT MATTERS AND
WHETHER OR NOT IT IS TOO STICKY
AFTER A CERTAIN POINT.
>> THANK YOU.
I HAD A QUICK QUESTION FOR
EVERYBODY ON THE PANEL AND THAT
IS AS WE KNOW, TYPE~2 DIABETES
IN YOUTH IS ASSOCIATED WITH MUCH
MORE SEVERE AND MUCH MORE RAPID
ONSET OF COMPLICATIONS THAN WE
SEE IN ADULTS.
I WAS WONDERING IF ANY OF YOU
HAVE LOOKED AT THAT KIND OF
INTERSECTION OF AGING AND, OF
COURSE, INDIVIDUAL TYPE
2 DIABETES AND SOME OF THESE
OTHER EX-PRESSORS WE'VE TALKED
ABOUT IN THE RMD SPACE, SO
LOOKING AT THESE -- TYPE
2 DIABETES IN YOUTH.
>> WE HAVE NOT, UNFORTUNATELY.
>> WE HAVEN'T, BUT THERE'S A
MULTISITE STUDY, I DON'T
REMEMBER WHAT IT'S CALLED,
BUT -- I'M A CO-INVESTIGATOR ON
IT, BUT IT'S A MULTISITE STUDY,
IT'S A LARGE STUDY OF -- I THINK
IT'S TYPE 2 DIABETES IN EUROPE,
AND THEY ARE LOOKING AT THE
EARLY LIFE STRESS AS ONE OF THE
FACTORS AS WELL AS A LOT OF
OTHER FACTORS, SO I IMAGINE WE
WILL BE ADDRESSING SOME OF THOSE
QUESTIONS, IN THAT STUDY.
>> SORRY, I JUST HAD TO COMMENT
A LITTLE BIT ON -- ABOUT GENES
NOT MATTERING AS MUCH.
I THINK WE'VE GOT A HUGE
DISCUSSION ON THAT BUT I WILL
SAY A COUPLE THINGS.
ONE, BECAUSE YOU CAN ALTER SOME
OF THE BIOLOGICAL RESPONSES AND
BEHAVIOR OF PRETTY MUCH
GENETICALLY VERY SIMILAR
ANIMALS.
DOES NOT MAKE GENES NOT
IMPORTANT.
OBVIOUSLY.
BUT WE KNOW HUMANS ARE
INCREDIBLY DIVERSE, AND IN FACT,
OUR GENES DETERMINE VERY MUCH
THESE RISKS.
SO -- YOU WEREN'T MEASURING --
ANIMALS RISK OR MAJOR DEPRESSIVE
DISORDER OR AUTISM OR
HYPERTENSION.
SO I THINK WE HAVE TO BE VERY
CAREFUL WHEN YOUR GENES DON'T
MATTER BECAUSE ULTIMATELY
INDIVIDUALS IN VERY SIMILAR
ENVIRONMENTS, AND EVEN IN SAME
HOUSEHOLDS, CAN PRESENT -- THE
FACT THAT OUR GENES VERY MUCH
MATTER AND THAT THEY INTERACT
WITH OUR ENVIRONMENT.
SO I THINK WE SHOULD BE VERY
CAREFUL TO NOT MAKE STATEMENTS
LIKE GENES DON'T MATTER.
>> I WOULD PUSH BACK A LITTLE
BIT, I THINK, ACTUALLY.
[LAUGHTER]
GLOVES ARE COMING OFF.
SO I WOULD PUSH BACK SLIGHTLY
BECAUSE I DO THINK THAT THERE IS
EVIDENCE FOR, YOU KNOW, GENETIC
DIFFERENCES FOR SOME DISEASES,
BUT MANY COMPLEX --
>> NO, NO, NO, SAY THAT AGAIN?
>> THERE'S EVIDENCE FOR GENES,
YOU KNOW, INCREASING RISK FOR
SOME DISEASES, RIGHT?
MANY DISEASES.
>> THERE'S A LOT OF EVIDENCE --
>> THERE TOTALLY IS, BUT GENES
HAVE LARGE EFFECT ON MANY
DISEASES LIKE COMPLEX DISEASES
LIKE MDD YOU MENTIONED, RIGHT?
DO NOT HAVE THE -- HAVE A
STRONGER EFFECT ON MDD THAN
CHILDHOOD EXPOSURES TO
ADVERSITY, CORRECT?
>> IT'S AN INTERACTION.
IT'S AN INTERACTION OF GENES BY
ENVIRONMENT, 100% IT'S AN
INTERACTION.
WE HAVE NO GENES THAT -- TO
DEVELOP --
>> CORRECT.
SO I GUESS I WAS -- MY PUSHBACK
THERE WAS NOT NECESSARILY THAT
GENES DON'T MATTER COMPLETELY,
BUT THAT I THINK THEY HAVE A
SMALLER EFFECT THAN OUR
ENVIRONMENT, AND WHEN WE'VE DONE
LARGE SCALE STUDIES OF THESE, I
THINK WE'VE SEEN THAT YOUR DNA
SEQUENCE AND POLYGENIC RISK
SCORES -- LARGE STUDIES IN THE
UK BIOBANK SHOW THEY HAVE A
SMALLER EFFECT THAN OTHER
FACTORS LIKE YOUR EXPOSURES AND
LIFE EXPERIENCES.
>> THAT GROUP DIFFERENCES IN
HEALTH ARE DRIVEN MORE BY
ENVIRONMENT THAN GENES.
GEANS WILL HELP -- DIFFERENCES
FOR THE ENVIRONMENT.
BUT THE GENETIC RISK IS FAIRLY
UBIQUITOUS AND EQUAL BETWEEN
GROUPS.
THERE ARE SOME SMALL DIFFERENCES
IN GENE PROMINENCE ACROSS
DIFFERENT GROUPS, BUT THE KISS
PATHEDISPARITIES WE SEE -- BY
DEFINITION DISPARITIES ARE.
SO DIFFERENCES WE SEE IN
POPULATIONS ARE MOSTLY DRIVEN BY
THE SOCIAL FACTORS THAT --
ENVIRONMENT GENE INTERACTION.
MOST PEOPLE IN GENERAL HAVE A
SIMILAR GENETIC PROFILE.
DOES THAT SOUND --
>> I FEEL, YOU KNOW, IN A
CONFERENCE ON MARGINALIZATION,
RIGHT, I THIDGES T I THINK THATT
OF US PUSH BACK AGAINST, THIS
IDEA THAT YOU SEE -- DISEASE IN
LATINO AND BLACK PEOPLE BECAUSE
THEY ARE INHERENTLY BIOLOGICALLY
INFERIOR AND I THINK THAT'S IS
WHAT THESE ARGUMENTS PUSH BACK
AGAINST, AND I THINK WE'RE
LIVING IN A TIME IN A SOCIETY
WHERE PEOPLE WHO EXIST THIS IDEA
THAT THERE ARE SOCIAL
HIERARCHIES IN SOCIETY AND
PEOPLE WHO RE TOP OF THOSE
SOCIAL HIERARCHIES, AND FOR
REASONS I THINK SOME PEOPLE ARE
AT THE TOP OF THE SOCIAL
HIERARCHY FEEL INVALIDATED IN
THEIR OWN PERSONAL EXPERIENCE
AND I DON'T THINK THAT'S WHAT WE
WANT TO SAY OR DO, BUT I THINK
WE DO WANT TO ACKNOWLEDGE THAT
TO PUSH AGAINST BU BIOLOGIC
ESSENTIALISM THAT ESSENTIALLY
ARGUES THAT THESE GROUPS HAVE
WORSE DISEASE BECAUSE IT'S THEIR
FAULT OR BECAUSE IT HAS NOTHING
TO DO WITH POLICIES AND
PRACTICES THAT HAVE BEEN IN
PLACE FOR HUNDREDS AND HUNDREDS
OF YEARS THAT DISENFRANCHISE
GROUPS VIS-A-VIS ONE ANOTHER.
AND I WOULD ARGUE THAT PEOPLE
WHO WANT TO SAY THAT THOSE
THINGS DON'T MATTER, THEY SHOULD
VOLUNTEER TO BE IMPOVERISHED,
THEY SHOULD VOLUNTEER TO BE
DISCRIMINATED AGAINST, THEY
SHOULD VOLUNTEER TO HAVE THE
WORST JOBS AND WORK THE WORST
SHIFTS IN SOCIETY AND THEN WE
CAN HAVE THAT CONVERSATION AGA
AGAIN.
>> I'LL ASK A QUESTION FROM THE
VIRTUAL PARTICIPANTS.
SO GETTING BACK TO THE QUESTION
OF ACCELERATION OF EPIGENETIC
AGING.
CAN THE PANELISTS CLARIFY WHAT
ARE THE CONCRETE OR SPECIFIC
OUTCOMES OF THE DIFFERENCES IN
OR ACCELERATION OF EPIGENETIC
AGING THAT ARE OBSERVED?
OR MAYBE WHAT DOES IT MEAN?
>> SO I GUESS THE QUESTION IS
GETTING AT IS THE ACCELERATED
AGING RELATED TO DISEASE
OUTCOMES?
SO YES, IN OUR WORK, WE'RE
FOCUSING ON CARDIOMETABOLIC
HEALTH, SO WE'VE SORT OF TAKEN
THIS KIND OF AS A TWO-STEP
LOOKING FIRST AT THE STRESSORS
AND THESE MEASURES IN RELATION
TO EPIGENETIC AGING AND
SEPARATELY LOOKING AT THE IMPACT
ON CARDIOMETABOLIC HEALTH
OUTCOMES.
SO I JUST PRESENTED THE FIRST
PART OF THAT, BUT WE DO ALSO SEE
THAT THE AGING IS ASSOCIATED
WITH INCREASE INCIDENCE, FOR
EXAMPLE, OF METABOLIC SYNDROME
IS ONE OF THE FIRST MEASURES
THAT WE'RE LOOKING AT.
>> SO ACTUALLY THE SECOND AND
THIRD GENERATION EPIGENETIC
CLOCKS WERE DEVELOPED TO PREDICT
FASTER CHRONIC DISEASE,
MORTALITY, SO THEY'RE PRETTY
ROBUST PREDICTORS OF ALL SORTS
OF FUNCTIONAL DECLINE INCLUDING
COGNITIVE DECLINE AS WELL AS
DIFFERENT TYPES OF CHRONIC
HEALTH CONDITIONS AS WELL AS
MORTALITY.
SO YES, THEY HAVE BEEN QUITE
ROBUST IN PREDICTING THOSE
HEALTH OUTCOMES.
>> CAPTURING THE PACE OF AGING
SO THIS IS A UNIQUE CLOCK
COMPARED TO THE OTHER CLOCKS.
IT ALSO SHOWING TO WORK IN
INTERVENTION STUDIES, SO THERE
WAS A RECENT PAPER THAT WAS
TESTING THE IMPACT OF CALORIC
RESTRICTION WHICH IS A
SUCCESSFUL INTERVENTION TO SLOW
DOWN AGING AND A VARIETY OF
ANIMAL MODELS, SO THERE WAS ONE
DONE IN HUMANS AND -- THE ONLY
CLOCK THAT WORKED OVER TWO YEARS
TO SHOW THAT CALORIC RESTRICTION
ACTUALLY ABLE TO SLOW DOWN
AGING.
SO THERE'S A LOT OF PROMISE IN
THIS TYPE OF MEASURES TO BE USED
IN INTERVENTION STUDIES, EVEN
THOUGH THE MECHANISMS AS I
MENTIONED IN MY TALK ARE NOT
CLEAR, WHAT DOES IT MEAN TO HAVE
THESE ACCELERATED AGING -- WITH
ALL OF THE DIFFERENT MECHANISMS
THAT ARE REGULATED.
SO WE KNOW TELOMERES ARE GETTING
SHORTER -- SENESCENT -- TO DIE.
-- ACROSS THE GENOME THAT MAY
OR MAY NOT BE RELATED TO
DISEASE.
>> THANK YOU.
ONE LAST QUESTION.
>> GREAT SESSION.
I HAVE A QUESTION ABOUT MAYBE
MOVING TOWARDS SOLUTIONS.
WE HEARD THAT WE DO WAY MORE --
WAY LESS THAN WHAT WE KNOW, AND
WE CAN DO MORE.
I THINK DR. LEWIS OR TENE
BROUGHT OUT THE IMPORTANCE OF
POWERFUL EFFECT ON SOCIAL
REJECTION ON THE EXPERIENCE OF
STRESS OR DIFFERENTIAL
EXPERIENCE OF THAT.
AND I -- YOU TALK ABOUT THE
DOMINANT AND -- BEHAVIORS THAT
WERE EXPRESSED.
DID YOU NOTE ANY -- THE ONES
THAT MADE A DIFFERENCE AND ALSO
THE IP COLLUS --
>> ALL I TALKED ABOUT HERE WAS
PART OF THE PAPER WHERE WE WERE
LOOKING AT SORT OF THE DOMINANT
AND SUBORDINATE SMI S SUBMISSIVE
BEHAVIORS, WE WERE NOT VIOLENT
BEHAVIORS IN THESE ANIMALS,
THESE WERE NON-CONTACT,
DISPLACEMENTS, ONE FEMALE WAS
SITTING IN A CORNER, ANOTHER
CAME BY AND LOOKED AT HER AND
THEN SHE WALKED AWAY BECAUSE SHE
WAS SUBORDINATE, SO THIS
CONSTANT SORT OF HARASSMENT EVEN
IN SOME SENSE.
IT WASN'T FUN, I THINK.
AND SO -- THEY ARE ALSO SOCIAL
ORGANISMS IN THE SENSE THAT
THEIR SOCIAL RELATIONSHIPS
MATTER, SO IN CAPTIVITY AND IN
WILD POPULATIONS FOR MANY SOCIAL
ANIMALS, YOUR LEVEL OF SOCIAL
INTEGRATION VERSUS ISOLATION HAS
A STRONG IMPACT ON YOUR HEALTH,
REPRODUCTION AND SURVIVAL, MUCH
AS IT DOES IN US, MENTIONED
EARLIER, TALKING ABOUT THE COVID
PANDEMIC LEAVING US ISOLATED AND
LEADING TO INCREASES IN MANY
DISEASES, MENTAL HEALTH
DISORDERS AND OTHER DISEASES AND
EVEN MORTALITY, RIGHT?
SO WE THINK THAT THOSE THINGS
CAN INTERSECT, RIGHT, AND THEY
CAN INTERACT.
AND WE ACTUALLY DID SEE THAT A
LOT OF THE DIFFERENCES THAT WERE
DRIVING -- WHICH I DIDN'T GET
INTO THAT WERE DRIVING SOME OF
THESE INFLAMMATORY RESPONSES WAS
THE FACT THAT THESE SOCIALLY
SUBORDINATE FEMALES WERE ALSO
ACTUALLY MORE SOCIALLY ISOLATED
IN THE GROUPS.
THEY DIDN'T HAVE AS MUCH SOCIAL
CONTACT AND CONNECTION, SO WE
THINK THAT THIS SOCIAL
BUFFERING, RIGHT, SO HAVING A
STRONG SOCIAL SUPPORT NETWORK IS
A WAY TO PROTECT FROM SOME OF
THE NEGATIVE EFFECTS OF ADVERSE
SITUATIONS, BE IT SOCIAL,
ENVIRONMENTAL, BE IT PHYSICAL,
ENVIRONMENTAL, THINGS LIKE THAT.
SO I THINK THAT'S A GREAT POINT
AND I THINK MOVING TOWARDS
SOLUTIONS AND FINDING WHAT WE
CAN DO ABOUT IT IS REALLY,
REALLY IMPORTANT.
>> THANK YOU.
AND WITH THAT, LET'S THANK THE
PANELISTS ONCE AGAIN.
[APPLAUSE]
>> WE'LL GO AHEAD AND GET
STARTED WITH THE TALK HERE.
THE GREAT THING ABOUT GOING IN
THE AFTERNOON FOLLOWING SO
MANY --
>> DO WE NEED TO INTRODUCE YOU?
SHE'LL BE INTRODUCING HERSELF.
>> NO I, WILL NOT.
>> I'M NOT READING YOUR BIOBUT I
CAN SAY NEXT UP, OUR SESSION ON
ENERGETIC MECHANISMS -- IS
CHANTEL MARTIN, TALKING ABOUT
EPIGENETIC MECHANISMS OF
PRENATAL SOCIAL ENVIRONMENT
STRESSORS AND OFFSPRING,
OFFSPRING HEALTH DISPARITIES.
>> THE GREAT THING ABOUT GOING
IN THE AFTERNOON AFTER SO MANY
AMAZING SESSIONS IS THAT I CAN
KIND OF BREEZE THROUGH AND NOT
GO INTO TOO MUCH DETAIL ABOUT
SOME OF THESE EARLY BACKGROUND
SLIDES AND KIND OF GET TO THE
STUDIES THAT IE I'VE BEEN
CONDUCTING WITH MY RESEARCH LAB
LOOKING AT THE NEIGHBORHOOD,
SOCIAL ENVIRONMENT, PRENATAL
PERIOD AND OFFSPRING HEALTH AND
HEALTH DISPARITIES.
STARTING OUT WHY WE'RE ALL HERE,
THAT AS MANY HAVE POINTED OUT
BEFORE, DESPITE IMPROVEMENTS IN
MEDICINE AND TECHNOLOGY, BLACK
AMERICANS HAVE WORSE HEALTH
OUTCOMES AT EVERY STAGE OF THE
LIFE COURSE.
HERE I'M JUST NOTING SOME OF THE
MANY OUTCOMES.
THE WORK THAT I'VE BEEN DOING
AND THINKING ABOUT EARLY IN LIFE
WITH PRETERM BIRTH, LOW BIRTH
WEIGHT AND CHILD OBESITY, A LOT
OF THE HEALTH OUT COMES WE'RE
TALKING ABOUT BEGIN EARLY IN THE
LIFE COURSE, AND THAT IS WHEN A
LOT OF THE DIFFERENT HEALTH
TRAJECTORIES ARE FORMED AND
THESE OUTCOMES TRACK INTO LATER
LIFE, WHERE BLACK ADULTS HAVE
THE PHYSIOLOGICAL PROFILE ABOUT
SIX TO 10 YEARS OLDER.
SO IN MY WORK THINKING ABOUT
INTERVIEWABLE PERIODS AND
FACTORS THAT CAN BE MOST
EFFECTIVE DURING EARLIER TIME
PERIODS, BEFORE DISEASE
MANIFESTATION.
THANKS TO AN EARLIER TALK ON
STRUCTURAL RACISM AND ITS
MANIFESTATIONS, I JUST WANT TO
REAL QUICKLY TALK ABOUT
STRUCTURAL RACISM AS IT'S
MULTIDIMENSIONAL AND COMPLEX
SYSTEM OF MANY INSTITUTIONS SUCH
AS THE HOUSING MARKET, CREDIT,
EDUCATIONAL, LABOR, ALL OF THESE
WORKING TOGETHER TO INFLUENCE
HEALTH.
THIS STRUCTURAL RACISM REFLECTS
THE HISTORICAL AND PERVASIVE
FORMS OF RACISM THAT ARE
ENTRENCHED IN YOUR SYSTEM'S
LAWS, POLICIES AND PRACTICES AND
CAN BE TRACKED TO DELIBERATE
ACTS OF DISCRIMINATION AND
REVERSE EVEN AFTER THE MEASURE
IS NO LONGER IN PLACE.
RACIAL RESIDENTIAL SEGREGATION
AS MANIFESTATION OF STRUCTURAL
RACISM HAS ACTUALLY BEEN
ESTABLISHED AS A FUNDAMENTAL
CAUSE, SAYING IF WE WANT TO
ELIMINATE HEALTH DISPARITIES, WE
HAVE TO CONFRONT THE PERVASIVE
EFFECTS OF RACIAL RESIDENTIAL
SEGREGATION.
I WON'T TALK ABOUT REDLINING
BECAUSE THE PREVIOUS -- ONE OF
THE SESSIONS EARLIER TALKED
ABOUT IT, BUT WHAT'S IMPORTANT
ABOUT RED LINING AS THIS
IMPACTFUL FORM OF RACIAL
RESIDENTIAL SEGREGATION, WAS
HISTORICALLY CONSTRUCTED AND
THESE POLICIES AND PRACTICES
WERE PUT IN PLACE TO ACTUALLY
EXCLUDE BLACK AND OTHER
IMMIGRANT GROUPS FROM BEING ABLE
TO PARTICIPATE IN THE HOUSING
MARKET, DENYING THEM ACCESS TO
THIS WEALTH ACCUMULATION.
BUT AS THESE ARTICLES SHOW ON
THE RIGHT-HAND SIDE, THE
HISTORICAL POLICY AND THE
PRACTICE OF RED LINING HAS
ACTUALLY SHAPED NEIGHBORHOODS AS
WE SEE THEM TODAY.
SO WHY IS THIS IMPORTANT?
BECAUSE RACIAL AND ETHNICALLY MY
MINORITIZED GROUPS ARE -- TODAY
ARE CHARACTERIZED BY POORER
EDUCATIONAL AND EMPLOYMENT
OPPORTUNITIES, LIMITED ACCESS TO
QUALITY NUTRITION, RECREATIONAL
SPACE AND HEALTHCARE, AS WELL AS
HIGHER DISADVAN DISADVANTAGE, CD
POLICING.
WHAT WE'VE ACTUALLY LEARNED FROM
STUDIES THAT HAVE TAKEN PLACE,
THAT NEIGHBORHOOD ENVIRONMENTS
AND EXPOSURES CAN ACTUALLY GET
UNDER THE SKIN THROUGH WHAT
NANCY KRUEGER ACTUALLY TERMS AS
BIOLOGICAL EMBODIMENT, WHERE
INDIVIDUALS INCORPORATE
BIOLOGICALLY THEIR LIVED
EXPERIENCES AND SOCIAL SYSTEMS
AND CONTEXT THROUGH THIS IMAGE.
SHE TALKED ABOUT DIFFERENT
PATHWAYS OF -- THE SOCIAL
ENVIRONMENT, ALL THIS CAN LEAD
TO BIOLOGICAL STRESS RESPONSES
AND PHYSIOLOGICAL DYSFUNCTION.
YET EPIGENETIC MECHANISMS IS ONE
OF THOSE -- THANKS TO THAT LAST
SESSION I WILL SLIP THIS SLIDE
AND TRY AND GET US BACK ON TRACK
A LITTLE BIT WITH TIME.
BUT A LOT OF MY WORK IS TRYING
TO UNDERSTAND HOW THESE
DISPARATE NEIGHBORHOOD
ENVIRONMENTS, AS A RESULT OF
RACIAL RESIDENTIAL SEGREGATION
AND STRUCTURAL RACISM, IMPACT
HEALTH INEQUALITIES.
WHAT'S IMPORTANT HERE IS THAT
WHEN LOOKING AT THESE AND
STRATIFYING ON RACE AND
ETHNICITY, WHAT WE'RE NOT SAYING
IS THAT THESE GROUPS ARE
DIFFERENT, BUT THAT THEY HAVE
THESE DISPARATE EXPOSURES AND
EXPERIENCES DUE TO LIVING IN
DIFFERENT OR SEGREGATED AND
DISINVESTED NEIGHBORHOODS.
SO THESE DISPARATE NEIGHBORHOOD
ENVIRONMENTS LEAD TO DIFFERENCES
IN CHRONIC STRESS, DIFFERENCES
IN ALTERED DNA METHYLATION,
WHICH IMPACT OUR GENE
EXPRESSION, TURNING OUR GENES ON
AND OFF AND POTENTIALLY
RESULTING IN HEALTH INEQUALITY.
SO MY WORK HAS BEEN TRYING TO
GET AT AND UNDERSTAND HOW THE
NEIGHBORHOOD ENVIRONMENT OR THE
NEIGHBORHOOD SOCIAL ENVIRONMENT
CAN ACTUALLY GET UNDER THE SKIN
TO PRODUCE EARLY LIFE, DISPARATE
HEALTH TRAJECTORIES.
SO IN THE LITERATURE, THERE'S
BEEN ABOUT EIGHT STUDIES THAT
HAVE LOOKED AT NEIGHBORHOOD
ENVIRONMENT IN RELATION TO
EPIGENETIC MECHANISMS, BUT VERY
FEW IN EARLY LIFE, THINKING
ABOUT THESE PRENATAL EXPOSURES
DURING A PERIOD WHERE WE HAVE
BOTH A PREGNANT PERSON BEING
EXPOSED TO THESE ENVIRONMENTAL
STRESSORS AND THEN AN OFFSPRING
THAT IS ALSO BEING EXPOSED
THROUGH THE FETAL ENVIRONMENT.
AND WHAT THE THREE STUDIES HERE
THAT I'M SHOWING HAVE LOOKED AT,
NEIGHBORHOOD POVERTY AND
DEPRIVATION HAVE BEEN FOUND IN
THE OFFSPRING -- I THINK ONE OF
THEM LOOKED AT BUCCAL CELLS, BUT
HAVE FOUND THAT THOSE LIVING IN
NEIGHBORHOODS WITH HIGHER
POVERTY OR DEPRIVATION HAS BEEN
ASSOCIATED WITH HIGHER GLOBAL
DNA METHYLATION, HIGHER
METHYLATION IN IMPRINTED GENES
SUCH AS MEG3, AS WELL AS
METHYLATION IN THESE CANDIDATE
STRESS-RELATED GENES.
BUT THERE ARE STILL SOME GAPS IN
THE LITERATURE, MAINLY THAT
FOCUSING ON THESE CANDIDATE
GENES OR THESE IMPRINTED GENES
WERE MISSING MAYBE SOME NOVEL
MEASURES OR SOME NOVEL
EPIGENETIC PATHWAYS THAT COULD
BE AT PLAY HERE.
ALSO, THESE STUDIES HAVE BEEN --
INK THINKING OR LOOKING AT THE
DIFFERENTIAL EFFECTS OF THESE
DISPARATE EXPOSURES.
MANY OF THAT IS BECAUSE OF DATA
AVAILABILITY OR -- DATA
AVAILABILITY AND LACK OF
DIVERSITY IN FAMILIES TO BE ABLE
TO LOOK AT THESE.
AND THEN ALSO KIND OF PUTTING
THE PIECES OF THE PUZZLE
TOGETHER FROM THAT CONCEPTUAL
MODEL, BUT HOW DO THESE
NEIGHBORHOOD ENVIRONMENTS AND
EPIGENETIC MECHANISMS ACTUALLY
RELATE TO OFFSPRING HEALTH
OUTCOMES?
SO THAT'S WHAT THE -- SHOW HERE
HAVE BEEN TRYING TO ADDRESS.
SO WE HAVE THIS NEIGHBORHOOD
EPIGENETIC STUDY, NEWBORN
EPIGENETIC STUD STUDY SORRY, OR,
WHICH IS A PROSPECTIVE BIRTH
COHORT STUDY WITH FOLLOW-UP OF
OFFSPRING INTO CHILDHOOD AND
ADOLESCENCE.
THE STUDY TOOK PLACE FROM 2005
TO 2011.
THE STUDY BEGAN WITH ABOUT 2700
MOTHER-CHILD PAIRS AND LED TO
SOME FINDINGS WE HAD, 427
INDIVIDUALS, BOTH MOTHER-CHILD
PAIRS, WITH DNA METHYLATION
ACROSS THE GENOME, 450K, WE'RE
NOW -- ABOUT 900,000 DNA
METHYLATION SITES, SO THIS IS
ONE OF THE OLDER WITH ABOUT
4,050,000 CPG SITES.
I WILL SAY WHEN THE NEST STUDY
WAS ORIGINALLY DESIGNED, IT WAS
MEANT TO LOOK AT DNA METHYLATION
IN RELATION TO THE CHILDHOOD
OUTCOMES, NOT WITH A SOCIAL
QUESTION IN MIND.
SO IT'S VERY LIMITED IN THE
INDIVIDUAL LEVEL, SOCIAL FACTORS
THAT WERE COLLECTED.
HOWEVER BECAUSE THE PARTICIPANT
AT ENROLLMENT PROVIDED THEIR
ADDRESSES, WE'VE BEEN ABLE TO
MAP ON A LOT OF ENVIRONMENTAL
STRESSORS BASED ON THEIR
RESIDENCE AT THE TIME OF ENROLL
M.
ENROLLMENT.
WE LOOKED AT THIS USING BUFFERS
OF 200 METERS, 600 METERS AROUND
THE HOUSE AS WELL AS CENSUS
BLOCK -- THAT MAY NOT MAP ON TO
HOW WE ARE CONCEPTUALIZING THAT
NEIGHBORHOOD, BUT WITH THIS
DATA, WE'VE BEEN ABLE TO MAP ON
THINGS LIKE CRIME AND POLICING,
AIR POLLUTION.
WE HAVE INFORMATION ON USING
COHORT ISSUES, TRYING TO DEVELOP
A NEW MEASURE OF REDLINING.
WE HAVE INFORMATION FROM THE
CENSUS TO LOOK AT DEPRIVATION.
AND OTHER MEASURES.
WE ALSO HAVE INFORMATION ON THE
OFFSPRING, HEIGHT, WEIGHT AND
BLOOD PRESSURE, INTO EARLY
ADOLESCENCE.
HERE I'M SHOWING SOME OF THE
CHARACTERISTICS OF THE STUDY
PARTICIPANTS WITH THE DNA
METHYLATION AS YOU CAN SEE IT'S
PRETTY DIVERSE COHORT WITH ABOUT
48% NON-HISPANIC BLACK, 44%
NON-HISPANIC WHITE, HIGHLY
EDUCATED ACTUALLY ABOUT 40%
HAVE -- ACTUALLY MORE THAN
THAT -- HAVE A COLLEGE DEGREE,
AND THEN ALSO OVERWEIGHT/OBESITY
ARE PRETTY PREVALENT IN THIS
COHORT, AS EARLY AS AGE 3.
SO ONE OF THE FIRST THINGS WE
DID WAS TRY TO ASSESS WHAT
NEIGHBORHOOD CRIME LOOKS LIKE IN
THE COHORT.
SHOWING GESTATIONAL EXPOSURE TO
NEIGHBORHOOD CRIME DIFFERS BY
RACE AND ETHNICITY.
WHAT I'M REALLY TALKING ABOUT IS
RACIAL SEGREGATION -- WHEN WE
TALK ABOUT VIOLENT CRIMES, WE'RE
TALKING ABOUT THINGS THAT
REQUIRE A RESPONSE.
YOU HAVE SIRENS, YOU HAVE
PEOPLE, EMERGENCY RESPONSE IN
THE AREA, SO THESE ARE THINGS
LIKE MURDERS, ASSAULT, ROBBERY,
THINGS OF THAT NATURE.
SO WHEN WE'RE THINKING ABOUT A
PREGNANCY, WE SAY EVERYONE MAKES
TO FULL TERM, WHICH WE KNOW
THAT'S NOT ACCURATE, BECAUSE
CERTAIN GROUPS, BLACK AND
HISPANIC POPULATIONS HAVE
DELIVERED BABIES EARLIER, BUT
SAY IT'S 40 WEEKS.
ON AVERAGE, BLACK PREGNANT
PEOPLE EXPERIENCE 19 VIOLENT
CRIMES DURING THE COURSE OF
THEIR REG SEE IN THIS STUDY.
24 FOR HISPANIC PEOPLE AND 4 FOR
WHITE PREGNANT PEOPLE.
IN A 40-YEAR SPAN, WE'RE TALKING
ABOUT BLACK AND HISPANIC PEOPLE
EXPERIENCING A VIOLENT CRIME
EVERY 1 1/2 TO 2 WEEKS OF THEIR
PREGNANCY, WHEREAS A WHITE
PREGNANT PERSON OR OVER THE
COURSE OF THE ENTIRE PREGNANCY.
SO WHAT DOES THIS MEAN FOR THE
OFFSPRING?
WELL, I KNOW THIS IS VERY
COMPLICATED, BUT TO POINT YOU TO
LOOKING AT BLOOD PRESSURE
PERCENTILES WHERE ABOVE THE
LINE, ABOVE ZERO IS SYSTOLIC
BLOOD PRESSURE BEING HIGHER AND
DIASTOLIC BLOOD PRESSURE BEING
HIGHER, BELOW IT WILL MEAN IT'S
NOT AS HIGH.
WE FOUND GESTATIONAL EXPOSURE TO
NEIGHBORHOOD CRIME -- WE DIDN'T
FIND ANYTHING FOR THE CHILDREN
OF WHITE WOMEN OR THE CHILDREN
OR HISPANIC WOMEN.
A LOT OF THESE ARE DUE TO SAMPLE
SIZES.
WE DID SEE, IF YOU NOTICE HERE
EVEN IN THE CHILDREN OF HISPANIC
WOMEN, WE DO SEE THAT SOME OF
THE -- ARE ABOVE ZERO BUT WE
WOULD LOVE TO REPLICATE THIS IN
A LARGER STUDY AT SOME POINT.
AND THINKING ABOUT METHYLATION,
WHAT DOES T IS THIS PATHWAY RELG
THE NEIGHBORHOOD CRIME EXPOSURE
TO THESE OFFSPRING HEALTH
OUTCOMES.
OVER TO THE LEFT I'M SHOWING A
TABLE OF THE SPECIFIC CBG SITE
THAT WERE ASSOCIATED WITH THE
NEIGHBORHOOD CRIME EXPOSURES TO
REALLY SUMMARIZE WHAT'S GOING ON
HERE.
WHAT WE ESSENTIALLY FOUND IS
THAT HIGHER EXPOSURE TO
GESTATIONAL -- HIGHER
GESTATIONAL EXPOSURE TO
NEIGHBORHOOD CRIME IS ASSOCIATED
WITH CPG SITE THAT ARE RELATED
TO GENES, SO THEY'RE ANNOTATED
TO GENES THAT ARE ASSOCIATED
WITH AGING AS WELL AS
CARDIOMETABOLIC OUTCOMES.
AND THESE ARE ALL -- I DON'T
KNOW IF THIS WILL WORK.
IF YOU LOOK HERE AT THE EFFECT
SIZES, THEY ARE INVERSELY
ASSOCIATED WITH GESTATIONAL
EXPOSURE TO NEIGHBORHOOD CRIME.
SO GIVING SOME EVIDENCE THAT
THERE COULD BE SOMETHING ON WITH
NEIGHBORHOOD CRIME AND --
POSSIBLY IMPACTING BLOOD
PRESSURE PERCENTILES, WE HOPE TO
EVENTUALLY PUT THOSE PIECES OF
THE PUZZLE TOGETHER AND DO A
MEDIATION ANALYSIS.
WE ALSO HAVE LOOKED AT
NEIGHBORHOOD DEP VISION EXPOSURE
IN ASSOCIATION WITH THE DNA
METHYLATION.
AS I MENTIONED DUE TO
RESIDENTIAL SEGREGATION, AS WE
EXPECT NEIGHBORHOOD DEPRIVATION
DIFFERS BY RACE AND ETHNICITY
WHERE NEIGHBORHOOD DEP VISION
DEPRIVATIONSCORE BASED ON THESEE
INDICATORS, THE PREGNANT PEOPLE
LIVE DURING PREGNANCY.
MEDIAN HOUSEHOLD INCOME, THE
HOME VALUE, PERCENT BELOW
POVERTY LEVEL, FEMALE HEAD OF
HOUSEHOLDS, HOME OWNERSHIP, ALL
THESE CAME TOGETHER TO CREATE
THIS MEASURE OF NEIGHBORHOOD
DEPRIVATION WHERE A HIGHER SCORE
INDICATED MORE OR GREATER
NEIGHBORHOOD DEPRIVATION.
AND IN THIS COHORT, BLACK
INDIVIDUALS HAD HIGHER
NEIGHBORHOOD DEPRIVATION THAN
WHITE INDIVIDUALS, AS WELL AS
THOSE THAT ARE CHARACTERIZED AS
OTHER.
NEIGHBORHOOD DEP VISION IN THIST
VERY UNLIKELY THAT THERE'S ONE
CPG SITE THAT IS CAUSING THIS
ARRAY OF OUTCOMES THAT ARE
ASSOCIATED.
SO WHAT WE LOOKED AT WERE THESE
REGIONS OR HOW POTENTIAL CPG
SITES ARE WORKING TOGETHER TO
IMPACT HEALTH OR -- YEAH, WHILE
WORKING TOGETHER.
SO WITH THESE DIFFERENTIALLY
METHYLATED REGIONS, WE FOUND
THAT 12 WERE ASSOCIATED WITH
NEIGHBORHOOD DEPRIVATION.
THIS PAPER IS UNDER REVIEW, A
GOOD REVIEW, I'LL SAY, BUT
INCREASING NEIGHBORHOOD
DEPRIVATION SCORE WAS ASSOCIATED
WITH DIFFERENTIALLY METHYLATED
REGIONS RELATED TO
CARDIOMYOPATHY, THESE ARE GENES
WITH CARDIOMYOPATHY, FAT
ACCUMULATION AND LIPID
METABOLISM, OBESITY, METABOLIC
DISEASE AND ADIPOSE TISSUE
DYSFUNCTION, A ARTERIOSCLEROSIS
AND IMMUNE FUNCTION.
SO -- TO -- EVEN AS EARLY AS THE
FETAL EXPOSURE.
AND THIS IS VERY COMPLICATED,
BUT JUST TO KIND OF -- WE LOOKED
AT THIS STRATIFIED BY RACE AND
ETHNICITY TO SEE IF THE CPG
SITES WE FOUND THAT WERE
ASSOCIATED WITH NEIGHBORHOOD
DEPRIVATION DIFFERED BY RACE AND
ETHNICITY AND FOUND THAT THEY
DID, WHERE SIGNIFICANT POSITIVE
EFFECTS ARE FOUND ACROSS CPG
SITES FOR BLACK AND THOSE
CATEGORIZED AS OTHER, BUT
NEGATIVE EFFECTS AMONG WHITE
PARTICIPANTS.
AND THEN THE CPT1B GENE FROM THE
LAST SLIDE IS ASSOCIATED WITH --
OR RELATED TO FAT ACCUMULATION
IN LIPID METABOLISM, SO WE'RE
FINDING THAT THE NEIGHBORHOOD
DEPRIVATION RELATED GENES OR
RELATED CPG SITES MIGHT DIFFER
BY RACE AND ES NIS IT.
-- DIFFERENTIALLY IMPACTING CPG
SITES.
LASTLY, WE THEN TRIED TO CONNECT
THE PIECES OF THE PUZZLE AND
LOOK AT NEIGHBORHOOD DEPRIVATION
ASSOCIATED CPG SITES IN RELATION
TO THE OFFSPRING -- AT 6 AND 12
MONTHS, AND INDEED, DID FIND
THAT SOME OF THESE CPG SIZE WERE
ASSOCIATED WITH HIGHER --
INCLUDING THE ONE HIGHLIGHTED IN
GREEN, WHICH FREQUENTLY WAS
MENTIONED RELATED TO FAT
ACCUMULATION.
SO JUST SOME KEY TAKEAWAYS TO
PRESENT HERE, GESTATIONAL
EXPOSURE TO NEIGHBORHOOD SOCIAL
STRESSORS ASSOCIATED WITH EARLY
OFFSPRING HEALTH INEQUALITIES.
WE'RE PROVIDING SOME EVIDENCE OF
THAT.
THAT THE NEIGHBORHOOD SOCIAL
ENVIRONMENT MAY ALTER DNA
METHYLATION IN OFFSPRING, AND
THAT EPIGENETIC MECHANISMS MAY
SERVE AS A BIOLOGICAL PATHWAY.
WELL, WHERE DO WE GO WITH THIS
RESEARCH?
I THINK AS MENTIONED -- WAS
ABOUT 427 PARTICIPANTS SO WE
NEED TO REPLICATE THESE FINDINGS
IN LARGER RACIALLY AND
ETHNICALLY DIVERSE COHORTS,
WE'RE LOOKING AT THE SNAPSHOT OF
DNA METH LITION AT ONE POINT IN
TIME.
I KNOW YOU MENTIONED YOU MIGHT
HAVE MULTIPLE MANAGERS.
SO KIND OF LOOKING AT THE CBG
SITE, IN PARTICULAR WHEN WE'RE
TALKING ABOUT THIS STUDY BECAUSE
I'M MEASURING PRENATAL
ENVIRONMENT, BUT WHAT HAPPENS
WHEN THEY START TO EXPERIMENT
THEIR OWN ENVIRONMENT, DO WE SEE
THAT THESE GPG MARKERS ARE
RESISTANT, AND THEN ALSO ABLE
TO -- THEN USING METHODS AROUND
MEDIATION TO SEE WHAT OR TO
ESTIMATE THE CONTRIBUTION OF
THESE EPIGENETIC MECHANISMS SO
PUTTING THE PETE'SS OF TH THE PE
TOGETHER, WE HAVE THESE
STRESSORS, WOULD LOVE TO BE ABLE
TO LOOK AT HOW THEY ACTUALLY
IMPACT GENE EXPRESSION AND THEN
THE HEALTH OUTCOMES, SO REALLY
LOOKING AT THESE PAST ANALYSES.
AND THEN INVESTIGATING THIS
IMPACT OF THE SOCIAL AND
ENVIRONMENTAL EXPOSURES,
NEIGHBORHOOD CRIME, THESE
INDIVIDUALS ARE LIVING IN
NEIGHBORHOODS ARE PROBABLY BEING
IMPACTED BY ALL OF THESE
NEIGHBORHOOD STRESSORS OR NOT IN
A VACUUM, SO THINKING ABOUT HOW
WE MEASURE THESE TOGETHER.
THEN JUST ACKNOWLEDGE THE
INDIVIDUALS I WAS ABLE TO
COLLABORATE WITH IN MY LAB AND
THE FUNDING THAT HAS BEEN SO
GENEROUS, AS WELL AS THE STUDY
PARTICIPANTS AND STAFF THAT HAVE
MADE THIS RESEARCH POSSIBLE.
THANK YOU.
>> THAT WAS FANTASTIC.
THANK YOU, CHANTEL.
NEXT UP IS NANA MATOBA FROM
UCSD.
FETAL ORIGINS OF HEALTH
DISPARITIES: TRANS GENERATIONAL
CONSEQUENCES OF RACISM.
>> MY NAME IS NANA MATOBA.
I AM A NEONATOLOGIST AND PEE
TRISH AND BRADY CHILDREN'S
HOSPITAL SAN DIEGO, UNIVERSITY
OF CALIFORNIA SAN DIEGO.
MY TALK IS FETAL ORIGINS OF
HEALTH DISPARITIES: TRANS
GENERATIONAL CONSEQUENCE OF
STRUCTURAL RACISM.
WE'RE DISCUSSING SOME -- SOARNLL
DETERMINANTS AND STRUCTURAL
RACISM, USING THE PLACENTA AS A
MARKER OF DISPARITIES AND
CHALLENGES AND FUTURE DIRECTIONS
OF THIS RESEARCH.
AS A NEONATOLOGIST, I TAKE CARE
OF SICK TERM INFANTS, PRETERM
INFANTS -- COMPLICATIONS -- AND
WHILE ON A DAILY BASIS IN THE
NEONATAL ICU -- I WITNESSED
AND -- DISPARITIES IN THE CARE
THAT WE PROVIDE, IT WAS REALLY
IN FOLLOW-UP FOR A -- WHEN I
BECAME INTERESTED IN -- LINE OF
WORK, BECAUSE THEY WENT FORWARD,
THEY'RE AT THE SAME STARTING
LINE, BUT WHAT WE SAW IN CLINIC
AND WHAT WAS SO CRUSHING WAS THE
SAME -- SIMILAR COMPLICATIONS
WOUND UP HAVING WIDELY DIFFERENT
DEVELOPMENTAL OUTCOMES WHERE --
WITH PHYSICAL THERAPY -- TO YOUR
HOME SO [INAUDIBLE].
ACADEMICALLY, I WAS INSPIRED BY
DR. JEAN -- AT -- UNIVERSITY --
BUT HE DESCRIBED 30 YEARS AGO
ABOUT DIFFERING BIRTH WEA WEIGHF
INFANTS -- WHERE HE SHOWED THAT
FOREIGN-BORN BLACK WOMEN WHO
IMMIGRATE TO THE U.S. FROM
AFRICA HAVE BIRTH OUTCOMES
SIMILAR TO THOSE WHITE WOMEN.
ON THE LEFT GRAPH IS THE
DISTRIBUTION OF INFANTS' BIRTH
WEIGHT AND THE BLUE ARROW IS
POINTING TO THE BIRTH WEIGHT
DISTRIBUTION OF INFANTS BORN TO
BLACK WOMEN -- [INAUDIBLE]
HIGHER THAN THE DOTTED LINE
WHICH IS THE INFANT BIRTH
DISTRIBUTION OF BLACK --
U.S.-BORN BLACK WOMEN.
HOWEVER, THIS FAVORABLE BIRTH
OUT COME -- ONE GENERATION FOR
THE IMMIGRANTS' DAUGHTERS GO ON
TO BE A BIRTH WEIGHT THAT IS NOW
LOWER THAN THAT OF WHITE WOMEN
AND -- EXPERIENCE THIS IN THIS
COUNTRY FOR ONE GENERATION.
TRANS GENERATIONAL FACTORS,
FACTORS, CONDITIONS AND
ENVIRONMENTS EXPERIENCED BY ONE
GENERATION THAT RELATE TO THE
PREGNANCY OUTCOME OF THE NEXT
GENERATION.
THE OTHERS INCLUDE FACTORS SUCH
AS MOTHER'S OWN PRETERM BIRTH OR
LIFETIME NEIGHBORHOOD ECONOMICS,
AND UPWARD AND DOWNWARD ECONOMIC
MOBILITY.
AND -- BY BUILDING A TRANS
GENERATIONAL DATASET -- BETWE
BETWEEN -- [INAUDIBLE].
SOCIAL DETERMINANTS IN THESE
STUDIES INCLUDE THOSE ALREADY --
GUN VIOLENCE AND REDLINING WHICH
I'LL BE TALKING ABOUT, TEEN
BIRTH ACROSS GENERATIONS AND
SOCIAL AND RACIAL POLARIZATION.
THE STUDY ON GUN VIOLENCE AND
BIRTH OW OUTCOMES IN CHICAGO,
EXPOSURE TO HIGH RATES OF GUN
VIOLENCE IN THE CITY IMPACT
MATERNAL STRESS DURING HER
PREGNANCY, AND THEY AFFECT BIRTH
OUTCOME.
SO THESE ARE TWO -- IN THE CITY
OF CHICAGO.
THE MAP ON THE LEFT IS
GUN-RELATED CRIME RATES.
GUN-RELATED CRIMES IN PUBLIC
SPACES -- REPRESENTING -- THE
RED RUP CE REPRESENTS CENSUS TRN
THAT ROW LATED C RELATED CRIME,]
AND THE MAP ON THE LEFT SHOWS A
SIMILAR MAP OF LOW BIRTH WEIGHT
RATES IN THE CITY, AGAIN, THE
DARKER, THE HIGHER THE BIRTH
WEIGHT.
IT APPEARS TO BE SOMEWHAT ROLL
OUT.
SO THESE ARE GEOGRAPHICAL --
THREE CATEGORIES.
THERE APPEARS TO BE INCREASING
TREND IN LOW BIRTH WEIGHT --
LESS THAN -- 5 POUNDS, 5 1/2
POUNDS.
PRETERM BIRTH.
WE TREAT -- GESTATION AND SMALL
FOR GESTATIONAL AGE WHICH IS 1
10% -- BUT WHEN WE STRATIFY --
[INAUDIBLE] WHEN WE STRATIFY BY
RACE, THERE WAS VERY LITTLE
EFFECT OR NONE AT ALL OF GUN
VIOLENCE, MEANING THAT ACROSS
LOW VIOLENCE AREAS WHERE -- WERE
HIGH, AFRICAN AMERICAN WOMEN IN
THE CITY TEND TO HAVE SIMILAR --
TWICE THE ODDS RATIO GIVING
BIRTH TO LOW BIRTH WEIGHT
INFANTS, PRETERM BIRTH, WHICH IS
NOT WHAT WE EXPECTED TO FIND,
BUT I THINK -- EXPLAIN BETTER BY
THIS MA'AM SHOWING PROPORTION OF
WHITE IN BLUE AND BLACK IN
ORANGE AND HISPANIC IN GREY,
WHEN THEY'RE RESIDING IN THESE
LOW, MEDIUM AND HIGH GUN
VIOLENCE TERTILES, AND YOU CAN
SEE 18% OF THE STUDY POPULATION
COMPARE TED TO ONLY 2% OF WHITE
WOMEN, REFLECTING LONG-STAN
LONG-STANDING -- AND ALSO
REINFORCING THE IDEA THAT RACE
IS A PROXY FOR SOCIAL AND
ENVIRONMENT ASSISTANCE, UNJUST
PROCESSING INTERACTIONS, LOST
OPPORTUNITIES, IMPACTED BY --
RELATIONSHIP BETWEEN REDLINING
AND BIRTH OUTCOMES HAVE BEEN --
AFFECTING PHYSICAL AND SOCIAL
ATTRIBUTES, IMPACTING INDIVIDUAL
HEALTH CHARACTERISTICS AND
THEREBY CONTRIBUTING TO HEALTH
OUTCOMES SUCH AS BIRTH OUTCOMES.
SO WE CREATED A MAP OF REDLIN
REDLINING -- IT'S A BIT OLD BUT
DARKER BLUE SHOWS A HIGHER --
COMPARED TO WHITE FAMILIES AND
THEY'RE REALLY INTERSPERSED
THROUGHOUT THE CITY.
AND AS THE X AXIS GOES UP, THERE
IS A SLOW TREND IN INCREASED
PRETERM BIRTH RATES.
WE'RE NOT SURE WHAT HAPPENED
WITH THE --.
AND PRETERM BIRTH RATE,
REDLINING CATEGORIES SHOW
THAT -- LIVING IN REDLINED ARE
AREAS, THERE IS A SLIGHT
INCREASE IN -- BIRTH RATE, 18%
COMPARED TO 17.1% OF ALL AFRICAN
AMERICAN WOMEN IN NON-REDLINED
AREAS, ADJUSTED ODDS RATIO WAS
SMALL -- 1.08.
CHANGING TO THE IDEA, THE
PLACENTA AS A MARKER OF
DISPARITY, -- PLACENTA,
PRINCIPAL METABOLIC, RESPIRATORY
ENDOCRINE ORGAN OF THE FETUS, SO
MANY PREGNANCY COMPLICATIONS
SUCH AS PRETERM BIRTH ORIGINATE
FROM ITS DYSFUNCTION, A KEY
ROUTE BY WHICH EXPOSURES ARE
TRANSMITTED TO THE FETUS, A
MARKER OF DIFFERENCES IN
PRENATAL EXPOSURES THAT DIFFER
BETWEEN POPULATION AND RACIAL
GROUPS.
THE PLACENTA IS A FASCINATING
ORGAN BUT IT IS HIGHLY AVAILABLE
BUT ALSO VERY MUCH UNDERUTILIZED
AND THERE'S A CROSS-SECTION AND
WHOLE PLA PLACENTA, SO MANY
OPPORTUNITIES TO STUDY WHAT WAS
GOING ON.
WHAT WE STUDIED WERE FOUR
DOMAINS OF PLACENTAL HIS POE
PATHOLOGY.
ACUTE INFLAMMATION, WHICH --
CHRONIC INFLAMMATION, MATERNAL
VASCULAR MALL PERFUSION AND
FETAL VASCULAR PATHOLOGY.
IN COMPARING BETWEEN WOMEN IN
THE STUDY, THERE WERE INCREASED
INCIDENCE OF ACUTE INFLAMMATION,
CHRONIC INFLAMMATION AND FETAL
VASCULAR PATHOLOGY.
AMONG AFRICAN AMERICAN WOMEN.
IT SHOWED THAT -- WERE INCREA
INCREASED -- COMPARED TO WHITE
WOMEN.
THE SAME ACROSS MALE SEX AND
FEMALE SEX AND ACROSS A WIDE
RANGE OF GESTATIONAL AGE,
GREATER THAN 28 WEEKS.
SO HOW THIS ALL COMES TOGETHER
IS STILL UNCLEAR, ESPECIALLY
BECAUSE WE DID NOT COLLECT IN
THE STUDY ANY -- MEASURES OF --
STRESS, WE DIDN'T COLLECT MANY
SOCIAL DEMOGRAPHIC BACKGROUNDS
OR -- CHARACTERISTICS, WE DIDN'T
COLLECT DATA, AND ADDRESSES THAT
COULD HAVE HELPED, BUT OTHER
STUDIES HAVE -- BETWEEN SERUM
BIOMARKERS OF STRESS SUCH AS C
CRP, IN ASSOCIATION WITH --
PLACENTAL INFLAMMATION,
PLACENTAL TELOMERE LENGTHS,
SHORTER -- PLACENTAS, AND PEOPLE
ARE SPENDING DRK MARKERS OF
PERFUSION.
AND THE STRESS MODELS FOR THIS
RELATIONSHIP IN DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE,
THE WEATHERING HYPOTHESIS,
ALLOSTATIC LOAD.
I BELIEVE RESEARCH GAPS ARE --
WE TALKED ABOUT THR, MORE
ACCURATE MEASURES OF STRUCTURAL
RACISM.
THAT'S WHY THERE NEEDS TO BE A
STANDARDIZED VIEW SO -- I THINK
THE -- SETTINGS, LOOKING AT HOW
HISTORICAL PRACTICES AND
HISTORICAL INSULTS AFFECT
CURRENT DISPARITIES.
IN MEDICINE, THERE IS -- NOT
HERE, BUT IN GENERAL, RESISTANCE
TO ACCEPT STRUCTURAL RACISM AS A
FORCE, WHAT I HAVE BEEN TALKING
ABOUT AND -- MY COLLEAGUES --
JUST LIKE LOCKED OUT BECAUSE
IT'S JUST SO HARD TO ACCEPT TH
THAT --
>> [INAUDIBLE]
[LAUGHTER]
>> SO HEALTHCARE DISPARITIES AND
HEALTH DISPARITIES ARE
DIFFERENT.
AND UNTIL TODAY, I OFTEN FEEL
VERY ISOLATED IN MY SEARCH OF
STUDYING THE PLACENTA AND HEALTH
DISPARITIES, SO THIS -- WITH
EPIGENETICS AND INTERVENTIONS
ARE GREATLY NEEDED.
THESE ARE SOME OF MY MENTORS AND
COLLABORATORS.
THANK YOU VERY MUCH.
>> FANTASTIC.
SO WE ARE NOW OPEN FOR QUESTIONS
FOR THE SPEAKERS.
I DON'T KNOW IF YOU HAVE
ANYTHING ONLINE.
YES, ANY QUESTIONS ONLINE?
NOT YET?
PEOPLE ARE STILL THINKING.
I HAD A QUESTION THAT I THINK
THAT SOMEBODY MENTIONED IT, I
CAN'T REMEMBER WHICH ONE, BUT
ESPECIALLY IN PREGNANCY, WHETHER
OR NOT THERE'S ANY DIFFERENCE IN
ANY OF THE OUTCOMES THAT YOU'RE
LOOKING AT, IF YOU'VE LOOKED AT
THE SEX OF THE FETUS, IF IT
MATTERED FOR EITHER MATERNAL
HEALTH OUTCOMES OR BABY'S
DEVELOPMENTAL OUTCOMES RELATED
TO ANY OF THE RACES AND
MARGINALIZATION OUTCOMES.
>> SO I DIDN'T GET TO PRESENT
THAT, BUT ONE OF THE -- IN THE
STUDY ON GESTATIONAL EXPOSURE TO
NEIGHBORHOOD CRIME AND
EPIGENETIC -- METHYLATION MARKS,
WE DID STRATIFY ABOUT OFFSPRING
SEX AND SAW SIGNIFICANT CPG
SITES OR DNA METH L METHYLATIONS
ONLY IN THE FEMALE OFFSPRING,
NONE WERE SIGNIFICANT IN THE
MALE OFFSPRING.
SO THE RESULTS THAT I SHOWED FOR
THAT STUDY WERE DRIVEN BY THE
FEMALE OFFSPRING.
AND SO WE'VE BEEN THINKING A LOT
ABOUT THAT BECAUSE, YOU KNOW,
STRESS RESPONSE PATHWAYS AND
STRESS DIFFERS, AND WE DIDN'T
EXPECT TO SEE THAT SO EARLY,
ESPECIALLY IN THE EPIGENETIC
MARKS.
SO THE SAMPLE SIZE -- WHEN WE
STRATIFIED, I THINK WE'RE
LOOKING AT 56 FEMALE OFFSPRING
AND MAYBE 70 MALE OFFSPRING.
SO WE'RE NOT ABLE TO REALLY DIG
TOO MUCH ABOUT THAT BUT IT
SOMETHING WE'VE BEEN THINKING A
LOT ABOUT WITH THOSE RESULTS.
THANK YOU.
>> THANK YOU VERY MUCH FOR YOUR
TALK.
SO ONE THING WE KNOW IS THAT
MORE FETAL OUTCOMES, WHEN WE
LOOK AT PARTICULARLY BLACK WOM
WOMEN, THE RATES ARE HIGHER OF
ADVERSE -- WHEN YOU ADJUST FOR
SOCIAL ECONOMICS, IT ONLY
IMPROVES JUST A LITTLE.
DO THE EPIGENETIC CHANGES VARY
AS YOU LOOK AT THAT -- IN OTHER
WORDS, IS THERE SOME ADDITIONAL
EPIGENETIC CHANGE THAT WE SEE
RELATED TO SORT OF SES?
>> THAT'S A GREAT QUESTION.
SO WHEN OUR STUDIES ADJUSTED FOR
SES, WE DIDN'T STRATIFY BY SES
TO SEE IF THEY DIFFERED BY
INDIVIDUAL LEVEL SES, AS I
MENTIONED EARLIER, THE STUDY DID
NOT COLLECT -- THERE IN NO
SOCIAL EPIDEMIOLOGISTS ON THE
STUDY TEAM WHEN THEY ORIGINALLY
DESIGNED THIS, BUT THERE'S
DEFINITELY SEVERAL STUDIES THAT
HAVE SHOWN SES RELATED
EPIGENETIC MARKS, PARTICULARLY
IN INFLAMMATION-RELATED
PATHWAYS.
USING THE VERY LIMITED SES DATA
THAT WE HAVE, WHICH IS
EDUCATION, WE DO HAVE SOME CRUDE
MARKS OF, LIKE, OCCUPATION THAT
WE MIGHT BE ABLE TO UTILIZE.
WE DO -- ACTUALLY WE DID LOOK AT
GESTATIONAL AGING, SO THESE
EPIGENETIC AGING MARKS TO
PREDICT EPIGENETIC AGING, AND
DID FIND SOME ASSOCIATIONS WITH
SES, BUT WE HAVEN'T KIND OF
LOOKED AT THIS INTERACTION
BETWEEN THE MATERNAL
CHARACTERISTICS AND INDIVIDUAL
SES.
THAT'S A GREAT QUESTION.
>> THANK YOU BOTH FOR YOUR TALK
TODAY.
I THINK I LEARNED A LOT.
FOR DR. MARTIN, IN YOUR LAST
ANSWER, WHEN YOU SHOWED THE DATA
COMPARING BLACK VERSUS WHITE,
ARE THERE OTHER FACTORS THAT YOU
WOULD CONSIDER THAT COULD BE
DISTINGUISHING TO START TO
EXPLAIN THAT BLACK VERSUS WHITE
DIFFERENCE?
AND IT SOUNDS LIKE MAYBE FOR
THIS STUDY THAT YOU SHARED WITH
US TODAY, THAT WASN'T COLLECTED.
SO ARE THERE THINGS LOOKING AT
COLLECTING FOR FUTURE STUDIES SO
THAT THERE COULD BE MORE NUANCE
IN TERMS OF PLAINING OF EXPLAINT
RACIAL DIFFERENCE?
>> THANK YOU FOR THAT QUESTION.
ONE OF THE THINGS WE TRY TO BE
CAREFUL ABOUT WHEN WE ADJUST OR
TRY TO ACCOUNT FOR WHAT MIGHT BE
GOING ON IS THAT WE'RE NOT
ADJUSTING FOR THINGS THAT ARE
ACTUALLY -- ON THE MEDIAN
PATHWAY, SO THAT MIGHT BE
DOWNSTREAM OF THESE NEIGHBORHOOD
CHARACTERISTICS, BUT THINGS THAT
ARE IMPACTING LIVING IN THESE
TYPES OF NEIGHBORHOODS.
SO WE ACCOUNT FOR FACTORS LIKE
THE MOTHER'S AGE, EDUCATION,
EMPLOYMENT STATUS, MARITAL
STATUS, THINGS THAT MIGHT
PREDICT WHY SOMEONE LIVES IN A
CERTAIN NEIGHBORHOOD.
KNOW THATNOW THAT WE HAVE SOME O
LOOK AT THINGS THAT PRECEDE OR
MAYBE POLICIES THAT WOULD PUT
PEOPLE OR SORT PEOPLE INTO
CERTAIN NEIGHBORHOODS, SO
THINKING ABOUT HISTORICAL
REDLINING OR HISTORICAL -- WE'VE
HAD SOME DISCUSSIONS ABOUT
SHOULD WE BE ACCOUNTING FOR
THOSE TYPE OF FACTORS, FACTORS
LIKE MATERNAL HEALTH OUTCOMES
WHERE WE CAN LOOK AT THOSE AS
POTENTIAL EXPLANATORY FACTORS
BECAUSE WE DO BELIEVE THAT'S
NEIGHBORHOOD ENVIRONMENTS MIGHT
BE IMPACT BEING THE MATERNAL
HEALTH WHICH THEN MIGHT BE
IMPACT THE THE EPIGENETIC
MECHANISMS POTENTIALLY.
AND SO WE DIDN'T HAVE ENOUGH OF
THOSE OUTCOMES IN OUR SAMPLE TO
LOOK AT THE MATERNAL HEALTH
FACTORS.
OH, AND WE ALSO ACCOUNTED FOR
BEHAVIORAL FACTORS, SO
DIFFERENCES IN MATERNAL SMOKING,
DIFFERENCES IN -- MAYBE I THINK
WE HAVE PHYSICAL ACTIVITY?
I MIGHT BE THINKING OF ANOTHER
STUDY, BUT THESE MATERNAL
BEHAVIORAL FACTORS STILL SEE
THESE.
DOES THAT ANSWER YOUR QUESTION?
OKAY.
>> SO A COUPLE QUESTIONS FROM
THE ZOOM.
THANK YOU FOR SUCH AN
INTERESTING PRESENTATION.
DID YOU CONSIDER ADJUSTING FOR
MATERNAL METABOLIC STATUS GIVEN
RECENT ASSOCIATIONS BETWEEN THAT
AND DNA METHYLATION?
AND OFFSPRING ADIPOSITY WHICH
SUPPORTS WORK -- IN PROMOTING --
>> SO I THINK -- WE DID NOT
ADJUST FOR THEM, AND BECAUSE WE
WERE KIND OF WORRIED ABOUT KIND
OF GETTING INTO THE ACCOUNTING
FOR THEM.
THINK WHAT WOULD BE INTERESTING
IS ACTUALLY STRATIFYING THEM,
THOUGH, TO SEE IF THESE
ASSOCIATIONS DIFFER BASED ON THE
MATERNAL OUTCOMES,
CARDIOMETABOLIC OUT COME AND
THOSE THAT HAVE MAYBE
HYPERTENSION OR CHRONIC
HYPERTENSION, GESTATIONAL
DIABETES AND THOSE THAT DO NOT.
I THINK WE HAD PROBABLY 96% DID
NOT HAVE ANY OF THOSE
COMPLICATIONS DURING PREGNANCY,
SO WE WEREN'T ABLE TO KIND OF
ACCOUNT FOR THOSE IN THIS
ANALYSIS.
>> AND THEN ANOTHER QUESTION
ABOUT CAN THE SPEAKERS PROVIDE
ANY THOUGHT OF WHETHER THE
PREDICTORS THEY EXAMINED SUCH AS
NEIGHBORHOOD CONDITIONS WERE
CAUSAL FACTORS OR COLLINEAR WITH
OTHER FACTORS THAT THEY NEED
MORE PROXIMAL MECHANISMS.
>>
>> THE FACTORS THAT WE STUDY,
GUN VIOLENCE OR REDLINING IS
JUST ONE OF MANY AND PROBABLY DO
COEXIST WITH MANY OTHER MEASURES
OF DISCRIMINATION.
AS FAR AS THE PLACENTAL
FUNCTION, AGAIN, IT WAS JUST
PURELY DIFFERENCES IN PATHOLOGY.
I THINK THERE COULD BE MORE
STUDIES LOOKING AT THE SOCIAL
FORCES AND THE DIFFERENCES IN
PLACENTAL FUNCTION PATHOLOGY.
>> ALL RIGHT.
WITH THAT, CAN WE GIVE ONE MORE
ROUND OF APPLAUSE FOR THE PANEL?
[APPLAUSE]
AND UP NEXT WE HAVE OUR FINAL
PANEL OF THE DAY.
>> OKAY.
SO I'M GOING TO GO AHEAD AND GET
US STARTED ON OUR LAST SESSION
OF THE DAY AND I APPRECIATE
EVERYBODY'S ATTENTION.
AND I AM EXCITED TO MODERATE
THIS SESSION ON STRESS
ALLOSTATIC LOAD AND
INFLAMMATION-RELATED MECHANISMS.
AS AN IMMUNOLOGIST DOING
ENVIRONMENTAL TOXICOLOGY AND I
FIND THAT IT'S REALLY KEY FOR US
TO THINK ABOUT THE FACT THAT A
LOT OF THE COMMUNITIES THAT
EXPERIENCE ENVIRONMENTAL
EXPOSURES ARE ALSO ONES WHO
EXPERIENCE RACISM,
MARGINALIZATION AND
DISCRIMINATION AND A LOT OF
THESE PATHWAYS ARE OVERLAPPING
AND LIKELY SYNERGISTIC SO WE
NEED TO WORK TOGETHER MORE AND
NOT BE SO REDUCTIONIST IN OUR
APPROACH TO UNDERSTANDING THESE
MECHANISMS.
AND WITH THAT, I WOULD LIKE TO
INTRODUCE OUR FIRST SPEAKER, DRO
TALK TO US ABOUT DISCRIMINATION
AS A STRESSOR INFLUENCING
BRAIN-GUT MICROBIOME
ALTERATIONS, DYSREGULATION OF
THE GUT BRAIN SYSTEM.
>> THANK YOU.
I WANT TO START OFF BY SAYING
HOW I REALLY GOT STARTED WITH
THIS WORK.
I'M BORN AND RAISED IN -- MY DAD
STILL LIVES THERE, SO
INTERSECTING, NAVIGATING -- SO
I'M VERY PASSIONATE ABOUT THIS
WORK.
SO THANKS TO SPEAKERS BEFORE US,
WE KNOW THAT DISCRIMINATION IS
RISING, WE KNOW THAT IT HAS
NEGATIVE EFFECTS, ANXIETY,
DEPRESSION, AND MORE RECENTLY,
STUDIES WE'VE SEEN BY OTHER
SPEAKERS, ASSOCIATING
DISCRIMINATION WITH PHYSICAL
HEALTH, THINGS LIKE DIABETES,
OBESITY, CARDIOVASCULAR DISEASE.
WHAT'S REALLY NICE IS HOW PEOPLE
ARE STARTING TO LOOK AT THESE
BIOMARKERS RELATED TO
DISCRIMINATION, SO LOOKING AT
THINGS LIKE INFLAMMATION,
EPIGENETICS AND CORTISOL.
AND WE ALSO SEE THAT
DISCRIMINATION IS ASSOCIATED
WITH HIGHER RATES OF OBESITY, SO
WHEN WE LOOK AT NON-RACIAL
DISCRIMINATION, WE CAN SEE THAT
THE ODDS OF HAVING OBESITY IS
THREE TIMES MORE, WHERE WE LOOK
AT RACIAL-BASED DISCRIMINATION,
YOU SEE THE ODDS RL 6 TI ARE 6 S
MORE.
WHEN WE LOOK FROM 1991 TO 2010,
WE'VE GONE UP ABOUT 15% TO OVER
30%, AND BASICALLY IT WENT FROM
BLUE COUNTRY TO A RED ONE.
I DON'T MEAN THAT POLITICALLY.
I KNOW WE'RE IN D.C. -- AND I
WANT TO ENCOURAGE FRIENDS RIGHT
NOW, WE'RE AT ABOUT 42%
ACCORDING TO THE CDC PROJECTED
TO BE ABOUT 51% BY 2030.
SO WE KNOW THAT OUR -- WE WERE
STILL TALKING ABOUT BEAZ AFTER
ALLOBESITYAFTER ALL THIS TIME AL
DON'T FULLY UNDERSTAND WHAT
THE -- MECHANISMS ARE.
SO THIS -- WHEN WE LOOK AT
OBESITY, IT IS A VERY COMPLEX
DISORDER, IT IS VERY
HETEROGENEOUS AND IT'S NOT JUST
ABOUT NEVER EATING, IT'S NOT
JUST ABOUT WHAT WE'RE PUTTING IN
OUR MOUTH BUT -- MAYBE RELATED
TO WHERE -- ENVIRONMENTAL
FACTORS SUCH AS DISCRIMINATION
AND STRESS.
SO WHAT I'M GOING TO TALK MORE
ABOUT TODAY IS TAKING THIS WHOLE
PERSON OR THIS SYSTEMS BIOLOGY
APPROACH BY LOOKING AT THE BR
BRAIN-GUT MICROBIOME SYSTEM, AND
HOW IT LEADS TO ALTERED EATING
BEHAVIORS AND OBESITY.
SO PEOPLE OFTEN ASK ME, IS THE
BRAIN AND THE GUT REALLY
CONNECTED, AND I TELL PEOPLE,
THINK ABOUT THOSE STRESSFUL
SITUATIONS.
LOOK AT US TODAY, ADVANCING
THESE SLIDES HAS BEEN REALLY
TRAUMATIC.
SO -- BUTTERFLIES IN YOUR
STOMACH, LIGHT-HEADED, STRESSED
OUT, THAT DOES PROVIDE SOME
EVIDENCE FOR THIS BRAIN-GUT
CONNECTION.
WE KNOW FROM CLINICAL AND
PRE-CLINICAL STUDIES THAT THERE
IS THIS -- CONNECTION BETWEEN
THE BRAIN AND WE HAVE THIS KIND
OF TOP-DOWN SIGNALING FROM THE
BRAIN TO THE GUT AND THIS
SIGNALING TO THE BRAIN.
WHEN WE THINK ABOUT THIS REALLY
TIGHTLY REGULATED COORDINATED
SYSTEM AND WHEN WE THINK ABOUT
THE USE OF OBESITY, THERE'S THIS
SHIFT IN HOMEOSTASIS AND YOU
KIND OF GET THIS DISREGULATED --
BETWCOMMUNICATION BETWEEN THE BN
AND GUT.
SO I IF YOU HAVE A MESSED UP GUT
MICROBIOME, YOUR -- IS GOING TO
FALL BUT WE DON'T LIVE IN
ISOLATION SO OF COURSE THIS
BRAIN-GUT SYSTEM IS INFLUENCED
BY ENVIRONMENTAL FACTORS SUCH AS
DISCRIMINATION.
I'M GOING TO TALK ABOUT A COUPLE
STUDIES WHERE WE TALK ABOUT THE
EFFECT OF -- HOW IT ALTERS THE
BRAIN IN RESPONSE TO FOOD CUES,
WE ALSO LOOK AT HOW IT ALTERS --
AFFECTS THAT CROSSTALK BETWEEN
THE GRAIN AND BRAIN AND GUT MIC.
SO WE HAD 107 PARTICIPANTS.
VALIDATED SCALE WHERE IT ASKED
ABOUT CHRONIC EXPOSURE TO
DISCRIMINATION SO YOU ASK
QUESTIONS ABOUT HOW OFTEN YOU --
A WHOLE BUNCH OF QUESTIONNAIRE
BEHAVIORAL DATA, DIET
INFORMATION, WE PUT IT IN A
SCANNER AND SHOW PICTURE OF
FOOD, THEN WE ALSO COLLECTED --
THEIR METABOLITES.
WHEN WE STRATIFY BY RACE AND
ETHNICITY, ALL RACES EXPERIENCE
DISCRIMINATION.
LET ME SAY THAT AGAIN.
ALL RACES EXPERIENCE
DISCRIMINATION.
SO YES, YOU CAN SEE THE BLUE BAR
IS A LITTLE LARGER BUT THERE
WERE NO SIGNIFICANT DIFFERENCES
IN DISCRIMINATION BETWEEN THE
DIFFERENT RACIAL GROUPS,
HOWEVER, WHAT WAS DIFFERENT WAS
WHAT THEY ATTRIBUTED
DISCRIMINATION TO.
SO FOR EXAMPLE, WHEN YOU LOOK AT
BLACK, YOU SEE -- ASSOCIATED
WITH RACE/ETHNICITY OR SKIN
COLOR, WHEREAS WHEN YOU LOOK AT
WHITE, YOU SEE THEY ATTRIBUTE TO
THINGS LIKE GENDER OR RELIGION.
AND WHAT WE DID WAS WHEN WE
DIVIDED THE GROUP BY HIGH
DISCRIMINATION WILLOW -- WE ACTY
HAVE LOWER LEVELS OF
SOCIOECONOMIC STATUS.
THEN WHEN WE WERE TRYING TO LOOK
AT HOW DISCRIMINATION IMACTS THE
BRAIN -- WE HAVE THESE HIGH
CALORIE SA SAVORY FOODS, THEN WE
HAVE HIGH CALORIE SWEET FOODS,
THINK ABOUT DESSERTS, CAKES,
THINGS LIKE THAT, ICE CREAM.
WE ALSO HAVE LOW CALORIE SWEETS
LIKE FRUITS AND CONTROL -- WHAT
WE FOUND IS WHEN THEY WERE
LOOKING AT THESE HIGH CALORIE --
DISCRIMINATION TO -- HIGHER
CRAVINGS BUT SURPRISINGLY OR NOT
SURPRISINGLY, DISCRIMINATION DID
NOT HAVE AN AFFECT ON -- HEALTHY
FOODS.
WHEN WE LOOKED AT -- WE SAW
INCREASED ACTIVITY IN THE --
WHICH IS ASSOCIATED WITH THE --
AND -- UNHEALTHY SAVORY FOODS WE
ALSO SAW -- INCREASED ACTIVITY
IN THE ORBITOFRONTOCORTEX, BUT
WHAT'S INTERESTING ABOUT THE
FRONTAL CORTEX IS IT'S ALSO
RELATED TO EMOTIONAL MEMORY, AND
THEY WERE LOOKING AT PICTURES OF
HEALTHY FOODS WE SAW INCREASED
ACTIVITY IN THE MIDDLE AND
SUPERIOR FRONTAL GYRUS AND --
CONTROL ACTIVITY.
WHEN WE'RE LOOKING AT -- WE SAW
HOW DISCRIMINATION IS ASSOCIATED
WITH HIGHER LEVELS OF THE GUT
METABOLITES, SPECIFICALLY
GLUTAMATE -- THINGS LIKE
OXIDATIVE STRESS, INFLAMMATION,
ACCELERATED AGING.
THEN WE LOOKED IT LOOKED AT THEK
BETWEEN THE BRAIN AND THE GUT,
ONE YOU HEALTHY SWEET, UNHEALTHY
SAVORY -- DISCRIMINATION IN THE
BRAIN AND GUT BUT ALSO
SIGNIFICANT INTERACTION BETWEEN
THE GUT AND THE BRAIN.
BUT THIS WAS NOT PRESENT WHEN WE
WERE LOOKING AT THESE UNHEALTHY
SWEET FOODS OR THESE HEALTHY
SAVORY FOODS.
AND THEN FOR THE SECOND STUDY,
WE WANTED TO LOOK AT THE
RELATIONSHIP OF THE BRAIN AND
GUT MICROBIOME IN BEHAVIORAL
DATA IN RESPONSE TO
DISCRIMINATION, SO WE HAD 154
PARTICIPANTS.
WE COLLECTED -- DA DATA -- ALSO
COLLECTED INFLAMMATORY MARKERS.
AND AS YOU CAN SEE, HIGH DISCELL
NADISCRIMINATION COMPARED TO LOW
DISCRIMINATION, PRETTY MUCH --
ANXIETY, DEPRESSION, MENTAL
HEALTH, IF PHYSICAL HEALTH SY
SYMPTOMS, STRESS, CAUSATIVE
MEASURES, THERE WERE SIGNIFICANT
DIFFERENCES BETWEEN HIGH
DISCRIMINATION AND LOW
DISCRIMINATION GROUP.
AND THEN IN ORDER TO KIND OF
LOOK AT HOW THESE DIFFERENT
DATASETS ACTUALLY KIND OF WORK
TOGETHER OR COME TOGETHER IN
RESPONSE TO DISCRIMINATION, WE
STRATIFIED BY RACE AND ETHNICITY
AND WE CREATED THESE
CONNECTOGRAMS, WALK THROUGH THIS
REALLY QUICKLY.
SO WE PULLED OUT THE DIFFERENT
DATASETS AND THEN WE --
CORRELATION ACROSS THE DATASETS.
SO IF THERE WAS A POSSIBLE
CORRELATION TO THE RED LINE,
NEGATIVE CORRELATION, IT'S A
BLUE LINE.
AND WE ALSO PLOTTED THE -- SO
THE THICKER LINE WITH THE
GREATER RELATIONSHIP.
AND WHAT WE FOUND, IF YOU JUST
LOOK AT THIS -- WE CAN SEE THAT
THERE ARE LESS LINES, OR LESS
ASSOCIATIONS WITH THE BLACK
GROUP THAN THE -- FROM HISPANIC
TO ASIAN TO WHITE, YOU SEE THOSE
GREATER CORRELATIONS.
SO IF WE TAKE A DEEPER DIVE,
WHAT WE FOUND WITH THE BLACK AND
THE HISPANIC GROUP WAS THAT
THERE WERE MORE CORRELATIONS,
MORE ASSOCIATIONS BETWEEN
DISCRIMINATION AND METABOLIZE
THE -- AND -- MARKERS.
HOWEVER THERE WERE CORRELATIONS
WITH BRAIN REGIONS.
THE BRAIN REGIONS THAT WERE
INVOLVED -- ASSOCIATED WITH
EXECUTIVE CONTROL AND --
NETWORK.
WHAT THAT PROBABLY SUGGESTS IS
THAT THERE'S THIS TOP-DOWN KIND
OF -- THAT WENT ON WHICH
SUGGESTS -- COPING MEMO NIRK OR
THIMECHANISM --BUT -- DISCRIMIN-
MANIFESTING MORE AS INFLAMMATORY
PROCESS -- INFLAMMATORY MARKERS.
AND WHAT WE SEE WITH BLACK
INDIVIDUALS IS GREATER
FORMATIONS IN THINGS LIKE
ANXIETY, DEPRESSION -- THERE WAS
ALSO INCREASED BRAIN ACTIVITY
IN -- REGIONS AND -- AND WITH
ASIANS, WE ALSO SAW INCREASED
CORRELATION OF -- DEPRESSION --
MORE ASSOCIATED WITH
SOMATOSENSORY REGIONS, SO KIND
OF LOOKING AT SOCIAL -- REGIONS,
WE ALSO SAW METABOLITES WERE
LINKED TO CHOLESTEROL, SO AGAIN,
THINKING THAT -- MORE OF THE --
USING FOOD AS A WAY OF COPING
WITH STRESSFUL RESPONSES.
THEN WITH THIS STUDY WHAT WE DID
IS WE LOOKED AT HOW LIVING IN A
DISADVANTAGED NEIGHBORHOOD
ACTUALLY IMPACTS THESE WEIGHT
STRUCTURES AND -- PATTERNS.
SO -- WE LOOKED AT 17 DIFFERENT
KIND OF MEASURES, THINGS LIKE
EDUCATION, -- FOOD, HOW SAFE A
NEIGHBORHOOD IT IS, AND WE KIND
OF CALCULATED THIS BASED UPON
THEIR ZIP CODE.
AND WHAT WE FOUND WAS THAT THE
HIGHER OF AREA OF DEPRIVATION,
THE MORE ALTERATIONS IN THE
BRAIN, BUT HIGHER EDI WAS ALSO
ASSOCIATED WITH GREATER BMI, SO
GREATER OBESITY AND GREATER
INTAKE OF TRANS FATTY ACIDS
WHICH IS SOMETHING WE FIND IN
FAST FOODS.
SO WHAT DO WE SEE?
WE SEE THAT THERE ARE NOVEL
ASSOCIATIONS BETWEEN
DISCRIMINATION AND LINKED TO
ALTERATIONS IN THE BRAIN AND THE
GUT MICROBIOME IMMUNE SYSTEM.
WE SEE THAT DISCRIMINATION
THAT'S BASED UPON RACE AND SKIN
COLOR LEADS TO CHANGES WITHIN
THOSE BRAIN-GUT -- MORE SKEWED
TOWARDS INFLAMMATION.
WE ALSO SEE DISCRIMINATION BASED
ON OTHER REASONS SUCH AS GENDER
OR RELIGION WHICH IS NOT AS
VISIBLE LEADS TO MORE ADVERSE --
REGIONS, MORE ANXIETY AND
DEPRESSION, WHICH KIND OF MAKES
SENSE BECAUSE WHEN YOU'RE
LOOKING AT THIS -- BASED
DISCRIMINATION -- RACE AND
ETHNICITY -- IT CAN GET AWAY
FROM WHAT'S REALLY VISIBLE, WHEN
YOU'RE LOOKING AT SOMEBODY LIKE
GENDER OR RELIGION THAT ISN'T AS
VIVISIBLE -- AND SO MAYBE THESE
FINDINGS KIND OF HIGHLIGHT HOW
DISCRIMINATION ACTUALLY LEADS TO
HEALTH DISPARITIES.
WE ALSO SEE THAT -- LEVEL OF
DISCRIMINATION IS ASSOCIATED
WITH PROCESSES LEADING TO
REWARD, TO EXECUTIVE CONTROL.
BUT THESE ARE VERY DEPENDENT
UPON THE TYPE OF FOOD WE'RE
EATING.
WE ALSO SEE THAT ALTERED
GLUTAMATE PATHWAY METABOLITES
CONTRIBUTING TO OXIDATIVE STRESS
AND INFLAMMATION, ACTUALLY
ACCELERATED AGING.
AND THEN THIS BRAIN-GUT
COMMUNICATION WHERE WE ONLY SEE
THIS IN FOODS WHICH TO BE HONEST
MAKES SENSE BECAUSE WE KNOW THAT
SWEET FOODS ARE HIGHLY
ADDICTIVE, WE KNOW THAT THEY
CAUSE INCREASED CRAVINGS.
IN FACT, IF YOU TRY TO --
BACTERIA IN FAT, IT WON'T GROW,
BUT IF YOU TRY TO GROW BA BACTEA
IN SWEET FOODS, IT WILL GROW.
SO WE DO THAT WHEN WE SEE THESE
ALTERATIONS, WHERE AGAIN -- SO
WITH THAT, WE -- SOME
PRELIMINARY EVIDENCE OF HOW
DISCRIMINATION DOES IMPACT --
MANIFEST IN OUR BODIES, THIS
KIND OF WHOLE BODY SYSTEM AND
EVEN GIVES -- TO THE STATEMENT
THAT RACISM PLAIX ME SICK TO MYY
STOMACH.
SO I WANT TO THANK EVERYBODY,
FOR FUNDING, AND WITH THAT
SHAMEFUL PITCH, WE WATCHED OUR
CENTER, OUR GOODMAN LUSKIN
MICROBIOME CENTER LAST YEAR AND
WE'RE LOOKING FOR POSTDOCS AND
WE ALSO HAVE -- [INAUDIBLE].
SO PLEASE WATCH.
[APPLAUSE]
>> THANK YOU VERY MUCH.
OUR NEXT SPEAKER IS DR. ADOLFO
CUEVAS, HE WILL BE GIVING A
DISCUSSION ON DISCRIMINATION
EXPOSURE AND INFLAMMATION.
>> GOOD AFTERNOON.
I RECOGNIZE THAT I AM ACTUALLY
CARRINGTON AND I ARE BETWEEN YOU
AND A DRINK.
SO I'M GOING TO EMBODY MY
MAIN -- TALK TODAY IN THE SLIDES
COULD WORK WELL WITH ME.
[INAUDIBLE] SO I WILL BE TALKING
ABOUT DISCRIMINATION EXPOSURE
AND INFLAMMATION, AND I WOULD
LOVE TO REALLY PROVIDE A --
DR. MORRIS EARLY THIS MORNING
PROVIDED A REALLY GOOD
FOUNDATION FOR WHY WE EVEN STUDY
DISCRIMINATION AND HOW HEALTH IE
FIRST PLACE, BUT IF YOU COULD
BEAR WITH ME, I'D LOVE TO AT
LEAST TAKE US DOWN MEMORY LANE
QUICKLY TO REALLY PROVIDE
FOUNDATION FOR WHY DO WE EVEN
WANT TO TALK ABOUT
DISCRIMINATION AS A SOCIAL
DETERMINANT OF NOT JUST
INDIVIDUAL HEALTH, POPULATION
HEALTH, AND ALSO WHY
INFLAMMATION SHOULD BE -- A
PARTICULAR -- SHOULD BE LOOKING
AT.
I THINK A LOT OF THIS IS
MOTIVATED BY THE PERSISTENT
BLACK AND WHITE DISPARITIES THAT
WE SEE HERE IN THE UNITED STA
STATES, WHERE BLACK AMERICANS
HAVE THE HIGHEST MORTALITY RATE,
EVEN WHEN WE LOOK INTO CHRONIC
DISEASE BURDEN, BLACK AMERICANS
REALLY SUFFER HIGHER RATES OF
CHRONIC DISEASE BURDEN FOR MANY
OF THE TOP 10 LEADING CAUSES OF
DEATH, INCLUDING HEART DISEASE,
DIABETES, ALZHEIMER'S DISEASE.
AS A RESULT, WHEN WE LOOKED INTO
LIFE EXPECTANCY, WHAT AMERICANS
HAVE SHORTER LIFE EXPECTANCY
COMPARED TO WHITE AMERICANS.
AND WHILE THERE HAVE BEEN
SIGNIFICANT GAINS OVER THE LAST
FEW DECADES, A LOT OF IT HAS
BEEN WASHED AWAY BY COVID-19 AND
WE'RE STARTING TO SEE THAT GAIN
BASICALLY PICK UP AGAIN IN THE
LAST TWO YEARS, BUT AS WE CAN
SEE HERE, BLACK AMERICANS TRAIL
BEHIND.
AND IT'S NOT SURPRISING THAT
FROM 1980 TO 1990s,
SOCIOECONOMIC STATUS IS -- NOT
JUST LIFE EXPECTANCY BUT CHRONIC
DISEASE BURDEN, AND THIS WAS --
AT THAT TIME, GIVEN THAT BLACK
AMERICANS AND EVEN HISPANIC
AMERICANS WERE OVERREPRESENTED
AT THE LOWER END OF THE
SOCIOECONOMIC STRATA, ESPECIALLY
IF WE LOOK INTO EDUCATION, WHICH
IS ONE OF THE STRONGEST
PREDICTORS OF HEALTH, JU EVEN JN
LOOKING AT BACHELOR'S DEGREE
ATTAINMENT, WHITE AMERICANS
CURRENTLY HAVE ABOUT -- OVER 40%
OF THEM HAVE A BACHELOR'S DEGREE
COMPARED TO JUST 26% OF BLACK
AMERICANS.
THIS WAS QUICKLY DISPROVEN IN
WORK BY DAVID WILLIAMS AND PAUL
BRAVEMAN SHOWING -- IN THIS
CASE, EDUCATION, WE STILL SEE
THAT BLACK AMERICANS HAVE
SHORTER LIFE EXPECTANCY COMPARED
TO THEIR WHITE COUNTERPARTS.
AND IN FACT, IN SOME OF THE
EARLY WORK, BRAVEMAN ACTUALLY
SHOWED THAT WHITE AMERICANS WITH
A HIGH SCHOOL DEGREE STILL LIVED
LONGER LIVES COMPARED TO BLACK
AMERICANS WITH A COLLEGE DEGREE
OR HIGHER.
THERE HAVE BEEN SIGNIFICANT
GAINS WITH REGARDS TO EDUCATION,
INCOME AND OCCUPATION WHEN IT
COMES TO LIFE EXPECTANCY,
BLACK-WHITE DISPARITIES.
SPECIFICALLY FOR BLACK MEN WITH
BACHELOR'S DEGREE AND THOSE
WITHOUT A BACHELOR'S DEGREE, BUT
WHAT THIS -- THIS STORY HERE,
WHICH IS THAT EDUCATION, INCOME
AND OCCUPATION DOES NOT FULLY
EXPLAIN BLACK-WHITE DISPARITIES
IN LIFE EXPECTANCY.
SO THE QUESTION IS HERE WHAT ARE
THE DRIVERS OF RACIAL HEALTH AND
EQUITY ABOVE AND BEYOND INCOME,
EDUCATION AND OCCUPATION?
AND I THINK THERE IS A LOT TO BE
SAID ABOUT POLICIES AND THE
ABSENCE OF POLICIES, MANY OF US
HAVE APPROACHED TODAY AND HOW
THEY HAVE -- I JUST CAN'T GET
INTO THAT TODAY BUT IF WE COULD
AT LEAST FOCUS AT THE
INTERPERSONAL LEVEL AND HOW THAT
IS A SOCIAL DETERMINANT OF
HEALTH AND HEALTH DISPARITIES,
WE SEE MANY OF THESISMS HAVE
CREATED OR INFLUENCED
DISCRIMINATION AT THE
INTERPERSONAL LEVEL.
AND WHAT WE ALL HAVE IN COMMON,
DISCRIMINATION BASED ON SEX,
RACE, SEXUAL ORIENTATION, FILL
IN THE BLANK, IS THAT
DISCRIMINATION REALLY CHALLENGES
A VICTIM'S SENSE OF BELONGING
AND ACCEPTANCE IN SOCIETY.
AND BEING JUDGED NEGATIVELY,
ESPECIALLY BASED ON
CHARACTERISTICS THAT YOU CANNOT
CHANGE, CAN LEAD TO FEELINGS OF
ISOLATION, SENSE OF
WORTHLESSNESS AND INADEQUACY.
THIS CAN ACTUALLY, OF COURSE,
DAMAGE ONE'S SELF-ESTEEM, AND
CAN ERODE A VICTIM'S
SELF-CONCEPT OF THEMSELVES.
THIS IS A PSYCHOLOGICAL SOCIAL
STRESSOR THAT ACTIVATES STRESS
PATHWAYS.
DAVID WILLIAMS REALLY WAS ABLE
TO SAY THAT THIS FORM OF
DISCRIMINATION OPERATE LIKE ANY
OTHER PSYCHOLOGICAL SOCIAL
STRESSOR, AND THEREFORE, YOU
COULD CATEGORIZE IT BASED ON
CHRONIC STRESS AND ACUTE STRESS.
IT'S A CONSTRUCT THAT TENDS TO
CAPTURE THE MORE INSISTENT FORMS
OF DISCRIM NA INTEREST
EXPERIENCE THAT TEND TO BE
SUBTLE IN NATURE.
BEING TREATED WITH LESS RESPECT
AND LESS CURRENCY.
WHEREAS MAJOR LIFETIME
DISCRIMINATION TENDS TO CAPTURE
MUCH MORAL ACUTE FORMS OF
DISCRIMINATORY -- THAT ARE
ANALOGOUS TO MAJOR -- OR BEING
INVOLVED IN A CAR ACCIDENT.
WHAT WE FOUND EARLY ON IN A
NATIONALLY REPRESENTATIVE STUDY
WAS THAT DISCRIMINATION WAS
ACTUALLY QUITE COMMON.
61% OF PARTICIPANTS REPORTED
EXPERIENCING ONE TYPE OF
EVERYDAY DISCRIMINATION.
34% OF PARTICIPANTS REPORTED
EXPERIENCING AT LEAST ONE TYPE
OF MAJOR DISCRIMINATION.
THIS IS NOT SURPRISING TO ANY OF
US TODAY, BUT THIS WAS PIVOTAL
WORK BACK IN 1999, THAT ALSO
SHOWED THAT THOSE WITH
MARGINALIZED IDENTITIES ARE MORE
LIKELY TO REPORT MORE -- THOSE
PRIVILEGED BY IDENTITIES.
ALSO, THOSE WHO REPORTED GREATER
MAJOR AND EVERYDAY
DISCRIMINATION WERE MORE LIKELY
TO HAVE HIGHER LEVELS OF
NONSPECIFIC PSYCHOLOGICAL
DISTRESS, AND MAJOR DEPRESSION.
THIS IS AFTER ADJUSTING FOR
SOCIOECONOMIC STATUS.
SINCE THEN, THERE HAS BEEN A LOT
OF WORK IN THIS AREA, SHOWING
THAT DISCRIMINATION IS
ASSOCIATED WITH A WIDE RANGE OF
DIFFERENT HEALTH OUTCOMES SUCH
AS PSYCHOLOGICAL DISTRESS,
NEGATIVE EMOTIONS AND NEGATIVE
AFFECTS.
-- ASSOCIATED WITH COGNITIVE
FUNCTION.
THERE HAS BEEN DECENT WORK IN
THE BEHAVIORAL PATHWAY REALM
SHOWING THAT DISCRIMINATION IS
ASSOCIATED WITH POOR SLEEP
QUALITY, SHORT SLEEP DURATION
AND EVEN THOSE WHO REPORT
DISCRIMINATION ARE MORE LIKELY
TO ENGAGE WITH COMPLEMENTARY AND
ALTERNATIVE MEDICINE.
I'M HERE TODAY TO TALK ABOUT
MORE OF THE BIOLOGICAL PROCESS,
YOU MAY ALSO FIND -- REALLY
GREAT WORK ALSO SHOWING THAT
DISCRIMINATION MAY ACTUALLY
OPERATE THROUGH CORTISOL AND THE
ACTIVATION OF THE APA ACCESS
WHERE PEOPLE HAVE MUCH MORE
FLATTER CORTISOL RHYTHMS.
FLOOND' ACTUALLY WHEN SHOWED
GREAT WORK SHOWING THAT
DISCRIMINATION IS ASSOCIATED
WITH WEIGHT GAIN AS WELL.
BULL IS INFLAMMATION A
BIOLOGICAL PROCESS THAT WE
SHOULD BE FOCUSING ON?
AND I SAY YES.
BEFORE I GO INTO THIS, I SHOULD
MENTION THAT WHAT DO WE MEAN BY
INFLAMMATION, POPULATION HEALTH,
YOU TEND TO SEE INFLAMMATION AS
SOMETHING NEGATIVE AND
ASSOCIATED WITH ADVERSE HEALTH
OUTCOMES.
BUT IT'S WORTH NOTING THAT
INFLAMMATION IS DESIGNED REALLY
TO PROTECT, AND IT WAS DESIGNED
TO FIGHT OFF PARASITES,
INFECTIONS, AND EVEN WOUNDS AND
OTHER FORMS OF DAMAGES.
SO THE CLASSIC INFLAMMATORY
RESPONSE IS TYPICALLY INDUCED BY
AN INFECTION, IT HAS A TIMELINE,
SHORT IN DURATION.
MONOCYTES TEND TO BE ACTIVATED,
A LOT OF THESE CHEMICAL
MEDIATORS TO REALLY ADDRESS THE
INFECTION OR THE 400 REGION THAT
MIGHT BE FLOATING IN YOUR GUT
STREAM.
SO THIS TENDS TO OPERATE FOR
OLDER ADULTS THE SAME WAY FOR
YOUNGER ADULTS, SO THERE'S NO
ASSOCIATION IN TERMS OF AN ACUTE
IINFLAMMATORY RESPONSE ASSOCIATD
WITH AGE.
BUT WE'RE REALLY NOT TALKING
ABOUT THE ONE ON THE RIGHT SIDE.
IT'S MUCH MORE SYSTEMIC --
INFLAMMATION.
THIS IS NOT NECESSARILY INDUCED
BY ANY FORM OF INFECTION.
IT TENDS TO BE LONG IN DURATION,
AND IT EXTENDS REALLY FOR A LONG
PERIOD OF TIME BUT ACTUALLY
CREATES COLLATERAL DAMAGE, WHERE
DAMAGING -- SO IT TENDS TO BE AT
THE POPULATION LEVEL ASSOCIATED
WITH AGE, THAT OLDER ADULT HAS
HIGH LEVELS OF CHRONIC
INFLAMMATION, IT'S AT A
SUBCLINICAL LEVEL.
IT'S THE -- BUT YET VERY, VERY
LOW.
SO WHILE T WHY THEN STUDY INFLAN
AND DISCRIMINATION?
WELL, FOR ONE, WE HAVE THESE
REALLY INTERESTING WHITE BLOOD
CELLS, MONOCYTES.
WE HAVE ABOUT FIVE TO 10 OF THEM
FLO10% OFTHEM FLOATING IN OUR
BLOODSTREAM.
THEY PLAY A REALLY INTERESTING
ROLE.
IF YOU ACTUALLY HAVE A FAVORITE
CELL, THIS IS ONE OF MY FAVORITE
CELLS, AND I THINK IT'S BECAUSE
IT TENDS TO BE QUITE RESPONSIVE.
THAT'S A VERY NERDY STATEMENT, I
RECOGNIZE.
INTENSITY, QUITE RESPOND SIEVE
TO WHERE WE BEHAVE, HOW WE
BASICALLY SEE THE WORLD AROUND
US.
THESE MONOCYTES ARE PLAYING A
REALLY INTERESTING ROLE.
THEY'RE -- AS ELLIOTT FRIEDMAN
WOULD SAY, YOU'RE FLOATING
AROUND THE TRUCK.
LET'S TRY TO DETECT A FOREIGN
AGENT.
AND IF THEY DO DETECT A FOREIGN
AGENT, THEY BASICALLY DUMP A LOT
OF THESE CHEMICAL MEDIATORS,
MANY OF US WOULD RECOGNIZE CRP
AND IL-6 AS SOME OF THESE
POTENTIAL MEDIATORS THAT TENDS
TO EVENTUALLY HEAL THAT WILL
PARTICULAR WOUND OR ATTACK THAT
INFECTION.
NOW, WHAT IS INTERESTING AS I
MENTIONED IS THAT THESE
MONOCYTES ARE QUITE SENSITIVE TO
HOW WE VIEW THE WORLD.
IN FACT, THEY ARE ACTIVATED BY
WHETHER WE ACTUALLY VIEW
SOMETHING IN THEIR ENVIRONMENT
AS QUITE THREATENING, WHETHER
IT'S PERCEIVED OR ACTUAL.
AND A BRAIN TENDS TO -- ON THE
PHYSIOLOGICAL BIOLOGICAL
SYSTEMS, PARTICULARLY THE -- AND
THE IMMUNE SYSTEM ACTIVATES
THESE MONOCYTES, BUT ONE OF THE
MORE INTERESTING THINGS AS WELL
ABOUT THESE MONOCYTES, NOT ONLY
DO THEY RELEASE THESE CHEMICAL
MEDIATORS LIKE DENDRITIC CELLS,
THEY ALSO TEND TO CONVERT
THEMSELVES INTO MICROPHAGES,
WHICH IS ACTUALLY PRETTY COOL.
ONE OF THE THINGS THAT'S
INFORMATION IS HOW WE VIEW THE
WORLD AROUND US AS WELL, GREAT
WORK OUT THERE SHOWING THAT HAVE
HIGH LEVELS OF INFLAMMATION TEND
TO VIEW -- WHEN THEY'RE EXPOSED
TO AN AK BIG WITH US EVENT, THEY
TEND TO VIEW THOSE AS QUITE
THREATENING.
SO THE OTHER REASON WHY I THINK
WE SHOULD LOOK INTO
INFLAMMATION, AS MENTIONED, YOU
BEGIN TO SEE OUR RATIO
DIFFERENCES REALLY EARLY ON IN
THE LIFE COURSE.
THIS IS WORK BY PB LAM, THAT
SHOWS IN THIS STUDY THAT BLACK
AMERICANS AS EARLY AS
ADOLESCENTS BEGIN TO EXHIBIT
HIGH LEVELS OF CHRONIC
INFLAMMATION COMPARED TO LIG WHE
AND ASIAN AMERICANS.
SO THESE TWO I GUESS FINDINGS
REALLY DROACH MY TEAM TO CONDUCT
A SYSTEMATIC REVIEW ON CURRENT
LITERATURE EX EXAMINING
INFLAMMATION.
I'VE GOT ABOUT 26 PAPERS THAT
EXAMINED THE ASSOCIATION BETWEEN
DISCRIMINATION AND INFLAMMATION.
WE FOUND COMPELLING EVIDENCE
THAT THERE IS AN ASSOCIATION
HERE.
ACTUALLY SOME OF THE GREAT WORK
BY TENE LEWIS SHOWED THAT THERE
IS BASICALLY A DOSE-RESPONSE
RELATIONSHIP BETWEEN EVERYDAY
INFLAMMATION AND C-REACTIVE
PROTEIN.
WORK BY ELLIOTT FREED PLAN
SHOWEFRIEDMAN SHOWEDTHAT SPECIFN
WHO REPORTED A MORE MAJOR
LIFETIME EXPOSURE TO
DISCRIMINATION HAD HIGH LEVELS
OF SERUM E E-SE ELECTIN.
SPECIFICALLY FOR THOSE REPORTING
DISCRIMINATION CONTEMPORANEOUSLY
BUT ALSO REPORTED EXPERIENCE OF
DISCRIMINATION IN EARLY LIFE AT
HIGHER LEVELS OF INFLAMMATION.
THIS WAS DIFFERENT THAN
INFLAMMATORY CYTOKINES.
I SHOULD MENTION THAT THE VAST
MAJORITY OF THE STUDY THAT FOUND
IN HIS REVIEW WERE
CROSS-SECTIONAL.
THERE'S NOW COMPELLING WORK
COMING OUT SHOWING THAT
DISCRIMINATION MAY ACTUALLY
PRECEDE INFLAMMATION.
WORK BY CHEN AND THAT -- SHOW
SPECIFICALLY FOR BLACK BOYS AND
BOYS OF COLOR, THOSE WHO
REPORTED DISCRIMINATION OVER
TIME HAD HIGHER LEVELS OF
INFLAMMATION OVER TIME.
NOW HERE'S WHAT WE KNOW THUS FAR
IN THIS LITERATURE IN
DISCRIMINATION FOR INFLAMMATION.
FOR ONE THE VAST MAJORITY OF THE
STUDIES WERE CROSS-SECTIONAL AND
THERE IS A POPULAR ASSOCIATION
BETWEEN DISCRIMINATION AND
INFLAMMATION FROM MOST OF THESE
STUDIES.
CRP AND IL-6 BASICALLY HAVE BEEN
THE PREDOMINANT OUTCOMES IN THIS
AREA OF DISCRIMINATION LIMITED
SUPPORTIVE EVIDENCE, I THINK
WHAT I FOUND MOST INTERESTING
FROM OUR REVIEW WAS THAT THERE'S
REAL STRONG SUPPORT FOR THE
VULNERABILITY HYPOTHESIS -- NO
SUPPORT, SUGGESTING THAT THE
EFFECT OF DISCRIMINATION ON
INFLAMMATION -- WE FOUND NO
EVIDENCE FOR THIS HYPOTHESIS.
I REALLY DO BELIEVE THERE NEEDS
TO BE A LIFE COURSE APPROACH IN
THIS AREA.
A LOT OF THE WORK IN THIS AREA
HAS MOSTLY FOCUSED ON MIDDLE AGE
AND OLDER ADULTS.
I SUSPECT FOR TWO REASONS.
ONE IS THAT AS I MENTIONED, THIS
TENDS TO BE ASSOCIATED WITH AGE,
TENDS TO SEE DISPARITIES MOSTLY
AROUND MIDDLE AGE AND OLD ARE
ADULTS, AND I THINK PEOPLE HAVE
DRAWN THEIR ATTENTION THERE.
I ALSO SUSPECT IT'S BECAUSE A
LOT OF PEOPLE USED A RETIREMENT
STUDY TO EXAMINE THOSE
QUESTIONS, BUT THAT DOES LEAVE
DIFFERENT LIFE COURSE STAGES
UNEXAMINED.
I REALLY BELIEVE, ESPECIALLY
KNOWING THAT CHILDREN THAT
REPORT DISCRIMINATION AS EARLY
AS 5 YEARS OLD, THAT WE SHOULD
BE GETTING -- WE SHOULD BEGIN
EXAMINING THESE QUESTIONS MUCH
EARLIER IN THE LIFE COURSE.
I DO BELIEVE THAT WE SHOULD BE
INCREASING GENERALIZABILITY.
MOST OF THE RESEARCH HAVE BEEN
FOCUSING ON BLACK, WHITE, ODD
DISPARITIES, BUT THERE ARE
ALSO -- I SHOULD MENTION THAT
EVEN THEN -- WE SHOULD BE
FOCUSING ON RACIAL DISPARITIES
WITHIN THE HISPANIC POPULATION.
WE ARE NOW NOTICING IN THE LAST
FEW YEARS THAT THE DIFFERENCES
AMONG AFRO LATINOS AND WHITE
LATINOS BEGINS TO MIRROR THAT OF
AMERICANS.
-- THAT MAKES MANY OF THESE
DIFFERENCES.
WE DON'T KNOW.
ALSO APPLYING AN INTERTEXTUAL
APPROACH EVEN THE CURRENT ERA
WE'RE IN IS IMPORTANT, GIVEN
THAT THERE'S MORE RECENT --
SHOWING THAT THE ASSOCIATION
BETWEEN INFLAMMATION AND
DISCRIMINATION IS MUCH -- FOR
BLACK WOMEN COMPARED TO BLACK
MEN AND HIGHER SES INDIVIDUALS.
THIS IS ALL FROM THE MID LIFE OF
THE UNITED STATES STUDY.
WHILE THERE ISN'T MUCH SUPPORT
FOR THE VULNERABILITY
HYPOTHESIS, THERE IS SUPPORT FOR
THE DIFFERENTIAL EXPOSURE
HYPOTHESIS.
THE HYPOTHESIS IS SUGGESTING
THAT FOR RACIALLY MINORITIZED
GROUPS, BECAUSE THEY'RE EXPOSED
TO DIFFERENT LEVELS OF
DISCRIMINATION, THAT WOULD BEGIN
TO EXPLAIN RACIAL DIFFERENCES IN
HEALTH OUTCOMES, AND IN FACT
WHAT WE DID FIND APPLYING A
BLINDER AND COMPOSITION METHOD
IS THAT LIFETIME DISCRIMINATION
EXPLAINED ABOUT 18% OF THE
RACIAL -- FOR SOCIOECONOMIC
STATUS.
I BELIEVE WE SHOULD MOVE BEYOND
CR3 AND IL-6 AT THIS POINT.
THERE ARE A WIDE RANGE OF
INFLAMMATORY CYTOKINE THAT HAVE
NOT BEEN EXAMINED, ESPECIALLY
ANTI-INFLAMMATORY CYTOKINES LIKE
IL10 AND IL11.
TUMOR NECROSIS FACTOR ALPHA,
THIS PAPER IS UNDER REVIEW, BUT
WE ACTUALLY FIND USING A LATENT
CONSTRUCT OF THIS DIT CRIM
NATION, THAT THE
COUNTERTERRORISM IS ASSOCIATED
WITH TNF ALPHA.
THIS WAS BASICALLY INSPIRED BY
DR. NORRIS, I WAS ACTUALLY
SURPRISED HE QUOTED ONE OF MY
FAVORITE PHILOSOPHERS, AND HE
HAS SAYING -- HE SAID THAT, IT
IS NO MEASURE OF HEALTH TO BE
WELL ADJUSTED IN A PROFOUNDLY
SICK SOCIETY.
AND IN FACT, WHAT WE FOCUS ON IS
INDIVIDUAL LEVELS OF
DISCRIMINATION, IT ONLY GETS --
ON -- A LOT OF THESE MEASURES
DON'T CAPTURE THE HISTORY,
POLICIES, IN THE SIX STEPS.
SO WE REALLY SHOULD BE FOCUSING
ON NOT JUST THE INTERPERSONAL
FORMS OF DISCRIMINATION BUT ALSO
THE NEIGHBORHOOD POLICY THAT
DRIVES POOR HEALTH, AND THIS IS
OBVIOUSLY WITHIN THE CONTEXT OF
INFLAMMATION.
SO I'M LEADING TO R01s RIGHT
NOW TO ANSWERING MANY OF THESE
QUESTIONS.
I'M LOOKING FOR A POSTDOC, SO IF
THERE ARE ANY WONDERFUL
CANDIDATES, HAVE THEM CONTACT
ME.
I WANT TO THANK SOME OF MY MANY
COLLABORATORS, AND THANK YOU
VERY, VERY MUCH.
[APPLAUSE]
>> THANK YOU VERY MUCH.
OUR FINAL SPEAKER OF THE DAY
WILL BE CARRINGTON MERRITT.
SHE WILL BE TALKING ABOUT
INFLAMMATORY MECHANISMS LINKING
DISCRIMINATION AND HEALTH.
>> HELLO, EVERYONE.
THANK YOU FOR BEARING WITH ME
THESE LAST 15 MINUTES, THEN WE
CAN KIND OF ENJOY THE REST OF
OUR EVENINGS.
LUCKILY DR. CUEVAS SET ME UP
WELL FOR THIS TO KIND OF CLOSE
OUT TODAY.
SO I'LL BE TALKING ABOUT
INFLAMMATORY MECHANISMS LINKING
DISCRIMINATION AND HEALTH.
I'M ACKNOWLEDGING I'M HERE TODAY
ON BEHALF OF MY ADVISER KEELY
MU.
SCATELL.
I ALONG WITH MANY OTHER GRADUATE
STUDENTS -- ARE INTERESTED IN
QUESTIONS OF HOW RACISM CAN
IMPACT HEALTH.
NA PARTICULAR, MANY OF US LOOK
AT THE BRAIN AND BODY MECHANISMS
THROUGH WHICH THIS HAPPENS.
SO THIS IS A RECENT REVIEW WE
WORKED ON TOGETHER SH WHERE WE
SORT OF WERE SUMMARIZING SOME OF
THE EC EXISTING WORK IN THIS AR,
SOME OF THE WORK THAT HAS BEEN
DONE BY SOME OF THE GREAT
SCHOLARS IN THE ROOM TODAY.
I WANT TO HIGHLIGHT THIS FIGURE
THAT COMES FROM THIS REVIEW,
SORT OF HELPS TO ILLUSTRATE HOW
WE ARE -- TO YOU TO SORT OF
ANSWER THESE QUESTIONS AND HOW
RACISM AND DISCRIMINATION
THROUGH BRAIN AND -- MECHANISMS.
SO WE LOOK AT THE DIFFERENT
LEVELS OF RACISM, AS WELL AS
LOOKING AT DIFFERENT BIOLOGICAL
OUTCOMES.
SO TODAY I'M GOING TO BE
SPEAKING TO YOU SPECIFICALLY
ABOUT INFLAMMATORY PROCESSES
OBVIOUSLY, BUT I'M SPECIFICALLY
GOING TO BE SHARING SOME
FINDINGS ON SOME WORK THAT WE
RECENTLY PUBLISHED -- AND HOW
THEY SORT OF IMPACT DOWNSTREAM
INFLAMMATION OR -- AND HOW THAT
IS RELATED TO PARTICULAR HEALTH
CONDITIONS, AS WELL AS
DISCUSSING THE POTENTIAL
PROTECTIVE FACTOR THAT MIGHT BE
RELEVANT IN THIS PARTICULAR
CONTEXT.
AND SO AS IT WAS VERY NICELY SET
UP, WE KNOW THAT THERE ARE A V
VA -- HELP THE RACIAL GROUPS
ESPECIALLY BETWEEN BLACK AND
WHITE AMERICANS, AND I WANT TO
THEORIZE THAT DISCRIMINATION
MIGHT BE CONTRIBUTING TO THOSE
DISPARITIES AND -- MECHANISM
THAT LINKS DISCRIMINATION AND
HEALTH OUTCOMES AMONG RACIALLY
MINORITIZED INDIVIDUALS.
AND WE HAVE LOTS OF EXISTING
EVIDENCE THAT IS SUGGESTING THAT
IS IN LINE WITH THAT IDEA,
GENERALLY -- SO WE HAVE CRITICAL
REVIEWS STATING THIS, AND EVEN
SOME OF THE GRADUATE STUDENTS IN
OUR LAB NOW, SO CURRENTLY UNDER
REVIEW, BUT ACROSS 112 --
EFFECTS LOOKING AT THE IMPACT OF
DISCRIMINATION AND INFLAMMATION,
THEY FOUND -- WHERE HIGHER
LEVELS OF DISCRIMINATION VERSUS
ENTIRE LEVELS OF INFLAMMATION.
SO WE KNOW THIS LINK BETWEEN
DISCRIMINATION IS CLEARLY FAIR,
AND THIS LINK IS IMPORTANT
BECAUSE IT IS -- INFLAMMATION IS
LOCATED IN A NUMBER OF CHRONIC
CONDITIONS.
IN THIS PARTICULAR STUDY, I'M
GOING TO FOCUS ON CARDIOVASCULAR
CONDITIONS BUT MANY OF YOU ARE
HERE AND INTERESTED IN THINGS
LIKE -- METABOLIC CONDITIONS.
AND DESPITE THE FACT THAT WE
HAVE THIS REALLY ESTABLISHED
DISCRIMINATION INFLAMMATION
LINK, THERE'S ACTUALLY LIMITED
WORK EMPIRICALLY
INVESTIGATING -- LINKING
EXPERIENCE WITH -- SPECIFIC
HEALTH CONDITIONS.
ET CETERA, WE HAVE A LOT OF
RESEARCH THAT SUGGESTS THAT
BLACK INDIVIDUALS AND PEOPLE
HAVE NUMEROUS OR NEGATIVE
IMPACTS OF DISCRIMINATION.
YET AT THE SAME TIME THERE'S
LESS WORK LACKING SPECIFICALLY
AT PROTECTIVE FACTORS, THAT SORT
OF RELATIONSHIP BETWEEN
DISCRIMINATION AND INFLAMMATION.
SO THAT'S WHAT I'M GOING TO BE
TALKING ABOUT TODAY.
HOWEVER, DR. -- HOPEFULLY THAT
MEANS I CAN KIND OF GO THROUGH
THE RESULTS A LITTLE MORE
QUICKLY.
BUT AGAIN SPECIFIC WITH THIS
STUDY WE WERE LOOKING AT WHETHER
INFLAMMATION MEDIATED THE
RELATIONSHIP BETWEEN
DISCRIMINATION AND
CARDIOVASCULAR HEALTH CONDITION,
AND WE'RE ALSO INTERESTED IN
LOOKING AT A PARTICULAR
EFFECTIVE FACTOR OF PERCEIVED
CONTROL -- AND CARDIOVASCULAR
HEALTH.
SO BEFORE I GET INTO THE
FINDINGS, I'M JUST GOING TO TAK
A LITTLE ABOUT WHAT -- REFERS TO
AN INDIVIDUAL'S PERCEPTION THAT
THEY CAN INFLUENCE WHAT HAPPENS
IN THEIR LIFE.
SO THE PARTICULAR MEASURE THAT
WE USED ASKED QUESTIONS TO
GATHER INDIVIDUAL' PERCEPTIONS
OF WHETHER THEY BELIEVE WHAT
THEY REALLY WANT TO DO
SOMETHING, THEY CANNOT USUALLY
FIND A WAY TO SUCCEED AT IT, SO
GETTING AT ASPECTS -- IT ALSO
ASKED QUESTIONS THAT BROUGHT OUT
PERCEPTIONS OF EXTERNAL BARRIERS
SO HOW MUCH TO THE EXTENT DO YOU
BELIEVE -- AND WE DECIDED TO
FOCUS ON PERCEIVED CONTROL FOR A
NUMBER OF REASONS.
FIRST THERE'S RESEARCH SHOWING
THAT IT HAS BEEN POSSIBLY
ASSOCIATED WITH OTHER
PHYSIOLOGICAL -- AS WELL AS
WE'RE SHOWING THE EFFECTS OF
CHRONIC STRESS HAVE BEEN BEEN
BUFFERED BUT CONTROL HAVE EARLY
EFFECTS OF -- LEVELS OF
PERCEIVED CONTROL.
AND THERE'S ALSO WORK SHOWING
THAT INTERVENTION, THAT TARGET
INCREASING PERCEPTIONS OF
CONTROL HAVE BEEN BENEFICIAL FOR
HEALTH MORE BROADLY, SO IT
SUGGESTS THAT PERCEPTIONS OF
CONTROL ARE SOMETHING THAT MIGHT
BE VALUABLE.
SO IT'S SORT OF -- THE STUDY
AIMS TO EXAMINE INFLAMMATION AS
A MECHANISM LINKING CHRIS CRIM
NATION AND CARDIOVASCULAR HEALTH
IN MIDDLE AGED BLACK AMERICANS
AND EMENTABLE INPERCEIVED
CONTROL AS A PROTECTIVE FACTOR
IN THE RELATIONSHIP OF
DISCRIMINATION AND INFLAMMATION,
AND FINALLY EXAMINING THE LINK
BETWEEN -- AND CARDIOVASCULAR
HEALTH INITIATIVE -- SO THIS
STUDY I'VE COME FROM THE NIDUS
STUDY, AGAIN A LOT OF RESEARCH
HAS ALREADY BEEN PUBLISHED
LOOKING AT DISCRIMINATION,
INFLAMMATION WITH THIS
PARTICULAR DATASET.
I HAVE SOME THOITS ON THAT TOO
I'LL SHARE TOWARDS THE END BUT
THIS STUDY IS COMING FROM THAT
DATABASE WHERE WE LOOKED AT
347 NON-HIS PAIRK OR LATIN F AND
OUR MEASURE AT PERCEIVED CONTROL
WITH ALSO A SELF-REPORT MEASURE.
AND FOR CARDIOVASCULAR HELP, WE
USED -- THEN FOR INFLAMMATION,
OUR PRIMARY ANALYSES FOCUSED ON
CRP AND IL-6 AGAIN BECAUSE
THAT'S WHERE THE WORK
INFLAMMATION HAS FOCUSED ON
THESE PARTICULAR MARKERS BUT WE
ALSO DID SOME EXPLORATORY -- I'M
JUST GOING TO PRESENT THE CRP
FOR SAKE OF TIME BUT HAPPY TO
DISCUSS THOSE OTHER MARKERS
DURING THE Q & A IF THERE'S
TIME.
SO FOR OUR FIRST RESULT WE DID
FIND A SIGNIFICANT MEDIATION OF
CRP LINKING DISCRIMINATION TO
CARDIOVASCULAR CONDITIONS.
AND THEN WHEN WE LOOKED TO SEE
WHETHER THERE WAS A MODERATION
HAPPENING BETWEEN DISCRIMINATION
AND LEVELS OF CRP, WE FOUND
PERCEIVED CONTROL DID MODERATE
THE EXROAL BETWEEN -- TO SHOW
HOW MODERATION IS OPERATING,
SO -- IF YOU CAN TELL THE COLOR
DIFFERENCE IS PEOPLE REPORTING
AVERAGE AND THEN THE BLACK LINE
IS TIME SO WHAT YOU CAN SEE IS
ACROSS ALL LEVELS THERE IS THIS
POSITIVE RELATIONSHIP BETWEEN
DISCRIMINATION AND INFLAMMATION,
WIBUT THAT RELATIONSHIP IS ONLY
SIGNIFICANT AMONG THOSE WHO
REPORTED LOW OR AVERAGE LEVEL OF
PERCEIVED CONTROL BUT IT IS NOT
SIGNIFICANT FOR THOSE REPORTING
HIGH LEVELS.
THEN FINALLY MEDIATION ANALYSIS,
AGAIN CRP WAS A SIGNIFICANT
MEDIATOR, BUT THIS WAS ONLY TRUE
FOR THOSE REPORTING LOW OR
AVERAGE LEVEL.
THE SAME AS WELL BECAUSE I JUST
SHARED.
SO WHAT DOES THIS ALL MEAN?
THIS OFFERS MORE EMPIRICAL
SUPPORT THAT INFLAMMATION CAN BE
A MECHANISM LINKING
DISCRIMINATION AND
CARDIOVASCULAR HEALTH.
SO AGAIN, THERE'S NOT -- I'M
GOING TO SORT OF ADD TO --
LITERATURE IN THIS AREA.
WE ALSO FOUND SUPPORT THAT
GREATER PERCEPTIONS OF CONTROL
MAY PROTECT AGAINST THE ILL
EFFECTS OF DISCRIMINATION.
THIS MIGHT BE USEFUL IN TERMS OF
LEVERAGING PERCEIVED CONTROL AS
A WAAS -- POINTED OUT EARLIER TE
INDIVIDUAL LEVEL INTERVENTIONS
OR SOLUTIONS ARE NEVER GOING TO
BE ENOUGH TO REALLY ADDRESS
THESE POPULATION-LEVEL NECK QUIT
WIDTHS, BUT OF COURSE THEY HAVE
THEIR FACE TOO, SO THERE'S
IMPORTIMPORTANT WORK TO BE DONE,
LOOKING AT THESE MORE SYSTEMIC
LEVELS THAT WE CAN ALSO BE
INTERVENING ON -- SPECIFIC
LIMITATIONS OF THE STUDY.
AGAIN THIS IS SECOND DRILL
ANALYSIS COMING FROM A PUBLICLY
AVAILABLE HAS UTILIZED THESE
LARGE SCALE DATABASES FOR A
PERFECT REASON.
THEY RIN CRED ARE INCREDIBLY VA,
BUT ANOTHER FINDING OF
META-ANALYSIS, THERE ARE
ACTUALLY ONLY 27 REPORTED UNIQUE
EFFECTS OF DISCRIMINATION AND
INFLAMMATION, SO AGAIN, WHILE WE
HAVE THESE -- RELYING ON THESE
PUBLICLY AVAILABLE DATASETS THAT
MIGHT SORT OF DISTORT OUR
IMPRESSIONS OF HOW MUCH IS
ACTUALLY OUT THERE.
SO THIS JUST SUGGESTS FOR NEW
AND VARIED COMPAQS FOR -- THIS
SAY 'NOTHER CORRELATIONAL OR --
THAT'S A SORT OF CAUSAL LINK
BETWEEN DISCRIMINATION AND
INCREASED INFLAMMATION, SO IT'S
RELATIVELY UNSUSTAINED, SO AGAIN
MORE WORK, WE REALLY GETS AT
THAT REAL CAUSAL ASSOCIATION.
SOME OF THAT WORK CAN COME
FROM -- MORE LONGITUDAL
SETTINGS, BUT I ACTUALLY WANT TO
TALK ABOUT OUR LAB IS ALSO
TRYING TO LOOK AT THIS FROM AN
EXPERIMENTAL STIRMT.
THAT ACTUALLY GETS US THE LINK
BETWEEN DISCRIMINATION AND
INFLAMMATION.
SO AGAIN THIS IS AN AREA FOR
FUTURE RESEARCH.
I'M GOING TO TALK ABOUT WHAT
WE'RE TRYING TO DO THAT KIND OF
RESEARCH IN OUR LAB RIGHT NOW.
BUT I ALSO WANT TO ACKNOWLEDGE
THAT JUST THE IDEA OF TRYING TO
CREATE SORT OF LAB MANIPULATED
EXPERIENCES OF DISCRIMINATION,
THAT PRIORITIZE THE WELL-BEING
OF OUR RESEARCH PARTICIPANTS
WHILE ALSO BE VALID IS A
CHALLENGE AND ONE THAT SHOULD
NOT BE TAKEN LIGHTLY, AND SO WE
RECOGNIZE THAT THIS CAN BE A
CHALLENGING METHODOLOGICAL AREA
FOR THIS PARTICULAR RESEARCH, SO
ONE PARTICULAR TENTH THAT WE
HAVE MADE WITH OTHER RESEARCH
THAT IS BEING -- THAT JUST SINCE
RECENTLY BEEN COLLECTED IN OUR
LAB IS A PARTICULAR LAB
MANIPULATION OF A DISCRIMINATION
RELATED STRESS WITH FIVE YOUNG
BLACK ADULTS WHERE WE USED A
MODIFICATION OF A TIERED SOCIAL
STRESS TEST.
SO IN OUR LAB, WE ARE TRAINING
TO BE SOCIAL PSYCHOLOGISTS SO WE
OFTEN LOOK TO PSYCHOLOGICAL KNOW
THODZ IN TERMS OF HOW WE
ACTUALLY TRY TO TEST SOME OF
THESE THREE RED CAL IDEAS WE'RE
INTERESTED IN TESTING OUT.
IT A WELL VALIDATED LABORATORY
STRESSOR WHERE INDIVIDUALS
COMPLETE THIS SORT OF ON THE GO
10-MINUTE SPEECH IN FRONT OF A
PANEL OF INTERVIEWERS, AND THE
INTERVIEWERS ARE SUPPOSED TO BE
STOIC, NONRESPONSIVE, SO IT'S A
VERY AVERSIVE EXPERIENCE FOR
THOSE GOING THROUGH IT.
BUT YEAH, SO IN THE STUDY, WE
WERE SPECIFICALLY -- WAS ONE WAY
TO KIND OF GET AT AN EXPERIENCE
OF DISCRIMINATION.
SO BASICALLY WE'RE ASKING --
RELATIVE TO SAME RACE.
PARTICULARLY WE WERE INTERESTED
IN WHETHER INDIVIDUALS'
PERCEPTION OF DISCRIMINATION
DURING THAT SOCIAL EVALUATION
WOULD BE PREDICTIVE.
SO I'M GOING TO WALK THERE YOU
METHODS OF WHAT WE DID WITH THE
STUDY.
BEFORE WE CAME INTO THE LAB, WE
DID GET MEASURES OF EVERY
DISCRIMINATION, RACIAL AND
ETHNICITY, OTHER TYPES OF
DIFFERENCES, AND SO THEN THEY
CAME TO THE LAB WHERE THEY WERE
RANDOMIZED IN FRONT OF A PANEL
OF TWO BLACK EVALUATORS OR TWO
WHITE EVALUATORS.
AGAIN ALL HAD AT LEAST ONE
FEMALE PRESENTING PARTICIPANT
AND ONE -- I'M SORRY, ONE MALE
PRESENTING EVALUATOR, ONE FEMALE
PRESENTING.
AND SO WHILE WE LOOKED AT BOTH
AUTONOMIC AND EFFECTIVE
REACTIVITY, WHAT WE ARE MOST
INTERESTED AGAIN OF SORT OF
WHETHER OR NOT WE SAW
DIFFERENCES IN TERMS OF
INFLAMMATORY REACTIVITY, SO WE
COLLECTED BLOOD SAMPLES
POTASSBOTHBEFORE AND 60 MINUTESS
SOCIAL STRESS TASK SO WE'LL BE
REALLY RECENTLY FINISH
COLLECTING DATA FOR THIS.
I DON'T HAVE ANY DATA TO PRESENT
WITH YOU GUYS TODAY
UNFORTUNATELY.
BUT I WANTED TO KIND OF GIVE A
SAMPLING OF A POTENTIAL METHOD.
WE ARE ALSO INTERESTED IN GOING
BEYOND INFLAMMATORY MARKERS
LOOKING AT WHETHER THE TYPE OF
STRESS CAN BE -- INFLUENCE OTHER
ASPECTS OF IMMUNE FUNCTIONING SO
WE CAN USE SORT OF A NOVEL
ACTIVATION OF SOMETHING CALLED A
HISTAMINE SCRATCH TEST, SO
ESSENTIALLY WE APPLY A SMALL
AMOUNT OF HISTAMINE TO THE
PERSON'S SKIN, EVERYONE -- KNOWS
PEOPLE ARE GOING TO SHOW SOME
SORT OF RESPONSE TO IT, SO THIS
WILL OFFER US A METRIC OF HOW
ROBUST OF AN IMMUNE RESPONSE
PEOPLE MIGHT BE SHOWING, BOTH
BEFORE AND AFTER THE STRESS
MANIPULATION SO WE'RE INTERESTED
IN SEEING WHAT THIS PARTICULAR
STRESSOR, PARTICULARLY THOSE WHO
ARE SORT OF ENDORSING PERCEIVING
DISCRIMINATION, HOW THAT AFFECTS
A SORT OF IMMUNE RESPONSE THERE
IN ADDITION TO LEVELS OF
INFLAMMATION.
SO AGAIN, I DON'T HAVE ANY
SPECIFIC DATA TO SHOW YOU.
I DID WANT TO HIGHLIGHT, SO
AFTER THE STUDY COMPLETED, WE
DID A PRETTY EXTENSIVE
DEBRIEFING PROCESS WITH ALL OF
OUR PARTICIPANTS.
PARTICULARLY BECAUSE ONE, WE
WERE RECOGNIZING THAT WE WERE
SORT OF LIKE STILL TRYING TO
UNDERSTAND WHAT WOULD BE THE
BEST WAY OF GOING ABOUT DOING
RESEARCH OF THIS NATURE, SO WE
WANT TO GET PERSPECTIVES AS TO
WHETHER THIS WAS AN EXPERIENCE
THAT MAPPED OUT TO THE
EXPERIENCE THEY MIGHT HAVE IN
THE REAL WORLD IN TERMS OF
EXPERIENCING DISCRIMINATION OR
RACISM AND STRESS, AS WELL AS
THEIR THOUGHTS ON HOW THESE
TYPES OF TASKS WILL BE APPROVED.
SO I WANTED TO SHOW THESE QUOTES
TO HIGHLIGHT THAT WHILE WE DON'T
HAVE A QUANTITY OF DATA TO SPEAK
TO WHETHER PARTICIPANTS PERCE
PERCEIVED THE CROSS RANK
EVALUATION -- WHAT WE ARE SEEING
IS THAT PEOPLE ARE DEFINITELY
ENDORSING THINGS THAT SORT OF TO
ME FEEL LIKE ON THE THEME OF
SORT OF THIS RACISM-RELATED
VIGILANCE OR JUST BEING MORE VEG
LAMOREVIGILANT WITH WHITE INDIV,
SO I WANTED TO HIGHLIGHT
SOMETHING THAT MORE WORK WILL
CERTAINLY BE COMING FROM THIS.
BUT WE'RE VERY INTERESTED TO SEE
KIND OF HOW THESE PERCEPTIONS
ARE SORT OF MAPPING ON TO THEIR
ACTUAL INFLAMMATORY REACTIVITY.
SO THANK YOU TO DR. MUSCATELL
AND THE CHAIR CAROLINA LAB.
YOU CAN CHECK OUT THE FULL
MANUSCRIPT THERE.
>> ALL RIGHT.
SO WE ARE OPEN FOR QUESTIONS.
I HAVE A QUESTION FROM THE ZOOM
FIRST.
IS THERE ANY EVIDENCE FOR
SUBGROUP DIFFERENCES IN LEVEL OF
SERUM INFLAMMATORY MARKERS, WITH
SOME GROUPS MORE OR LESS LIKELY
TO HAVE INFLAMMATORY SYMPTOMS
BUT NORMAL SYMPTOMS OF
INFLAMMATORY MARKERS?
>> I THINK THAT'S A ME QUESTION.
I DON'T KNOW.
THE BEST KNOWLEDGE I HAVE OF
THAT IS MORE AT THE POPULATION
LEVEL, AND THERE WE ACTUALLY DO
NOT FIND MUCH OF AN EVIDENCE
PERTAINING TO THAT.
BUT MAYBE BASED ON MORE OF LIKE
AT THE EXPERIMENTAL DESIGN, THEY
MIGHT BE -- THERE MIGHT BE SOME
SUBTLE DIFFERENCES THERE.
>> SO THERE ARE CERTAINLY SOME
MARKERS THAT TEND TO -- THAT WE
TEND TO SEE MORE SIGNIFICANT
EFFECTS FOR IN RESPONSE TO SORT
OF ACUTE MANIPULATIONS OF STRESS
RELATIVE TO MORE CHRONIC STRESS.
SO FOR EXAMPLE, THERE'S META
EVIDENCE SORT OF SHOWING THAT
IL-6 IS A PARTICULARLY
RESPONSIVE TO ACUTE STRESS OF
SOMETHING LIKE THE STRESS TASK,
WE DO SEE ROBUST INCREASES IN
IL-6 BUT NOT SO MUCH THE SORT OF
THINGS LIKE CRP OR IF ASSOCIATED
WITH MORE CHRONIC FORMS OF
STRESS OR MORE CHRONIC
DISCRIMINATION.
>> AND THE SECOND QUESTION, I
THINK THIS ONE IS FOR YOU,
CARRINGTON.
HOW DOES ONE TAKE THIS
INFORMATION, IMPLEMENT IT IN
REAL LIFE FOR THOSE WITH
LOWER -- CONTROL -- ESPECIALLY
IF THEY ARE FROM A MARGINALIZED
GROUP WHERE THEY MIGHT ACTUALLY
HAVE THE CONTROL?
>> YES.
THIS IS A GREAT QUESTION.
AS SOMEBODY WHO'S ALSO TRAINING
AS A CLINICAL PSYCHOLOGIST AND
INTERESTED IN HOW PSYCHOLOGICAL
OR PSYCHOTHERAPY INTERVENTIONS
CAN ALSO BE LEVERAGED TO HELP
WITH ADDRESSING EXPERIENCES OF
DISCRIMINATION, I DEFINITELY
THINK THAT, YOU KNOW, IT'S TRUE
THAT WE ARE ABLE TO JUST KIND OF
ALLOW -- IF WE WERE MAGICALLY
ABLE TO HAVE PEOPLE BE MORE
RESOURCED AND HAVE MORE ACCESS
TO RESOURCES, THAT CERTAINLY
WOULD BE A SIGNIFICANT
IMPROVEMENT IN THE LIVES OF MANY
PEOPLE, AND IT TRUE THAT, YOU
KNOW, PERCEIVED CONTROL IS
DEFINITELY ASSOCIATED WITH
ASPECTS OF SOCIOECONOMIC STATUS,
LIKE EDUCATION AND INCOME, BUT
THERE'S ALSO WORK SHOWING THAT
THERE IS STILL A VARIATION OF
PER ACCEPTINGS OF CONTROL EVEN
PERCEPTIONS OF CONTROL EVEN AT
THE LOWER SOCIOECONOMIC STATUS
END OF THE POLE, SO THAT
SUGGESTS THAT THAT IS SOMETHING
THAT CAN STILL BE SORT OF
INTERVENED UPON EVEN FOR PEOPLE
WHO ARE LOWER RESOURCED.
AND SO AGAIN, I THINK THAT PART
OF BEING ABLE TO INTERVENE ON
THAT MEANS THAT, YOU KNOW, THERE
JUST NEEDS TO BE MORE EFFORTS
AND RESOURCES FOR THOSE WHO ARE
DOING THAT KIND OF WORK OR FOR
THOSE WHO ARE IN THOSE POSITIONS
TO ACCESS THOSE KINDS OF
INTERVENTIONS, WHETHER IT IS
PSYCHOLOGICAL OR HOW DO WE MAKE
THOSE MORE AVAILABLE, I THINK
THAT'S A QUESTION THAT STILL
NEEDS WORK BUT I THINK THAT'S
CERTAINLY SOMETHING THAT CAN BE
LEVERAGED IN THOSE CONTEXTS
WHERE BEING ABLE TO ACTUALLY
INCREASE PHYSICAL RESOURCES IS
NOT AN OPTION.
>> I'D LIKE TO ADD TO THAT.
OF COURSE WE'RE ALL TALKING
ABOUT POLICY CHANGES, SO IF WE
CAN IMPLEMENT POLICY THAT WOULD
BE THE IDEAL SITUATION, BUT I
KNOW THAT'S GOING TO HAPPEN IN
MY LIFETIME, I DON'T KNOW IF
IT'S GOING TO HAPPEN IN MY KIDS'
LIFETIME.
BUT WHAT WE CAN DO IS I THINK,
YOU KNOW, LIKE YOU MENTIONED,
GIVE THEM SMALL THINGS SO THEY
FEEL MORE CONTROL, SO WHETHER
IT'S LIFESTYLE -- I THINK,
DR. NORRIS, YOU MENTIONED
WHETHER IT'S LIFESTYLE, WHETHER
IT'S DIET, WHETHER IT'S PHYSICAL
ACTIVITY, EVEN SOCIAL
CONNECTEDNESS, FEELING CONNECTED
TO PEOPLE CAN BUFFER AGAINST
NEGATIVE EFFECTS, FEELING THAT
YOU HAVE -- SOMEBODY HAS YOUR
BACK, YOU KNOW, SO IF THINGS DO
GO DOWN, THERE ARE THINGS THAT
YOU CAN DO.
I THINK ABOUT THIS, WE TALKED
ABOUT VITAMIN C, WE USED TO TALK
ABOUT VITAMIN C AS BEING LIKE
THAT, THAT PREEIVETS YOU FROM
GETTING SICK.
WE'RE SEEING THAT DISCRIMINATION
DOES MAKE US SICK.
WE'RE SEEING THAT.
SO MAYBE SOMETHING RELATED TO
THAT THAT AT LEAST HELPS US COPE
IN THE MOMENT.
WHILE HOPEFULLY THE POLICY STUFF
IS HAPPENING.
>> I'M JUST GOING TO ADD TO THAT
FOR JUST A SECOND BEFORE I TAKE
THE NEXT QUESTION, AND I JUST
WANTED TO FIND OUT IN TERMS OF
SOME LEVELS OF CONTROL, IT MADE
ME THINK BACK TO THE PANEL WE
HAD THIS MORNING WITH OUR
PATIENT ADVOCATES, THE
ADVOCATES -- COMMUNITY
ADVOCATES, I THINK HAVING
SOMEBODY LIKE BOBBY HOWARD TO
TALK TO YOU AND GIVE YOU SOME
GUIDANCE AND GIVE YOU A LITTLE
BIT OF A SENSE OF CONTROL, SO
HAVING ADVOCATES AT THAT LEVEL,
I THINK WOULD BE VERY HELPFUL.
YES, QUESTION IN THE BACK.
>> THANK YOU FOR THE
PRESENTATIONS.
SO DR. GUPTA, I WAS WONDERING
FROM THE EARLIER SLIDES IN YOUR
PRESENTATION, IS THERE SOMETHING
ABOUT PERCEIVING RACE AS A BASIS
OF DISCRIMINATION THAT LEADS TO
WORSE OUTCOMES, LIKE WORSE
INFLAMMATION, AND HEARING WHAT
WAS REPRESENTED TODAY, I'M
WONDERING IF IT COULD BE RELATED
TO PERCEPTION OF CONTROL OR
VIGILANCE.
>> WE CAN SPECULATE ON THAT.
I THI DIDN'T DIRECTLY MEASURE T.
I DID A VERY DANGEROUS THING
THAT I USUALLY DON'T LIKE TO DO,
WHEN WE STRATIFY BY RACE AND
ETHNICITY, WE'RE KIND OF
ATTRIBUTING THAT IT'S A RACE
BASED OR ETHNICITY BASED VERSUS
WHAT'S REALLY GOING ON.
BUT LIKE WE CAN SEE, EVERY
GROUP, EVERY RACIAL AND ETHNIC
GROUP ENDORSE DISCRIMINATION BUT
IT'S DIFFERENT FOR DIFFERENT
PEOPLE.
SO IF WE KIND OF COGNITIVELY
THINK ABOUT IT, YOU KNOW, BLACKS
AND HISPANICS HAVE BEEN
EXPERIENCING DISCRIMINATION FOR
GENERATIONS.
SO IT'S NOT ONLY BEING -- THE
BIOLOGICAL EFFECTS ARE NOT ONLY
BEING TRANSFERRED FROM
GENERATION TO GENERATION, BUT
WHEN YOU THINK ABOUT IT, YOU
EXPERIENCE DISCRIMINATION,
YOU'RE GOING TO BE LIKE, OKAY,
HERE WE GO AGAIN.
SO IT'S KIND OF ALMOST THAT,
LIKE, ALL RIGHT, I KIND OF
EXPECTED THAT, WHEREAS SOMEBODY
WHO EXPERIENCES DISCRIMINATION
WHICH MIGHT BE A NOVEL
EXPERIENCE, LIKE OH, MY GOD, WHY
IS THIS HAPPENING TO ME?
SO WE KIND OF SEE THAT BASED
UPON WHAT THEY ATTRIBUTE THE
DISCRIMINATION TO COULD BE
RELATED TO THOSE DIFFERENCES IN
THE BRAIN SIGNATURES AND IN THE
MICRO BAY ONLY AND THE
METABOLITES, WHICH ARE MORE
EXCUSE SCEUD TOWARDS
INFLAMMATION IN THE BLACK AND
HISPANICS VERSUS THE OTHER
GROUPS.
>> THANK YOU.
>> DR. NORRIS?
>> THANKS VERY MUCH FOR A GREAT
PANEL AND SORT OF WINDING UP THE
DAY FOR US.
I HAD A QUESTION.
SITTING HERE THINKING ABOUT --
DATASETS, I DON'T KNOW ABOUT --
I WAS JUST THINKING -- SO LOOK
AT THE RELATIONSHIP BETWEEN
DISCRIMINATION AND DIFFERENT
INFLAMMATORY MARKERS AND
MEDIATORS, OTHER YO SUBSTANCE, T
CETERA.
ONE -- DISCRIMINATION CAN COME
THIS ONGOING COGNITIVE PROCESS,
INTO THE EVENING, POOR SLEEP,
AND SO DO THOSE DATASETS HAVE
ANY MEASURES OF SLEEP QUALITY
OR -- I KNOW SOME OF THEM DO AND
DO YOU KNOW IF ANYBODY HAS USED
THOSE AS PART OF COVARIATES IN
MODELING?
>> WHY THIS DOES -- JACKSON
HEART STUDY, THEY DO, AND I
THINK THAT DOES PROVIDE -- THAT
DOES PROVIDE GREAT OPPORTUNITY
JUST TO LOOK AT POTENTIAL
MECHANISMS HERE, BECAUSE
ACTUALLY THIS ACTUALLY GOES BACK
TO AN EARLIER DISCUSSION HAD
WITH DR. JETER ABOUT HOW DOES
DISCRIMINATION OPERATE, THAT
IT'S NOT JUST A PSYCHOLOGICAL
SOCIAL EVENT THAT JUST HAPPENS
AT ONE TIME POINT.
THERE IS A LEVEL OF RUMINATION
THAT OCCURS THAT DOES LEAD TO
PEOPLE HAVING POOR SLEEP.
THAT DOES LEAD TO PEOPLE THEN
HAVING SOME LEVEL OF VIGILANCE.
THAT DOES CONTRIBUTE TO A WIDE
RANGE OF DIFFERENT BEHAVIORAL
RESPONSES THAT ARE CONNECTED TO
INFLAMMATION.
I THINK MOST OF THE MODELS, JUST
KIND OF LIKE LOOKING THROUGH THE
REVIEW ON
DISCRIMINATION/INFLAMMATION,
PEOPLE HAVE ADJUSTED FOR THE
TRADITIONAL COVARIATES, YOU
KNOW, AGE, GENDER,
SOCIOECONOMIC.
I MEAN, BMI IS ONE OF THE
BIGGEST -- ONCE YOU ADJUST FOR
BMI, IT SOMETIMES ATTENUATES THE
RELATIONSHIP BETWEEN
DISCRIMINATION AND INFLAMMATION,
BUT MANY OF THESE BEHAVIORAL
RESPONSES, PARTICULARLY SLEEP,
HAVE NOT BEEN EXPLORED AS
EXTENSIVELY AS THEY SHOULD.
>> SO I'M MOSTLY HERE TO THANK
THE PANEL AND GIVE THEM ONE MORE
ROUND OF APPLAUSE.
[APPLAUSE]
AND WELCOME DR. GERMINO TO THE
STAGE.
-- LOOKING AT DISPARITIES AND
SLEEP AND DISCRIMINATION AND
SOME OF THE SOCIAL TRIGGERS OF
THAT.
>> WHAT CAME UP EARLIER, I JUST
WANT TO EMPHASIZE THE IMPORTANCE
OF HAVING COMMUNITY MEMBERS AS
PART OF OUR RESEARCH TEAM.
IF YOU DON'T HAVE COMMUNITY
MEMBERS ON YOUR RESEARCH TEAM,
YOU'RE MISSING AN IMPORTANT
COMPONENT OF THE INTELLECTUAL
INPUT THAT YOU NEED ON YOUR
TEAM.
WE HAVE TWO TERMS WE USE FOR OUR
COMMUNITY PARTNERS.
ONE IS PH.D. TO THE -- AND THE
OTHER IS CALLED BONUS POINTS FOR
WMD.
WHO KNOW WHAT IS THAT MEANS?
A WHAT MATTERS DEGREE.
SO MAKE SURE WHEN YOU -- SO MAKE
SURE YOU GET COMMUNITY PARTNERS
TO BE ON YOUR TEAM AS WELL.
>> THANKS, KEITH.
IT'S AN IMPORTANT PART THAT I'LL
TOUCH ON IN A SECOND.
BUT -- HE HAD HIS TALK SHORT.
I'M STANDING BETWEEN YOU AND THE
DOOR SO I'M GOING TO KEEP THIS
REALLY, REALLY -- THEY DID ASK
ME TO MAKE A FEW WORDS JUST TO
EMPHASIZE, AGAIN, RE-EMPHASIZE
JUST HOW IMPORTANT THIS WORK IS
TO OUR MISSION.
AS MANY OF YOU MAY HAVE HEARD,
NIDDK HAS WITHIN ITS MISSION
SOME OF THE MOST COMMON --
DISEASES THAT IMPACT THE
AMERICAN POPULATION, IN FACT
LOCALLY THESE DAYS, AND WE KNOW
MANY OF THESE DISPROPORTIONATELY
AFFECT MARGINALIZED MINORITIZED
COMMUNITIES, PEOPLE WITH
RACIAL/ETHNIC BACKGROUNDS.
THIS IS WHAT WE'VE BEEN TALKING
ABOUT ALL DAY, SO THIS IS
OBVIOUSLY AN IMPORTANT PROBLEM.
JUST LAST WEEK FIRST HAPPENED, I
WAS OUT IN PHOENIX MEETING WITH
SOME LEADERS WHERE WE HAVE A --
OVER THE YEARS LOOKING AT
DIABETES RISK, AND I WAS MEETING
WITH ONE OF THE TRIBAL LEADERS
THERE AND THEY WERE TELLING ME
THAT THE AVERAGE LIFE EXPECTANCY
IN THEIR COMMUNITY IS 46.
THAT'S -- IT REALLY IS JUST,
AGAIN, STRIKING DISPARITIES.
AND SO IN 2021, WHEN WE WERE
DEVELOPING OUR STRATEGIC PLAN,
OUR FIRST NIDDK STRATEGIC WIDE
PROGRAM IN ALMOST 20 YEARS, WHAT
IS IMPORTANT IN OUR REACHING OUR
EE MENTION, COULD CLEARLY
DEFINING PATHWAYS, WE WILL NOT
BE SUCCESSFUL IN OUR MISSION
UNTIL WE SEUK SEED IN -- AS BEST
AS WE CAN FOR EVERYBODY.
AND THIS IS WHAT LED TO OUR
EFFORT THAT THE CO-CHAIR OUT IN
THE AUDIENCE AS WELL, WHERE IT
WAS, AGAIN, A TWO-YEAR EFFORT.
SOME OF YOU PARTICIPATED IN THIS
PROCESS THAT WAS AS YOU HEARD
THIS MORNING, TO SEE HOW WE CAN
IMPLEMENT OUR PLAN, DEVELOP A
PLAN, IMPLEMENT A PLAN TO
ACHIEVE HEALTH EQUITY FOR ALL,
AND THIS IS WHAT HIS WORKSHOP IS
AN IMPORTANT ELEMENT IN.
I WANT TO JUST MAKE A COUPLE OF
POINTS ABOUT THAT PLAN.
ONE IS IF YOU HAVEN'T READ IT, I
ENCOURAGE YOU TO GO TO OUR
WEBSITE AND READ IT.
IT HAS A COUPLE IMPORTANT
ASPECTS TO IT.
BESIDES HAVING FIVE
RECOMMENDATIONS THAT WE PURSUE
AS AN INSTITUTE.
ONE OF THE IMPORTANT THINGS THAT
IT HAS A GUIDING PRINCIPLES
DOCUMENT AS WELL AS A TIPS FOR
PEOPLE WHO ARE NEW TO THE FIELD
TO THINK ABOUT HOW THEY SHOULD
ENGAGE IN THE RESEARCH IN A
RESPECTFUL AND MEANINGFUL WAY.
I THINK THE OTHER IMPORTANT
POINT I WANT TO EMPHASIZE ABOUT
THAT PLAN IS SOMETHING THAT
DR. MORRIS JUST MENTIONED WHICH
IS THE IMPORTANCE OF COMMUNITY.
WE HAD A WORKING GROUP, JUST
OF -- AND OUR STEERING
COMMITTEE.
THEY WERE AS -- EVERY OTHER
SCHOLAR THAT PARTICIPATED IN OUR
WORK, AND THE PLAN REFLECTS
THEIR INPUT IMPORTANTLY.
SO WE NEED TO BE SURE THAT WE
HAVE THE COMMUNITY AS WE GO
FORWARD, AS WE HAVE TODAY.
AS YOU HEARD, WE KNOW THAT MANY
OF THE CONTRIBUTORS TO THE
DISPARITIES WE SEE IN HEALTH ARE
RELATED TO STRUCTURAL FACTORS
LIKE STRUCTURAL RACISM AND
DIFFERENT SOCIAL DETERMINANTS OF
HEALTH, AND THE IMPORTANT THING
IS THAT THESE EXTERNAL FACTORS
ALL WEIGH IN ULTIMATELY ON
BIOLOGICAL PATHWAYS OF HEALTH.
THIS IS HOW WE GET SICK.
THIS IS WHAT OUR PATHWAYS ARE.
SO WE NEED TO BE ABLE TO CONNECT
AND UNDERSTAND THE RELATIONSHIP
BETWEEN ALL OF THAT ENVIRONMENT
AROUND US AND HOW TO TURN THAT
INTO ILLNESS OR HOW WE TURN THAT
INTO WELLNESS.
AND AS DR. NORRIS KICKED US OFF
THIS MORNING WITH HIS TALK, WE
REALLY NEED TO BE ABLE TO TACKLE
THE PROBLEM ON BOTH SIDES.
WE'VE HEARD ABOUT THE STRUCTURAL
AND POLICY THINGS WE NEED TO DO.
HOPEFULLY IT WON'T BE TOO
GENERATIONS BEFORE WE MAKE
PROGRESS IN THAT SPACE.
BUT WE NEED IN THE MEANTIME
STILL TO FIND SOLUTIONS FOR THE
PEOPLE WHO ARE SUFFERING TODAY
AND THE PEOPLE WHO MAY BE
SUFFERING TOMORROW.
THIS BRINGS ME TO WHAT WAS ONE
OF OUR STRENGTHS HISTORICALLY AS
NIDDK, WE HAVE BEEN FOCUSED FOR
DECADES ON MECHANISMS OF
DISEASE, BIOLOGICAL PATHWAYS.
THIS HAS REALLY BEEN OUR
STRENGTH FOR A LONG TIME.
WE ALSO KNOW WE'VE HAD A SMALLER
FOOTPRINT IN THE SOCIAL AND
BEHAVIORAL RESEARCH COMMUNITIES.
THIS IS SOMETHING THAT WE NEED
TO DO TO LEVERAGE -- WE WANT TO
BE ABLE TO LEVEL OUR INSTRIN
SICK STRENGTH AS AN INSTITUTE
THAT'S BEEN FOCUSED ON --
DISEASE WITH NOW THIS BROADER
PERSPECTIVE.
WHICH IS WHY WE HAD THIS
WORKSHOP, TO BRING DIFFERENT
COMMUNITIES TOGETHER SO WE CAN
ACTUACTUALLY -- TO TACKLE THIS
REALLY DIFFICULT AND COMPLICATED
PROBLEM.
A COUPLE IMPORTANT NOTES ABOUT
THAT, WE ALSO WANT TO BE SURE WE
RECOGNIZE THE IMPORTANT WORK
DONE BY THE PIONEERS INCLUDING
SOME OF YOU WHO ARE -- WHO'S
BEEN DOING IT, IT OFTEN WAS EVEN
IN FACT DISPARAGED BY OUTSIDE
INVESTIGATORS.
SO I WANT TO BE SURE THAT WE'RE
MINDFUL OF THE PRECEDENCE, THE
IMPORTANT PROGRESS OF OTHERS,
AND MAKE SURE THAT WE LEVERAGE
THEIR EXPERTISE AS WE GO
FORWARD.
I WANT TO THANK TODAY'S
SPEAKERS.
FANTASTIC, REALLY
THOUGHT-PROVOKING, VERY PRO V
PROVOCATIVE.
ENCOURAGING FOR TWO REASONS.
ONE, IT IDENTIFIES THE MANY
OPPORTUNITIES WE CAN COME IN AND
INTERSECT AND HOPEFULLY MAKE AN
EFFECT, AND TWO, IT DOES ALL
THE -- SOME OF THE STORIES HAVE
SUGGESTED -- SOME OF THE
PRESENTATIONS SUGGESTED THERE
MAY BE ELEMENTS OF REVERSIBILITY
AND PREVENTABILITY, AND SO AGAIN
I SEE THAT AS THE ENCOURAGING
ASPECT OF ALL OF THIS.
I WANT TO QUICKLY THANK OUR
COMMUNITY SPEAKERS FROM TODAY.
AGAIN AS I MENTIONED, THAT IS AN
IMPORTANT PART OF OUR -- OF OUR
SCIENCE, AN IMPORTANT WAY OF
SOLVING THE PROBLEMS, AND AGAIN,
I THINK AS WE KNOW, THE
ALTERNATE REASON FOR DOING ALL
OF THIS IS SO WE CAN MAKE SURE
WE HAVE PATHWAYS -- STORIES WERE
SOBERING BUT EMPOWERING AND
UPLIFT, RESILIENCE AND
WILLINGNESS TO WORK WITH US AS A
RESEARCH COMMUNITY TO IMPROVE
THE LIVES NOT ONLY OF THEMSELVES
BUT IMPORTANTLY OF OTHERS AROUND
US AND OUR COMMUNITIES.
I WANT TO REMIND YOU AGAIN
TOMORROW, WE HAVE A PACKED
AGENDA, LOTS OF IMPORTANT WORK
TO DO, CONTINUE ON TODAY'S
DISCUSSIONS.
AND LASTLY, I JUST WANT TO THANK
THE MANY INTERNAL AND EXTERNAL
CONTRIBUTORS TO TODAY'S WORKSHOP
AND TOMORROW'S WORKSHOP, WHO
HAVE REALLY PUT TOGETHER THIS
INCREDIBLE SET OF PRESENTATIONS
AND THOUGHTFUL QUESTIONS, AND
AGAIN I WANT TO THANK OUR SISTER
INSTITUTES, CENTERS AND OFFICES,
FOR THEIR SUPPORT.
WITH THAT, AGAIN THANK YOU VERY
MUCH, THANK YOU TO THE
PARTICIPANTS LISTENING HERE
ONLINE OR IN THE WORLD, YOUR
INPUT IS IMPORTANTS A WELL. 8389 05:59:05,724 SO HAVE A GOOD EVENING.