MY NAME IS DR. KELLY TENHAG ABOUTN CHAIR OF THE NIH WOMEN SCIENTIST ADVISORY COMMITTEE. I WOULD LIKE TO WELCOME EVERYONE TO THE ANNUAL ANITA ROBERTS LECTURE SPONSORED BY THE WSA AND HONORS THE LIFE AND CAREER OF ANITA ROBERTS. I WOULD especially like to welcome Dr. Roberts and members of anika Roberts family. THIS LECTURE IS DR. MICHELE EVANS OF THE NATIONAL INSTITUTE ON AGING. THIS LECTURE IS ONE OF THE ANNUAL WSA ACTIVITIES DESIGNED TO PROMOTE WOMEN IN SIGN HIGHLIGHTING THE LEGACY OF OUTSTANDING WOMAN SCIENTIST AND THE AMAZING ACCOMPLISHMENTS OF OUR CURRENT WOMEN SCIENTISTS. SO WITH THAT I WOULD LIKE TO SAY A FEW WORDS ABOUT ANITA ROBERTS. SHE WAS BORN IN PITTSBURGH, PENNSYLVANIA, SHE ATTENDED OVERLAND COLLEGE, EARNED HER DOCTORATE IN BIOCHEMISTRY FROM THE UNIVERSITY OF WISCONSIN IN P 1968. HER POST-DOCTORAL RESEARCH WAS DONE AT HARVARD. AND THEN SHE JOINED THE NIH IN 1976. SHE SPENT 30 YEARS AT THE NATIONAL CANCER INSTITUTE AND BECAME THE CHIEF OF THE LABORATORY OF CELL REGULATION AND CARCINOGENOSIS IN 1995. SHE WAS WELL KNOWN FOR HER PIONEERING WORK ON TRANSFORMING GROWTH FACTOR BETA. AND ITS ROLE IN WOUND HEALING, CARCINOGENOSIS AND AUTOIMMUNE DISEASE. HER PUBLISHED WORK HAS BEEN INCLUDED AMONG TOP 50 MOST CITED RESEARCH PAPERS, AND SHE'S BEEN THE THIRD MOST CITED WOMAN FEMALE SCIENTIST IN THE WORLD. DR. ROBERTS WAS RECIPIENT OF MANY AWARDS AND HONORS INCLUDING THE FASEB EXCELLENCE AWARD FOR DISTINGUISHED SCIENCE. DR. ROBERTS WAS NOT ONLY A HIGHLY ACCOMPLISHED AND RENOWNED SCIENTIST, BUT ALSO AN OUTSTANDING MENTOR AND COLLEAGUE. SHE PROVIDED A WONDERFUL EXAMPLE OF HOW TO INTEGRATE FAMILY AND WORK LIFE AND WAS UNFAILINGLY HELPFUL ENTHUSIASTIC AND SUPPORTIVE. I DIDN'T KNOW DR. ROBERTS PERSONALLY, BUT EVERY YEAR WHEN I SEND OUT ANNOUNCEMENTS FOR THIS LECTURE I RECEIVE EMAILS FROM PEOPLE WHO DID KNOW HER TELLING ME WHAT AMAZING SCIENTIST SHE WAS, WHAT A TREMENDOUS COLLEAGUE AND FRIEND SHE WAS AND HOW MUCH THEY MISS HERE HER. THAT'S WHY WE HONOR HER TODAY. SO I WOULD LIKE TO THANK THE PEOPLE WHO HELP WITH THIS LECTURE TOGETHER, DEE ANDREW, INTRAMURAL PROGRAM SPECIALIST WHO ORGANIZES ALL THE WSA ACTIVITIES WHO COULDN'T HAVE DONE THIS WITHOUT HER. DR. LO SENIOR INVESTIGATOR FROM NICHD WHO IS COORDINATED THIS LECTURE, OUR FORMER FELLOWCOM REPS, JIM BRAG NEAR AND SARA YOUNG. OUR CURRENT REPS AND AGNES KARISEC. FROM OUR CIT PRODUCTION TEAM, FELICE HARPER, JOY JACKSON FARRAR AND JEROME BATTLE AND NIKKI SWAN WHO HELPED WITH THE SLIDES AND POSTERS. I WOULD JUST LIKE TO REMIND YOU ALL TO USE THE LIVE FEEDBACK BUTTON BELOW THE SCREEN TO ENTER QUESTIONS. WITH THAT, I'M GOING TO TURN IT OVER TO OURCOM REMEMBER DR. TO INTRODUCE THIS YEAR'S SPEAKER, DR. MICHELE EVANS. >> GOOD AFTERNOON, EVERYONE. IT IS MY GREAT PLEASURE TO INTRODUCE OUR SPEAKER TODAY DR. MICHELE EVANS, SENIOR INVESTIGATOR AND CHIEF OF THE HEALTH DISPARITIES RESEARCH SECTION OF THE LABORATORY OF EPIDEMIOLOGY AND POPULATION SCIENCE AT THE NATIONAL INSTITUTE ON AGING KNOWN AS NIA. DR. EVANS AN INTERNIST AND MEDICAL ONCOLOGIST RECEIVED AN UNDERGRADUATE DEGREE FROM BARNARD COLLEGE COLUMBIA UNIVERSITY AND MEDICAL DEGREE FROM RUTGERS THE STATE UNIVERSITY OF NEW JERSEY ROBERT WOOD JOHNSON MEDICAL SCHOOL. SHE RECEIVED HER POST GRAD TRAINING IN INTERNAL MEDICINE EMORY UNIVERSITY SCHOOL OF MEDICINE AND A FELLOWSHIP TRAINING IN MEDICAL ONCOLOGY WITHIN THE MEDICINE BRANCH OF CLINICAL ONCOLOGY PROGRAM AT NATIONAL CANCER INSTITUTE. DR. EVANS JOINED NIA IN 1992 AS SENIOR CLINICAL INVESTIGATOR IN THE LABORATORY OF MOLECULAR GENETICS, AND NOW SERVES AS DEPUTY SCIENTIFIC DIRECTOR AT NIA AS WELL AS TRAINING DIRECTOR FOR THE NIA INTRAMURAL RESEARCH PROGRAM. TRAINED AS A PHYSICIAN SCIENTIST DR. EVANS AND HER TEAM CONDUCT INTERDISCIPLINARY CLINICAL AND BASIC RESEARCH -- SCIENCE RESEARCH TO FOCUSED ON EXAMINING THE CAUSE OF DISPROPORTIONATE INCIDENCE MORBIDITY MORTALITY OF AGE RELATED DISEASE AMONG MINORITIES LOW SOCIOECONOMIC STATUS AMERICANS. HEALTH DISPARITIES RESEARCH IS A DISCIPLINE THAT REQUIRES INTERDISCIPLINARY INVESTIGATIONS THAT CRITICALLY EXPLORE PSYCHOSOCIAL AND ENVIRONMENTAL BEHAVIORAL AND BIOLOGICAL FACTORS TO UNRAVEL THE CAUSES AND PROVIDES TARGETS OR FRAMES FOR INTERVENTIONS THAT LEAD TO ELIMINATION OF DIFFERENTIAL HEALTH BURDENS AND LIFE EXPECTANCY. THE DIFFERENTIAL COVID-19 PANDEMIC MORBIDITY AND MORTALITY STATISTICS AMONG MINORITY POPULATIONS REQUIRES US ALL TO EXAMINE HOW TO EQUITABLY EXTEND BENEFITS OF NIH MISSION TO ENHANCE HEALTH, LENGTH IN LIFE AND REDUCE ILLNESS AND DISABILITY TO ALL POPULATIONS. DR. EVANS WORK HAS TAKEN NIH MISSION TO THE NEIGHBORHOODS OF BALTIMORE TO EXAMINE THE BIOLOGIC TRANSDUCTION PATHWAYS WHICH SOCIAL DETERMINANTS OF HEALTH LEAD TO POOR HEALTH OUTCOMES. AT THE FOREFRONT IS INVESTIGATION OF THE TRANSDUCTION MECHANISMS THAT TRANSFORM SOCIAL DETERMINANTS OF HEALTH IN TO DISEASE AND IDENTIFICATION OF THE PIVOTAL INTERSECTIONS OR SOCIAL BIOLOGIC FACTORS REACT TO DRIVE DISPARITIES. DR. EVANS HAS EXTENSIVE PUBLICATION RECORD AND HAS RECEIVED MANY AWARDS INCLUDING THE NIH DIRECTORS AWARD, THE CHAMPION DIVERSITY AWARD AND UNITED STATES PUBLIC COMMENDATION LEVEL FOR HER TIME IN PUBLIC HEALTH SERVICE AS COMMISSIONED OFFICER. RECEIVE SHE SERVES ON EDITORIAL BOARD OF NEW ENGLAND JOURNAL OF MEDICINE AND SECTION HEAD COMMUNITY OUTREACH FOR THE ONCOLOGISTS. LIKE DR. ROBERTS DR. EVANS IS A DEDICATED TO MENTORING AND FOSTERING THE NEXT GENERATION OF SCIENTISTS. THIS IS CLEAR IN THE FEEDBACK WE RECEIVED FROM HER FELLOWS WHO SHARED. DURING MY TIME IN HER LAB IT WAS EVIDENT TO ME HOW MUCH DR. EVANS WANTS HER TRAINEES TO SUCCEED. ANOTHER SET WHEN I JOINED HER LAB SHE WAS SO SUPPORTIVE THAT I CAN LEARN NEW AREAS OF RESEARCH AND TIME AND THOUGH IT'S BEEN TWO YEARS SINCE I LEFT SHE'S HELPING ME AS A COLLABORATOR. SHE'S'S GENEROUS KIND AND COMMITTED. ANOTHER SET I HAVE ALWAYS KNOWN DR. EVANS TO BE SUPPORTIVE OF EXPLORING DIVERSE CAREER PATHS. I HAVE SEEN WORK WITH TRAINEE INDIVIDUALLY IN OUR LAB EMPHASIZING CAREER DEVELOPMENT PLANS FOR ALL OF HER NIH TRAINEES SO THERE IS A CLEAR CUT AHEAD HOW TO DEVELOP THE SKILLS NEEDED TO LAND A CAREER AFTER LEAVING NIH. THE EMPHASIZED HOW DR. EVANS PRIORITIZES MENTORSHIP TO MAKE HERSELF AVAILABLE TO TRAINEES TO HELP THEM AND THAT DR. EVANS CONTINUES TO BE IMMENSELY SUPPORTIVE OF THEIR SCIENTIFIC JOURNEYS AFTER THEY LEAVE THE LAB. ON LEADING BY EXAMPLE I ADMIRE DR. EVANS DEDICATION SUPPORTING TRAINEES IN EVERY ASPECT OF DEVELOPMENT. SHE SUPPORTED ME IN MY RESEARCH MY DESIRE TO FIND TEACHING EXPERIENCE, HELPING ME NETWORK AROUND AREA WHEN I WAS JOB HUNTING, AND PERHAPS MOST IMPORTANTLY, HELP MEG BECOME THE INDEPENDENT SCIENTIST THAT I AM. ANOTHER SET I ALWAYS ADMIRE HER DISCIPLINE PASSION AND COMMITMENT TOWARD THE RESEARCH AND THE LAB MEMBERS. SHE HAS BEEN A SOUNDING BOARD FOR MY SUCCESS AND STRUGGLES IN LAB AND AT HOME WITH A DAUGHTER. SHE HELPED ME PURSUE MY PASSION FOR TEACHING AND WRITING, GUIDING ME AND OTHERS TO HELP DISCOVER CAREERS AND NEVER ONCE TRIED TO -- SHE HAS SOMEONE WHO IS EXPERIENCED SO MUCH I RELY ON HER ENPUT WHEN DECIDING WHETHER TO TRY DIFFERENT EXPERIMENTAL APPROACH OR CHANGE CAREERS. LASTLY DR. EVANS HAS BEEN A FANTASTIC MENTOR ROLE MODEL AND SUPPORTER IN ALL THE YEARS I HAVE KNOWN HER. THIS EXAMPLES HELP HIGHLIGHT HOW DR. EVANS DEEM PLI PHIS THE SAME QUALITIES THAT MAKE DR. ANITA ROBERTS A BELOVED SCIENTIST AND MENTOR. IT IS OUR PLEASURE TO HONOR AND WELCOME DR. MICHELE EVANS TODAY TO PRESENT THE 2021 ANITA ROBERTS LECTURE. >> THANK YOU. VERY MUCH. GOOD AFTERNOON. I WOULD LIKE TO THANK THE WSA FOR SELECTING ME FOR THIS ENORMOUS ON NOR. I WOULD LIKE TO THANK FOR THE LOVELY INTRODUCTION AS WELL AS KELLY AND PIN LO AND MEMBERS OF THE WSA EXECUTIVE COMMITTEE FOR THE HARD WORK IN PREPARING FOR THIS EVENT. AS AN INAUGURAL MEMBER OF SWA BACK IN 1993 I AM DOUBLY HONORED TO PRESENT THIS YEAR'S LECTURE. THIS IS A WONDERFUL OPPORTUNITY FOR ME TO PAY TRIBUTE AND TO CELEBRATE THE LIFE OF DR. ANITA ROBERTS. ALTHOUGH WE NEVER MET, I WAS VERY AWARE OF HER IMPACT AND THE WAY SHE CONDUCTED HER SCIENCE. I HAVE READ HER WORK, BUT I HAVE ALSO READ ABOUT HER LIFE FROM SEVERAL SOURCES ESPECIALLY THOSE WHO WERE CLOSE TO HER AND WORKED IN HER LABORATORY. DR. WAKEFIELD WHO WORKED FOR DR. ROBERTS FOR MORE THAN 20 YEARS, REPORTED THAT SHE WAS WARM ENTHUSIASTICALLY AND CONSISTENTLY UPBEAT AS A SUPERVISOR WHO NOT ONLY FIGURED HOW TO BALANCE WORK AND FAMILY FOR HERSELF, BUT ALSO FOR HER COLLEAGUES. SHE SAID THAT DR. ROBERTS KEPT THE 17 PEOPLE IN HER LABORATORY HAPPY THROUGH THE FORCE OF HER PERSONALITY AND THAT SHE NEVER LOST SIGHT OF THE PERSONAL COMPONENT IN ALL OF THIS. THAT WORK IS DONE BY PEOPLE. AND IT NEEDS TO BE DONE IN A COOPERATIVE FASHION. SO FOLLOWING DR. ROBERTS TRADITION, I WOULD LIKE TO START TODAY'S TALK BY ACKNOWLEDGING THE INTELLECTUAL ENGINES THAT REV UP OUR RESEARCH BOTH INTRAMURAL AND EXTRAMURAL. WE HAVE BEEN FORTUNATE TO WORK WITH THE WIDE VARIETY OF TALENTED POST DOCS, AND STAFF SCIENTISTS AND CLINICIANS. TODAY I ONLY HAVE TIME TO TALK ABOUT A CERTAIN PERCENTAGE OF THE WORK OF COURSE BUT WOULD LIKE TO HIGHLIGHT CHARLES WHO STARTED WORKING WHEN THEY WERE THIRD YEAR RESIDENTS IN INTERNAL MEDICINE. I WILL ALSO TALK ABOUT WORK BY DOUG, WHEN HE WAS ON THE TENURE TRACK AT MORGAN STATE UNIVERSITY. I WILL ALSO SPEAK ABOUT THE WORK IN DISCRIMINATION DONE WITH DANIELLE MOODY WHO USED OUR PROJECTS IN DISCRIMINATION AS PART OF HER TENURE PACKAGE AT UNBC. I WON'T HAVE TIME TO SPEAK ABOUT THE WORK OF OTHER POST DOCS WHO HAVE GONE ON TO DEVELOP THEIR OWN INDEPENDENT CAREERS. DOUG WAS A VERY PIVOTAL POINT IN OUR DEVELOPING OUR ONGOING RESEARCH COLLABORATION WITH MORGAN STATE AND WE HAVE GOT A Ph.D. OUT OF THIS, NICOLE ARNOLD WHOSE WORK I WILL TALK ABOUT, RECEIVED HER Ph.D. JUST LAST YEAR. AND THAT OF COURSE IS THE HOME TEAM. THE BROAD VARIETY OF HANDLE STAFF WHO COVER EVERYTHING FROM LOGISTICS MANAGEMENT TO DATABASE DATABASES. THEY ARE REPRESENTATIVE OF THE COMPLEX OF AMERICA AND ALSO HAVE DEDICATED THEMSELVES TO WORKING THROUGH THE PANDEMIC. I COULD NOT HAVE ANY SUCCESS IF IT WEREN'T FOR THREE VERY STRONG AND FEARFUL WOMEN, THE BIG THREE IN THE HANDLE STUDY. MY STAFF SCIENTIST, DR. LORN, JENNIFER NORVAC, A SOCIAL WORKER BY TRAINING BUT IS OUR CLINICAL STUDY MANAGER AND LOOKS AFTER MANY SOCIAL WORK NEEDS OF OUR COHORT AND THEN THERE'S DR. (INDISCERNIBLE) WHO IS HANDLE STAFF CLINICIAN WHO LOOKS AFTER ALL THE OTHER NEEDS OF OUR PARTICIPANTS. I WILL ALSO TOUCH ON WORK BY OUR STAFF SCIENCE P E DEEMOLOGIST WHO WORKED ON THE RENAL AND DISCRIMINATION WORK IN THE STUDY. THEN HERE IS OUR NEXT GENERATION POST BACKS AND SUMMER STUDENTS WHO WORKED IN OUR LABORATORY GOT A GROUNDING IN HEALTH DISPARITIES RESEARCH AND ARE NOW MOVING ON IN THEIR OWN CAREERS IN M.D. Ph.D. PROGRAMS AND Ph.D. PROGRAMS IN DIFFERENT AREAS BUT ALL WHO WOULD LIKE TO INCLUDE HEALTH DISPARITIES AS PART OF THEIR FUTURE RESERGE AGENDA. RESEARCH AGENDA. NIH'S MISSION IS TO SEEK FUNDAMENTAL KNOWLEDGE ABOUT NATURE AND BEHAVIOR OF LIVING SYSTEMS AND APPLICATION OF THAT KNOWLEDGE TO ENHANCE HEALTH, LENGTH IN LIFE AND REDUCE ILLNESS AND DISABILITY. WHEN I CAME TO NIH AS A MEDICAL ONCOLOGY FELLOW IN NCI, WHEN I HAD THE OPPORTUNITY TO GO TO THE LAB I WENT GLEEFULLY AS I INTERPRETED MY ROLE IN THE NIH MISSION IS TO CONDUCT CANCER RELATED BASIC RESEARCH. WHEN I JOINED THE LABORATORY OF MOLECULAR PHARMACOLOGY AND WORKED WITH THE CANCER INSTITUTE I FOCUSED ON GENE SPECIFIC REPAIR OR WHAT IS NOW KNOWN AS TRANSCRIPTION COUPLED REPAIR AND ENDEAVORED TO EXAMINE THAT IN CANCER CELLS AS WELL AS IN DISEASES ASSOCIATED WITH CANCER, DNA DAMAGE HYPERSENSITIVITY, AND DEFECTS IN DNA REPAIR. INCLUDING XERODERM PIGMENTOSA, FANCONI ANEMIA AND AGING RELATED SYNDROMES. WHEN I MOVED ON TO THE TENURE TRACK, IN THE AGING INSTITUTE, I CONTINUED TO DO DNA REPAIR RELATED WORK, THIS TIME FOCUSING ON OXIDATIVELY INDUCED LESIONS BUT STILL WORKING WITH WITHIN THE FRAMEWORK OF BREAST CANCER AS WELL AS PROSTATE CANCER. HOWEVER, AS A DAUGHTER OF THE SOUTH BRONX WHO LIVED AND WORKED THERE BEFORE COMING TO NIH I HAD AN INDELIBLE RECOLLECTION OF THE BROKEN PROMISES, THE FALSE PROMISES THAT NEVER MATERIALIZED TO AMELIORATE POOR HEALTH. AS I CAME TO WORK EVERY DAY IN BALTIMORE, THE SCENE WAS VERY MUCH THE SAME AS I HAD EXPERIENCED AS A CHILD 30 YEARS EARLIER. AS YOGI BERRA SAID IT WAS LIKE CAN DEJA VU ALL OVER AGAIN. I KNEW I HAD TO BECOME A PHYSICIAN TO IMPROVE HEALTH IN COMMUNITIES LIKE THIS SO I REDIRECT DIRECTIONED MY RESEARCH TO KEEP THAT PROMISE. -- REDIRECTED MY RESEARCH TO KEEP THAT PROMISE. AND DEVELOPED IN COLLABORATION WITH ALLEN ZONDERMAN THE HEALTHY AGING AND NEIGHBORHOODS OF DIVERSITY ACROSS THE LIFE SPAN STUDY. HANDLES IS AN INTERDISCIPLINARY COMMUNITY BASED LONGITUDINAL EPIDEMIOLOGIC STUDY THAT EXAMINES THE INTERACTION OF RACE AND SOCIOECONOMIC STATUS ON THE DEVELOPMENT OF AGE ASSOCIATED HEALTH DISPARITIES, AMONG SOCIOECONOMICICALLY DIVERSE COHORT OF AFRICAN AMERICANS AND WHITES WHO RESIDE IN THE CITY OF BALTIMORE. WE SET OUT TO UNDERSTAND OR TRY TO DICES ENTANGLE RACE FROM SES, TO UNDERSTAND HOW THEY WORKED INDEPENDENTLY OR CONTEXTUALLY TO EXAMINE HOW THEY INFLUENCE RATES OF AGING, FUNCTIONAL DECLINE AND WHAT WERE POSSIBLE BIOLOGIC MECHANISMS OR BIOMARKERS OF HEALTH DISPARITIES. HANDLES IS AN AREA PROBABILITY SAMPLE OF THE CITY OF BALTIMORE, BASED ON THE 2000 CENSUS. OUR SURVEY STATISTICIAN USING THE DATA FROM THE 2000 CENSUS IDENTIFIED 13 CENSUS SEGMENTS THROUGHOUT BALT MORE THAT YIELD A REPRESENTATIVE DISTRIBUTION OF THE ENTIRE CITY IN BALTIMORE AND YIELDS SUFFICIENT INDIVIDUALS TO FILL OUR SAMPLING FRAME. WHITES AND AFRICAN AMERICANS BETWEEN AGE 30 AND 64 AT BASELINE WHO WERE ABOVE AND BELOW THE 125% PUBLIC DEFENDER'S 125% POVE RTY LINE. THE GOAL WAS TO RECRUIT BETWEEN 3 AND 4,000 INDIVIDUALS AS A FIXED COHORT WE WOULD STUDY FOR MORE THAN 20 YEARS. WE WOULD VISIT THEM FOR DATA COLLECTION EVERY THREE TO FIVE YEARS. TO ACCOMPLISH THIS WE DESIGNED MOBILE MEDICAL RESEARCH VEHICLES TO SEARCH AS COMMUNITY BASED RESEARCH PLATFORMS. WE WERE SUCCESSFUL RECRUITING A BASELINE COHORT OF OVER 3700 INDIVIDUALS AND ARE CURRENTLY IN WAVE 5 OF THE STUDY THOUGH INTERRUPTED BY THE PANDEMIC. WE CONSIDERED THE SOCIAL DETERMINANTS OF HEALTH AS AGENTS OR TOXIC AGENTS ACTUALLY. THAT WORKED THROUGH BIOLOGIC TRANSDUCTION PATHWAYS TO LEAD TO THE DEVELOPMENT OF THE ACCELERATED AGING PHENOTYPE THAT HAS BEEN ASSOCIATED WITH HEALTH DISPARITIES AS WELL AS PRE-MATURE MORTALITY. THESE BIOLOGIC TRANSDUCTION PATHWAYS CAN INCLUDE A MYRIAD OF PATHWAYS INCLUDING THOSE RELATED TO GENETICS, INFLAMMATION, OXIDATIVE DNA DAMAGE, EPIGENOMICS. GENE EXPRESSION AS WELL AS IMMUNE FACTORS. WE STUDY RACE IN CONTEXT OF STUDY BUT AS A SOCIAL CONSTRUCT. RACE IS A SOCIAL CATEGORY THAT IS FORGED HISTORICALLY. GENETIC DIFFERENCES WITHIN RACIAL ARE GREATER THAN THOSE BETWEEN RACIAL GROUPS. SO RACE IS NOT A BIOLOGIC OR A GENETIC CONSTRUCT RACE SHAPES YOU IN EXPERIENCES AN CONFERS SOCIAL PRIVILEGE, SOCIETIES USE RACE TO ESTABLISH AND JUSTIFY SYSTEMS OF POWER PRIVILEGE, DISENFRANCHISEMENT AND AT TIMES OPPRESSION. FOR US RACE IS MEANINGFUL FOR HEALTH AS A RISK FACTOR FOR POOR OUTCOMES IN THE CONTEXT OF SOCIAL STATUS ACCESS TO RESOURCES AS WELL AS ANCESTRY. WHAT ARE THE OUTCOMES WHEN THESE SOCIAL DETERMINANTS OF HEALTH ILLUSTRATED HERE IN THE MLS GRAPHIC? WHAT HAPPENS WHEN THEY GET UNDER THE SKIN? INCOME INEQUALITY AND POVERTY, IN BALTIMORE, BALTIMORE HAS THE HIGHEST POVERTY RATE IN THE STATE OF MARYLAND. AND WE ARE FAIRLY RICH STATE BUT THE POVERTY RATE IN BALTIMORE IS 22.9% OVERALL BATIKS HIGHER FOR AFRICAN AMERICANS BEING SOMEWHERE BUT IT TICKS HIGHER, 25 TO 26%, THIS REMAINED RELATIVELY STABLE OVER THE LAST 20 YEARS OR SO. SO WE DECIDED TO LOOK AT POVERTY IN THE CONTEXT OF A DISEASE ASSOCIATED WITH HEALTH DISPARITIES. AS YOU KNOW, AFRICAN AMERICANS ARE MORE LIKELY TO DEVELOP RENAL DISEASE, AND ALTHOUGH AFRICAN AMERICANS MAKE UP ONLY 13% OF THE POPULATION, THEY MAKE UP 35% OF THOSE WITH END STAGE RENAL DISEASE. PREVIOUS WORK HAS SHOWN LOW SES AND AFRICAN AMERICAN RACE ARE INDEPENDENTLY ASSOCIATED WITH CHRONIC KIDNEY DISEASE. SO WE AT THE BASELINE OF HANDLS LOOK AT THE PRESENCE OF CKD DEFINED AS AN ESTIMATED FILTRATION RATE OF LESS THAN 60. WE FOUND THAT RACE WAS NOT SIGNIFICANTLY ASSOCIATED WITH CKD. ALTHOUGH AFRICAN AMERICANS WERE MORE LIKELY TO HAVE ADVANCED CKD. IT WASN'T UNTIL WE DID THE UNIVARIANT ANALYSIS OF PREVALENCE BY SES THAT WE FOUND WHAT OTHERS HAVE FOUND, IS THAT THERE WAS A GREATER PREVALENCE OF CKD IN THOSE WHO HAVE LOW SES, AND WHEN WE DID THE RACIAL STRATIFICATION WE SAW THAT LOW SES WAS ASSOCIATED WITH A GREATER PREVALENCE OF CKD IN AFRICAN AMERICANS BUT NOT WHITES. SUGGESTING THAT POVERTY IS A PARTICULARLY VIR RENT RISK CO-FACTOR FOR CKD IN AFRICAN AMERICANS. DISPARITIES IN BRAIN HEALTH ARE INCREASING AS THE U.S. POPULATION AGES. AMONG 65 OR OLDER, AFRICAN AMERICANS HAVE HIGHEST PREVALENCE OF ALZHEIMER'S DISEASE AND RELATED DEMENTIAS, FOLLOWED CLOSELY BY HISPANIC AMERICANS. WE WANTED TO EXAMINE THE RELATIONSHIP BETWEEN RACE AND SES TO MRI ASSESSED GLOBAL BRAIN VOLUMES. WE ALSO WANTED TO CA EXAMINE IN CONTEXT OF WHITE MATTER LESION BONE BECAUSE THESE ARE PREDICTORS OF FOUR BRAIN OUTCOMES, AND WE THOUGHT THIS WAS AN IMPORTANT RISK FACTOR TO UNDERSTAND IN THE CONTEXT OF SES. WE FOUND THAT THERE WERE SIGNIFICANT INTERACTIONS OF RACE AND SES, FOR TOTAL BRAIN, BRAIN MATTER VOLUME, AS WELL AS WHITE MATTER LESION VOLUME. WHITE PARTICIPANTS WITH GREATER SES HAD GREATER TOTAL BRAIN VOLUME, GREATER WHITE MATTER VOLUME, AS WELL AS GRAY MATTER VOLUME. THESE HAVE BEEN NORMAL RANGE. AFRICAN AMERICAN PARTICIPANTS WHO HAVE LOW SES EXHIBITED A GREATER VOLUME OF WHITE MATTER LESION VOLUME COMPARED TO WHITE INDIVIDUAL WHOSE ARE ALSO LIVING IN LOW SES COMMUNITIES. THESE FINDINGS MAY REFLECT ENVIRONMENTAL AS WELL AS INTERPERSONAL STRESSORS ENCOUNTERED BY AFRICAN AMERICANS AND THOSE LIVING IN POVERTY. AND COULD RELATE TO THE DISPROPORTIONATE RATES OF STROKE DEMENTIA, MAYBE OVERALL MORTALITY IN THESE PORTIONS OF THE AMERICAN POPULATION. WE WERE INTERESTED TO EXAMINE WHETHER THESE DISPARITIES IN VOLUME WERE FOUND IN OTHER PARTS OF THE BRAIN. WE WERE PARTICULARLY INTERESTED IN UNDERSTANDING THE ROLE OF STRESS AND EMOTION TRANSLATION OF STRESS AND EMOTION TO DISEASE INVOLVES COMMUNICATION AMONG SEVERAL CORTICAL AND SUB CORTICAL REGIONS. AS YOU KNOW THE CORTICAL LIMB BIC SYSTEM PRODS SYCESES A BROAD RANGE OF BEHAVIORAL AND COGNITIVE FUNCTION. WE WERE INTERESTED IN EXAMINING THE MEDIAL PREFRONTAL CORTEX, THE OR BY TALL PREFRONTAL CORTEX AND THE ANTERIOR SINGLET CORTEX AS WELL AS AMYGDALA AND THE HIPPOCAMPUS TO EXAMINE THE RELATIONS BETWEEN SES AND RACE, IN CORTICAL LIMB BIC VOLUME. REGIONAL BRAIN VOLUMES WERE DERIVED USING T 1 WEIGHTED IMAGES. WHAT WE FOUND WAS THAT IN FACT SES BY RACE INTERACTIONS WERE PRESENT IN THE RIGHT MEDIAL PREFRONTAL CORTEX, THE LEFT MEDIAL PREFRONTAL CORTEX, THE LEFT ORBITAL PREFRONTAL CORTEX AS WELL AS LEFT ANTERIOR SINGULAR CORTEX. ONCE AGAIN HIGH SES WHITES HAD GREATER VOLUMES THAN ALL OTHER GROUPS. HIGHER COMPARED TO LOWER SES PERSONS HAVE GREATER RIGHT AND LEFT HIPPOCAMPAL VOLUME. WHITES HAVE GREATER RIGHT AND LEFT HIPPOCAMPAL, RIGHT ORBITAL PREFRONTAL CORTEX AND RIGHT AN TEAR TIEANTERIOR SINGLET CORTEX VOLUMES. THE FINDINGS SUGGEST THAT HIGHER LEVELS OF CHRONIC STRESS WHICH ARE KNOWN TO BE ASSOCIATED WITH LOW SES IN AFRICAN AMERICAN RACE MAY ADVERSELY AFFECT CORTICAL CIRCUITRY. IT IS AT LEAST A HINT T. VOLUME METRIC ASSOCIATIONS MAY CONTRIBUTE TO THE ADVERSE OUTCOMES FOUND IN THIS GROUP. WE ARE CARRYING THIS RESEARCH FURTHER NOT ONLY TO LOOK AT BROADER SPECTRUM OF HANDLS COHORT IN TERMS OF IMAGING BUT ALSO TO DO LONGITUDINAL FOLLOW-UP ON THIS FIRST GROUP EXAMINED. THESE FINDINGS ABOUT THE RELATIONS BETWEEN BRAIN VOLUME AND POVERTY, LED US TO EXAMINE COGNITION IN A GROUP OF HANDLS PARTICIPANT WHO WE BELIEVE AT PARTICULAR RISK FOR COGNITIVE IMPAIRMENT. THOSE WHO HAD DIABETES MELITIS. SO HERE WE EXAMINED WHETHER RACE AND POVERTY MODIFIES ASSOCIATION BETWEEN DIABETES AND COGNITION. AND WE LOOKED AT OVER 2000 HANDLS PARTICIPANTS WHO WERE QUITE YOUNG BECAUSE THIS IS PART OF THE BASELINE WAVE OF DATA. WE USED WELL VALIDATED MEASURES OF COGNITIVE FUNCTION TO EXAMINE THESE ASSOCIATIONS AND FOUND THE ASSOCIATIONS BETWEEN DIABETES AND COGNITIVE FUNCTION WERE OBSERVED ONLY FOR AFRICAN AMERICANS BELOW POVERTY. ALL ASSOCIATIONS WERE NEGATIVE EXCEPT FOR CATEGORY FREQUENCY. FLUENCY. DIABETES WAS ASSOCIATED WITH POOR VERBAL MEMORY, WORKING MEMORY AND ATTENTION AMONG AFRICAN AMERICANS LIVING IN POVERTY AND THE AGE OF COHORT, THE MEDIAN AGE OF THE COHORT AT 47 ALMOST 48 MADE US THINK THAT AFRICAN AMERICANS BELOW POVERTY WITH DIABETES MAY HAVE INCREASE RISK FOR COGNITIVE DEFICIT AT YOUNGER AGE WHICH CERTAINLY WOULD SUGGEST THAT STUDIES EXAMINING COGNITIVE ENHANCERS AND OTHER DRUGS TO IMPROVE OUTCOMES FROM ALLS MIRE'S DISEASE SHOULD BEGIN EARLIER IN THE TRAJECTORY FOR THIS PARTICULAR GROUP OF THE PUB POPULATIONS AT RISK. SUBPOPULATIONS AT RISK. WE HAVE SEEN POVERTY INFLUENCES CHRONIC KIDNEY DISEASE, WHITE MATTER LESION VOLUME TOTAL BRAIN VOLUME, AND CORTICAL LIMB BIC STRUCTURE VOLUME AS WELL AS COGNITION. IN PERSONS WITH DIABETES LIVING IN POVERTY. BUT WHAT ABOUT THE MORE IMPORTANT OR PERHAPS THE MOST IMPORTANT CLINICAL OUTCOME? MORTALITY. WE FOUND THREE WAY INTERACTION BETWEEN SEX RACE AND POVERTY STATUS. SUCH THAT AFRICAN AMERICANS BELOW POVERTY STATUS HAD THE LOWEST OVERALL SURVIVAL. THEY HAD 2.7 TIMES HIGHER RISK OF MORTALITY THAN AFRICAN AMERICAN MEN INDICATED IN THIS DARK BLACK LINE, WHO ARE LIVING ABOVE POVERTY. THIS IS A WITHIN RACE DIFFERENCE. WE ALSO FOUND WHITE MEN LIVING ABOVE AND BELOW POVERTY HAD APPROXIMATELY THE SAME RISK, THESE THE GRAY LINE SUPERIMPOSED HERE. IS POVERTY SOMEHOW LESS VIRULENT FOR WHITES? I THINK IT IS UNCLEAR. BOTH AFRICAN AMERICAN AND WHITE WOMEN WHO ARE BELOW POVERTY, THESE DASHED LINES HERE, ARE AT INCREASE MORTALITY RISK WHEN COMPARED TO THOSE ABOVE BUT THE RISK WAS SIMILAR ACROSS RACE. SO THIS LINE HERE, THIS DISPARATE MORTALITY RISK, PUT IN OUR HEADS THE IDEA THAT AFRICAN AMERICAN MEN ARE TARGET POPULATION FOR DISCERNING POVERTY RELATED TRANSDUCTION FACTORS. WE WANTED TO STUDY MECHANISMS THROUGH WHICH SOCIAL ENVIRONMENTS AND EXPOSURES COULD POSSIBLY MODULATE GENOMIC ACTIVITY. THE WORK OF STEVEN COLE AND OTHERS HAVE SHOWN CLEARLY THAT SOCIAL ENVIRONMENTS CERTAINLY DO INFLUENCE GENE EXPRESSION THROUGH DIFFERENT EXPOSURES THAT TRIGGER RESPONSES. RESPONSES THAT INCLUDE BIOCHEMICAL MEDIATORS, THAT THEN ENGAGE CELLULAR RECEPTORS, AND MOVE THE ACTIVATE SIGNAL TRANSDUCTION WHICH COULD ACTIVATE OR REPRESS TRANSCRIPTION FACTORS WHICH ULTIMATELY REGULATE TRANSCRIPTION OF GENES. IN STEVEN COLE'S WORK HE DESCRIBED A CONSERVED TRANSCRIPTIONAL RESPONSE TO ADVERSITY WHICH IS A VALIDATED PATTERN OF GENE EXPRESSION THAT'S PREDICTED BY EXPOSURE TO ADVERSITY. WE INITIALLY DECIDESSED TO LOOK AT LONG ON CODING RNAs, AS YOU KNOW, THE FUNCTIONAL ROLES OF LONG NON-CODE RNAs OR LINK RNAs, HAS SOMEWHAT POORLY UNDERSTOOD HOWEVER INCREASINGLY KNOWLEDGE HAS BECOME AVAILABLE SUGGESTING THEY ARE INVOLVED IN NEURODEGENERATIVE DISEASES, CONTROL OF INNATE IMMUNITY AS WELL AS ROLE IN CANCER. LINK RNAs REGULATE GENE EXPRESSION AT TRANSCRIPTIONAL, POST TRANSCRIPTIONAL AS WELL AS TRANSLATIONAL LEVEL. SO WE SET UP TO LOOK AT PROFILING OF LINK RNAs AND MRNAs IN PBMC YOUNG AND OLD AFRICAN AMERICANS AND WHITES WHO ARE LIVING ABOVE AND BELOW THE POVERTY LINE. THIS WAS ONLY IN MEN. WE FOUND SUBSTANTIAL CHANGES IN NUMBER OF LINK RNAs THAT ALTERED WITH AGE IN WHITE MEN YOU CAN SEE HERE. ST. 30 VERSUS 26 SIGNIFICANTLY ALTERED AFRICAN AMERICAN MEN. POVERTY STATUS SIGNIFICANTLY INFLUENCED RNA EXPRESSION BUT AGAIN PREDOMINANTLY IN WHITE MALES COMPARED TO AFRICAN AMERICAN MALES. 1870 LINK RNAs VERSUS ONLY 245 IN AFRICAN AMERICAN MEN. mRNA ABUNDANCE WITH POVERTY WAS ALSO ALTERED MORE IN WHITE MEN COMPARED TO AFRICAN AMERICAN MEN. WE WENT ON IN A LARGER PORTION OF THE COHORT TO VALIDATE LINK RNA ASSOCIATED WITH POVERTY AND FOUND MANY WERE INVOLVED IN VARIOUS FORMS OF CANCER NOT ONLY WERE MANY INVOLVED IN TUMORIGENESIS, TUMOR SUPPRESSION AND EVEN REGULATION OF P53 TARGET GENES THESE WERE NOVEL FINDINGS THAT HAS NOT BEEN PREVIOUSLY REPORTED FOR LINK RNAs. WE ALSO IDENTIFIED ANOTHER LINK RNA THAT BINDS AND ACTS AS A CYTOPLASMIC DECOY FOR THE GLUCO CORD CONSOLIDATED RECEPTOR. THIS ON GLUCOCORTICOID RECEPTOR. THE CHANGES IN GLUCOCORTICOID SIGNALING RECEPTOR PATHWAYS ARE PART OF TRANSCRIPTIONAL RESPONSE TO ADVERSITY FOUND IN HUMAN AND MEN, AND IN PRY MATES. SO WE WERE ABLE TO IDENTIFY CHANGES IN LINK RNA AND mRNA WITH AGE AND POVERTY STATUS IN WHITE MALES, HOWEVER IN AFRICAN AMERICAN MALES LIMITED CHANGES. THE GENE ONTOLOGY ANALYSIS THOUGH DID INCLUDE PATHWAYS INVOLVED IN RESPONSE TO STRESS, VIRAL INFECTION AND IMMUNE SIGNALS. HOWEVER THESE WERE ENRICHED IN INDIVIDUAL ACE ABOVS ABOVE POVERTY, NOT BELOW POVERTY. THIS SUGGEST AGE BUT POVERTY A MARKER OF SOCIAL ADVERSITY INFLUENCES LINK RNA EXPRESSION. WORKING WITH DOUG WHILE HE WAS ON THE FACULTY AT MORGAN STATE, I HAD DOUG TAKE THIS PROJECT AS PART OF WHAT HE WAS BRINGING TO MORGAN STATE TO EXAMINE POVERTY AND PBMC DIFFERENTIAL GENE EXPRESSION IN MEN AND WOMEN IN THE HANDLS COHORT. SO WE FOUND AFRICAN AMERICAN MALE AND FEMALES IN POVERTY, HAD MORE GENES DOWN REGULATED OR DIFFERENTIALLY EXPRESS WHEN CONTROL WITH WHITES OR ABOVE POVERTY CONTROLS. WHEN WE FOCUS TO LOOK AT AFRICAN AMERICAN WOMEN BELOW POVERTY WHO HAD SO MANY DIFFERENTIALLY DOWN REGULATED GENES, WE FOUND MANY OF THEM WERE RELATED TO FATTY ACID BIOSYNTHESIS AND METABOLISM AS WELL AS TRANSCRIPTIONAL REGULATORS INCLUDING AGE AT 2 AND 4 WHICH ARE BOTH LINKED WITH A VASCULAR INFLAMMATION, AND ANGIOTENSIN 2 INDUCED AUTOPHAGY WHICH MAY GIVE INCITE TO HYPERTENSION AND RISK FOR HYPERTENSION IN THIS GROUP OF WOMEN. ONCE AGAIN, THESE WERE NOVEL FINDINGS. THESE GENES HAD NOT PREVIOUSLY BEEN ASSOCIATED WITH POVERTY STATUS. BECAUSE OF OUR INTEREST IN AFRICAN AMERICAN MALES WE WERE PARTICULARLY INTERESTED IN DOING AN mRNA VALIDATION STUDY MANY THE AFRICAN AMERICAN MEN LIVING IN POVERTY. THE DOWN REGULATED TRANSCRIPTS WITH POVERTY INCLUDING ONES INVOLVED IN PRO-INFLAMMATORY GENE EXPRESSION, ENDOTHELIAL CELLS, ENDOTHELIAL REPAIR, SUGGESTING TO US AT LEAST, WE HAVE TO DO FURTHER EVALUATION OF THIS, THAT KLF 6 RBM 38 AND DSDUSP 2 MAY BE NOVEL MECHANISM THROUGH WHICH AT LEAST SUSCEPTIBILITY TO VASCULAR INJURY OR INFLAMMATORY RELATED CONDITIONS ARE PROMOTED IN AFRICAN AMERICAN MALES LIVING IN POVERTY. IN SUMMARY OF THIS PART, AFRICAN AMERICAN MALES AN FEMALES LIVERRENING POVERTY HAD MOST GENES -- LIVING IN POVERTY HAD MOST GENES REGULAR LATED COMPARED TO POVERTY CONTROLS. THERE WAS AN OVERLAP OF CONSERVED TRANSCRIPTIONAL RESPONSE TO ADVERSITY IN AFRICAN AMERICAN MALE AND FEMALES BELOW POVERTY AT SIGNIFICANTLY LOWER LEVELS OF INTERFERON INDUCED WITH HELOCASE C DOMAIN ONE. IFIH 15 ENCODES MDA 5 WHICH IS AN INTRACELLULAR SENSOR FOR VIRAL RNA THAT TRIGGERS THE IMMUNE RESPONSE. IT IS ALSO A MEMBER OF THE TYPE 1 INTERFERON RESPONSE PATHWAY. IN ADDITION AFRICAN AMERICAN FEMALES BELOW POVERTY HAD LOWER LEVELS OF NF KAPPA B. THE GENE ONTOLOGY ANALYSIS IN AFRICAN AMERICANS BELOW POVERTY IDENTIFY UNIQUE OVERLAPPING PATHWAYS THAT RELATED TO ENDOSOMAL ORGANIZATION SINGLE STRANDED RNA BINDING AS WELL AS TOLL LIKE RECEPTOR SIGNALING. THAT IS A SKIMMING OF OUR WORK LOOKING AT POVERTY IN AS A SOCIAL DETERMINANT OF HEALTH. AS I MENTIONED EARLIER, THERE'S OTHER DETERMINANTS OF HEALTH OTHER THAN POVERTY INCOME INEQUALITY THAT ARE IMPORTANT. PERCEIVED DISCRIMINATION IS ALSO CRITICALLY IMPORTANT BECAUSE IT IS ASSOCIATED WITH CARDIOVASCULAR DISEASE AND OBESITY EVEN WORSE SELF-REPORTED HEALTH. WE DO MANY -- WE USE INSTRUMENTS AND HANDLES TO ASSESS DISCRIMINATION AMONG THEM ARE THE MCARTHUR MAJOR EXPERIENCES LIFETIME DISCRIMINATION INSTRUMENT THAT ASKS PARTICIPANTS OVERALL HOW MUCH HARDER HAS YOUR LIFE BEEN BECAUSE OF DISCRIMINATION? OVERALL, HOW MUCH HAS DISCRIMINATION INTERFERED WITH YOUR LIFE? WE ALSO USE NANCY KREIGER'S RACIAL AND GENDER DISCRIMINATION THAT THAT ASKS RESPONDERS WHETHER THEY EXPERIENCE RACIAL DISCRIMINATION IN SCHOOL, WHEN GETTING A JOB, AT HOME, HOUSING SETTINGS MEDICAL CARE SETTINGS, FROM THE POLICE OR IN COURTS. WE INITIALLY BEFORE LOOKING FOR A BIOLOGIC MARKER OF PERCEIVED DISCRIMINATION. SO BECAUSE OF THE DATA, THAT SHOW THAT IN INCREASE RED BLOOD CELL OXIDATIVE STRESS WAS REPORTED IN MANY DISEASES CARDS OWE VASCULAR DISEASE INCLUDED, AS WELL AS IN AGING, WE WANTED TO EXAMINE RBC STRESS IN THE CONTEXT OF PERCEIVED DISCRIMINATION. HEMOGLOBIN UNDERGOES AND AUTOAX DAYTIVE PROCESS THAT PRODUCES MANY REACTIVE OXYGEN SPECIES INCLUDING HYDROGEN PEROXIDE SUBSEQUENTLY INVOLVED IN OXIDATIVE MODIFICATIONS THAT ULTIMATELY RESULTS IN FLUORESCENT DEGRADATION PRODUCTS MAKING IT A BIOMARKER OF RBC OXIDATIVE STRESS. WE SELECT THIRD DEGREE MARKER BECAUSE IT IS SENSITIVE TO BLOOD FLOW CHANGES, AND TO TISSUE OXYGENATION, TRIGGERD BY PSYCHOLOGICAL STRESS THROUGH THE SYMPATHETIC NERVOUS SYSTEM. SO IN OUR CROSS SECTIONAL EVALUATION OF BLACKS AND WHITES IN THE COHORT, WE FOUND THAT WHEN WE STRATIFY DATA BY RACE DISCRIMINATION WAS NOT ASSOCIATED WITH RBC STRESS IN WHITES. HOWEVER IN AFRICAN AMERICANS, DISCRIMINATION WAS ASSOCIATED WITH RBC STRESS. THAT ASSOCIATION REMAINED ADJUSTING FOR AGE SMOKING STATUS OBESITY AND INFLAMMATORY MARKERS INCLUDING HIGH SENSITIVITY CRP. WE WANTED TO ALSO INVESTIGATE ROLE OF PERCEIVED DISCRIMINATION IN FUNCTION SINCE POVERTY CERTAINLY WAS ASSOCIATED WITH CKD PREVALENCE, SO WE LOOK AT BASELINE COHORT WITH NORMAL EGFR LEVELS OR NORMAL BASELINE FUNCTION AT GREATER THAN 60 MLs AND LOOKED AT THAT DATA IN THE CONTEXT OF REPORTED SELF-DISCRIMINATION. AND FOUND AFRICAN AMERICANS REPORTED HIGH LEVELS OF RACIAL AND GENDER CHRIS CRIMINATION HAD DECLINE IN RENAL FUNCTION BETWEEN WAVES ONE AND WAVE 3. WE ALSO FOUND PERCEIVED GENDER DISCRIMINATION, WAS ASSOCIATED WITH A LOWER BASELINE EGFR IN ALL MINDS, IN WHITE WOMEN A HIGH EXPERIENCE OF DISCRIMINATION WAS ASSOCIATED WITH LOWER BASELINE EGFR. THIS DATA SUGGESTS RACIAL AND GENDER DISCRIMINATION PLAY A ROLE OR CONTRIBUTE TO DECLINE IN RENAL FUNCTION THAT IS ASSESSED BY EGFR IN AFRICAN AMERICAN WOMEN. DISCRIMINATION ADDITIVELY IN SETTING OF POVERTY MAY IN FACT BE IMPORTANT PROMOTING FACTORS IN DISPARITY RENAL DISEASE WE SEE IN AFRICAN AMERICAN POPULATIONS. AS YOU KNOW AFRICAN AMERICANS HAVE DISPROPORTIONATE BURDEN OF POOR BRAIN CLINICAL OUTCOMES. SO WE WANTED TO EXAMINE THE ROLE OF DISCRIMINATION STRESS AND BRAIN HEALTH AND AGAIN, WE LOOKED AT WHITE MATTER LESION VOLUME, EVIDENCED HERE IN THIS, IN THE CONTEXT OF LIFETIME BURDEN OF DISCRIMINATION IN RACIAL DISCRIMINATION IN AFRICAN AMERICANS WITHIN THE COHORT WHO HAD A MEAN AGE OF 50. IT DIDN'T ALL TURN OUT THE WAY WE HAD HYPOTHESIZED. THERE WAS ACTUALLY A NON-LINEAR ASSOCIATION OF AT THIS CRIPPLE IN WHITE MATTER LESION VOLUME AS FUNCTION OF AGE SO THE PART OF THE COHORT, REALLY WAS CONCORDANT WITH OUR ORIGINAL HYPOTHESIS. AS RACIAL DISCRIMINATION AND END LIFETIME BURDEN DISCRIMINATION REPORTS INCREASE SO DID WHITE MATTER LESION VOLUME. THERE WAS NO EFFECT OF THOSE IN MIDDLE OF THE AGE BAND AT 50 YEARS OLD. THEN CONVERSELY, IN THE YOUNGER PORTION OF THE COHORT, REMEMBER WE STARTED RECRUITING AGE 30, GREATER EXPOSURE TO RACIAL DISCRIMINATION ASSOCIATED WITH LESS BRAIN TOPOLOGY, SUGGESTING DISCRIMINATION HAS AN EFFECT ON BRAIN HEALTH BUT IT DEPENDS ON THE AGE COHORT. ONE THING WE DIDN'T EXAMINE WE ARE IN THE PROCESS OF SETTING UP TO DO, IS IT MAY HAVE TO DO WITH HOW INDIVIDUALS IN DIFFERENT AGE GROUPS COPE WITH THE EXPOSURE TO DISCRIMINATION. BUT WE THINK THIS DATA AT LEAST SUGGESTS AGAIN, DISCRIMINATION BURDEN IS AT LEAST A CONTRIBUTOR FACTOR IN THE DISPROPORTIONATE BURDEN OF BRAIN HEALTH OBSERVED IN AFRICAN AMERICANS. BECAUSE OF THE VERY HIGH LEVEL HEALTH DISPARITIES RELATED TO CARDIOVASCULAR DISEASE MANY THE COHORT WE WANTED TO LOOK AT SUB CLINICAL MARKER OF ATHEROSCLEROSIS AND PULMONARY ARTERY DISEASE, THE CAROTID ARTERY NEEDSIAL THICKNESS. SO THAT'S THESE THICKNESS OF THE INTIMA MEDIA OF THE ARTERIAL WALL OF THE CAROTID. WE EXAMINE THE INTERACTION OF DISCRIMINATION AND DEPRESSIVE SYMPTOMS IN OVER 1900 AFRICAN AMERICANS AND WHITES USING HIGH RESOLUTION SONOGRAPHY. WE FOUND THAT IN AFRICAN AMERICANS, THOSE THAT REPORTED HIGH LIFETIME BURDEN OF DISCRIMINATION AND GREATER DEPRESSIVE SYMPTOMS HAD HIGHER VALUE FOR CAROTID MEDIAL THICKNESS. THESE ASSOCIATIONS WERE NOT PRESENT IN THE WHITES IN THE STUDY. SUGGESTING THAT HIGH LEVELS OF DISCRIMINATION, IN THE CONTEXT OF DEPRESSIVE SYMPTOMS, PROVIDE GREATER RISK PROFILE FOR HYPERTENSION AS WELL AS CARDS CATH OWE VASCULAR AND CEREBROVASCULAR DISEASE. WE ALSO LOOKED AT TELOMERES AS MANY OF YOU KNOW THOSE ARE THE RED CAPS ON THE PURPLE CHROMOSOMES. THEY ARE SHORT NUCLEOTIDE SEQUENCES AT THE ENDONUCLEOCHROMOSOME AND PLAY AN IMPORTANT ROLE. TEAL MERES PROTECT GENETIC INFORMATION AND -- TELOMERES PROTECT GENOMIC INFORMATION WHICH IS IMPORTANT PARTICULARLY IN CANCER. LONG TELOMERES ARE ASSOCIATED WITH GOOD HEALTH AND NORMAL LONGEVITY, SHORT TELOMERES RELATED TO AGE RELATED DISEASE AND SHORTENED LONGEVITY. TELOMERE SHORTING CAN OCCUR BY INTRINSIC CELLULAR MECHANISM BUS ALSO FROM ENVIRONMENTAL FACTORS SUCH AS STRESS. SO WE LOOKED AT INTERPERSONAL DISCRIMINATION WITHIN THE COHORT AND PERFORMED QUANTITATIVE POLYMERASE CHAIN REACTION AND ON PBMC TO ASSESS TELOMERE LENGTH. FOUND THAT IN AFRICAN AMERICANS, AFRICAN AMERICAN WOMEN HAD SHORTER TELOMERES THAN MEN. AFRICAN AMERICAN WOMEN WITH GREATER LIFETIME BURDEN OF DISCRIMINATION, BE IT RACIAL OR GENDER ALSO HAS SHORTER TELOMERES. INTERESTINGLY, HIGHER SES AFRICAN AMERICANS WHO REPORTED GREATER DISCRIMINATION ALSO HAD SHORTER TELOMERES. YOUNGER ADULTS WHO HAD HIGH LEVELS OF REPORTED DISCRIMINATION FROM MULTIPLE SOURCES IN ADDITION HAS SHORTER TELOMERES. AMONG WHITES AS YOU WILL SEE AMONG WOMEN RACIAL DISCRIMINATION HAD NO EFFECT ON TELOMERE LENGTH. HOWEVER FOR WHITE MEN YOUNG WHITE MEN AS THEY REPORTED MORE RACIAL DISCRIMINATION, HAD SHORTER TELOMERES. CONVERSELY OLDER WHITE MEN AS THEY REPORTED MORE RACIAL DISCRIMINATION HAD LONGER TELOMERES. SO IF THIS DATA IS A MIXED PICTURE, WE PLAN TO EXPAND TO BOTH LONGITUDINALLY IN COHORT NOW THAT WE THINK WE ARE FAR ENOUGH OUT BUT WE DO THINK THAT IN CERTAIN SELECTED SUB GROUPS, DISCRIMINATION MAY CONTRIBUTE TO TELOMERE SHORTENING WHICH MAY PLAY A ROLE IN WEATHERING OR ACCELERATED AGING THAT COULD BE ASSOCIATED WITH HEALTH DISPARITIES FOR THE NUMBER OF TIMES. I TRIED TO CAPITALIZE OUR WORK, WE IDENTIFIED NUMEROUS TRANSDUCTION PATH WAYS WHICH POVERTY AND DISCRIMINATION MAY POSSIBLY OPERATE. OXIDATIVE STRESS IS IMPORTANT TELOMERE SHORTENING AS WELL AS ALTERATIONS IN TRANSCRIPTOME AND THEY HAVE MULTIPLE DIFFERENTIAL EFFECTS IN TERMS OF FUNCTION, BRAIN VOLUME, COGNITION, PERHAPS MORTALITY AS WELL. THESE FINDINGS SUGGEST THAT THE SOCIAL DETERMINANTS OF HEALTH THAT WE LOOKED AT HERE POVERTY AND DISCRIMINATION BUT NOT RACE ALONE, ARE LIKELY PRIMARY DRIVERS FOR POOR HEALTH OUTCOMES. THESE OUTCOMES AND INSIGHTS REQUIRE MORE IN DEPTH DISSECTION TO IDENTIFY MORE SPECIFIC BIOLOGIC TARGETS OF INTERVENTION. AND WE ARE CERTAINLY DOING THOSE EXPERIMENTS. OUR WORK HAS I THINK WHICH IS HIGHLIGHTED HERE IN THIS WORD CLOUD HAS REALLY SOUGHT TO COVER THE EXPANSIVE INTERDISCIPLINARY NATURE OF HEALTH DISPARITIES RESEARCH. HOWEVER WE HAVE JUST SCRATCHED THE SURFACE. OF THIS CRITICAL FIELD OF RESEARCH. HEALTH DISPARITIES RESEARCH HAS BEEN DESCRIBED AS PERHAPS HAVING THREE GENERATIONS OR THREE LEVELS. AS A RELATIVELY YOUNG FIELD OF SCIENTIFIC ENDEAVOR WE ARE STILL IN SOME CASES DOCUMENTING THE EXISTENCE OF HEALTH DISPARITIES. AND THEN SIMULTANEOUSLY, WORKING TO EXPLAIN REASONS FOR HEALTH DISPARITIES, THE MOVE FOR US NOW I THINK FOR ALL HEALTH DISPARITIES RESEARCHERS IS TO BEGIN TO PROVIDE SOLUTIONS FOR ELIMINATING HEALTH DISPARITIES. THE COVID-19 CRISIS, UNCOVERED THE NATION'S GLASS JAW AS WELL AS SHORTCOMINGS IN THE NIH MISSION OR ACHIEVEMENT OF THE NIH MISSION. SO WHEN WE TALK A GLASS JAR WE ARE TALKING ABOUT A VULNERABILITY AS OF A BOXER TO KNOCK OUT AS STATED IN MIRIAM WEBSTERS DICTIONARY. THE GLASS JAW TURNED CAN DENOTE A PERSON OR INSTITUTION CRITICAL POINT OF WEAKNESS. ANTHONY WHITTLE IN 1914 IN EDITORIAL COINED THE TERM THE MORAL GLASS JAR OR A MORAL ACHILLES HEEL. OUR MORAL GLASS JAR IN THE TIME OF COVID, ARE INATTENTION TO UNDERLYING POPULATION HEALTH DISPARITIES AND THE SOCIAL DETERMINANTS OF HEALTH WHICH WE AL KNOW SO WELL IN COMMON SOCIAL STATUS, SOCIAL SUPPORT NETWORKS, EDUCATIONAL LITERACY, EMPLOYMENT IN WORKING CONDITION, SOCIAL ENVIRONMENT, PHYSICAL ENVIRONMENTS, PERSONAL HEALTH PRACTICESES AND COPING SKILLS. HEALTHY CHILD DEVELOPMENT AS WELL AS STRUCTURAL RACISM. WE KNOW THESE ARE IMPORTANT IN HEALTH AND SOME OF THEM WE DON'T HAVE A LOT THAT WE CAN DO ABOUT IT. BUT WE CAN SUPPORT AND DEFINE AND DEVELOP RESEARCH TO NOT ONLY IDENTIFY DISPARITIES BUT TO TRY AND DO SOMETHING ABOUT THEM. SO GOING FORWARD OUR WORK AS AN INSTITUTION HAS TO BE TO RECOGNIZE HEALTH DISPARITIES MINORITY HEALTH AND HEALTH EQUITY RESEARCH AS A CRITICAL VALUABLE SCIENTIFIC DISCIPLINE TO FAIRLY REVIEW IT, AND EQUITABLY SUPPORT IT. LEADERSHIP MUST PROMOTE A RESEARCH AGENDA THAT CONSISTENTLY INCORPORATES THE SOCIAL DETERMINANTS OF HEALTH AND INCLUDES AN APPROPRIATE REPRESENTATION AND PARTICIPATION ON MINORITY POPULATIONS IN CLINICAL STUDIES. WE MUST WORK TOGETHER TO TRANSFORM THE DEMOGRAPHICS OF THE BIOMEDICAL WORK FORCE BY FUNDING DIVERSE INVESTIGATORS AND TRAINING A DIVERSE POOL AS NEXT GENERATION OF PHYSICIANS. SCIENTISTS, AND PHYSICIAN SCIENTISTS BY BEGINNING THE PRE-COLLEGE LEVEL. WE MUST RECOGNIZE CONFRONT AND COMBAT STRUCTURAL AND INSTITUTIONAL RACISM WHERE IT EXISTS BECAUSE IT IS BAD FOR EVERYONE YOU SAW THE DATA ON WHITE WOMEN IN OUR COHORT. YOU HAVE TO GIVE THANKS TO THE GODFATHER OF HANDLS JOHN RUFFIN WHO PUT UP HIS DOLLAR IN 1997 TO GET THIS EFFORT FUNDED. AND TO MY PARTNER IN THE BEST TEAM SCIENCE I HAVE BEEN INVOLVED IN, ALAN SONDERMAN WHO SACRIFICED MUCH FOR US TO WORK TOGETHER TO RUN THIS MULTI-DISCIPLINARY STUDY AIMED AT AN AREA THAT IS VERY IMPORTANT TO BOTH OF US. AND I ALSO HAVE TO GIVE KUDOS TO MY LIFE PARTNER WHEN I WANTED TO LEAVE THE BENCH AND DO HEALTH DISPARITIES RESEARCH IN EPIDEMIOLOGY HE DIDN'T BAT AN EYE AND STEPPED UP AND DID WHAT HE NEEDED TO DO ON THE HOME FRONT TO ALLOW IT TO HAPPEN. AND I WOULD LIKE TO TELL YOU JUST A BIT ABOUT A BOOK THAT DR. ROBERTS' DAUGHTER-IN-LAW SUZANNE AND SON WROTE. IT WAS A STORY FOR HER WHEN THEY FOUND OUT ABOUT HER ILLNESS. IT CONVEYS AN IMPORTANT MESSAGE TO US ALL IN THESE TRYING TIMES. MOST IMPORTANTLY, EVERYONE SENDS LOVE FOR IT IS KNOWN THROUGHOUT THE LAND THAT LOVE IS THE GREATEST HEALING FORCE OF ALL. MAY OUR LOVE OF OUR WORK IN SCIENCE AND MEDICINE, OUR LOVE FOR NIH AND THIS NATION, PROPEL US TO FIND THE BEST WAYS FOR EACH OF US TO CONTRIBUTE OUR INTELLECTUAL CAPITAL TOWARDS EXTENDING AND INDEMNIFYING THE NIH MISSION TO ENHANCE HEALTH, LENGTHEN LIFE, AND REDUCE ILLNESS AND DISABILITY FOR ALL AMERICANS. AND MAY THE SPIRIT OF ANITA ROBERTS IN SELECT SCIENTISTS, MENTOR MOTHER OUTDOORS WOMAN, REMAIN WITHIN OUR COMMUNITY AS A SHINING EXAMPLE OF A LIFE WELL LIVED, AS WE WORK TOGETHER EMPLOYING OUR SCHOLARLY VIGOR AND THE RESOURCES OF NIH TO ENSURE HEALTH EQUITY FOR ALL. I THANK THE WSA AGAIN FOR THIS WONDERFUL HONOR. >> THANK YOU, DR. EVANS FOR SUCH A WONDERFUL TALK. I'M SURE YOU WILL TAKE A FEW QUESTIONS RIGHT NOW. >> OF COURSE. >> CAN I START OFF WITH ASKING YOU ARE THERE ANY HANDL STUDIES BEING DONE IN OTHER CITIES IN UNITED STATES? SO YOU HAVE SOME COMPARISON BETWEEN BALTIMORE AND OTHER CITIES? >> EXCELLENT QUESTION. NOT EXACTLY. I THINK HANDLS IS A GOOD EXAMPLE OF A HIGH RISK HIGH REWARD PROJECT THAT CAN ONLY BE DONE MANY THE INTRAMURAL PROGRAM. WE HAVE CERTAINLY WORKED WITH OTHERS TO PERHAPS DO SOME OF THE -- BEEN ABLE TO DO BUT AGAIN IT IS VERY DIFFICULT TO DO THIS. WE HOPE TO BE ABLE TO WORK WITH ALL OF US TO EXPAND OUR WORK AND OUR ABILITY TO LOOK HOW BALTIMORE MAY DIFFER FROM OTHER CITIES BECAUSE BALTIMORE HAS ITS OWN SIGNATURE AND HOW THAT COMPARES TO CLEVELAND, OR DALLAS OR COMPTON, LA, WE DON'T REALLY KNOW. >> SO THERE IS A LOT OF EXPENSE AND WORK TO BE DONE THROUGHOUT THE UNITED STATES. SO ARE THERE ANY PLANS TO LOOK AT NATIVE INDIANS IN THIS TYPE OF WORK? >> AMERICAN INDIANS. >> THERE WAS A GROUP AT THE INDIAN HEALTH SERVICE WHO WANTED TO DEVELOP VEHICLES FOR LOOKING AT DOING MRIs TO LOOK AT COGNITIVE IMPAIRMENT AND NEURODEGENERATION SO WE PROVIDED AS MUCH BACK UP INFORMATION IN TERMS OF HOW TO BUILD THE VEHICLES WHAT ARE THE REQUIREMENT, HOW TO WORK WITH GS AIR. THERE'S A LOT OF THINGS YOU QUANTITY WRITE A PAPER ON THAT YOU HAVE TO DO IN ORDER TO GET TO COMMUNITIES THAT MAYBE DIFFICULT TO REACH. SO AS I -- THE LAST I HEARD FROM THEM, THEY WERE ABLE TO GET THE VEHICLES NOW, HOW THEIR STUDY IS GOING, I HAVEN'T HEARD FROM THEM ON THAT BUT YES, BECAUSE THEY HAVE A PROBLEM REACHING THE NUMBERS OF COMMUNITIES THAT ARE FAR DISTANT FROM MAJOR METROPOLITAN AREAS. >> I WILL GO TO QUESTIONS IN THE CHAT BOX. ONE IS FROM HOWARD YOUNG. THE QUESTION IS, HAVE YOU EVER MEASURED INTERFERON LEVELS IN ANY OF THESE COHORT? AND HIGHER LEVELS COULD RESULT IN DEPRESSION? >> YES. WE HAVE MEASURED INTERFERON LEVELS. I THINK WE HAVE BEEN A LITTLE STYMIED BY THAT BECAUSE WE NEVER HAD ENOUGH MONEY TO DO THEM ALL AT THE SAME TIME. AS YOU KNOW THERE ARE MANY THINGS THAT CAN INFLUENCE INTERFERON LEVELS. AND SO IT WOULD BE DIFFICULT TO COMPARE BETWEEN DIFFERENT RUNS BUT THAT IS ONE THING THAT WE TRYING TO WRAP OUR HEADS AROUND IN TERMS OF MAYBE DESIGNING A SMALLER COHORT WHERE WE COULD MEASURE INTERFERON ALL AT THE SAME TIME. HOW THAT THOSE INTERFERON LEVELS RELATE TO DEPRESSION I DON'T KNOW BUTLY TELL YOU THAT IN TERMS OF OUR CESD SCORES, MEASURES DEPRESSION SYMPTOMS, WE HAVE VERY HIGH LEVELS OF DEPRESSION -- DEPRESSIVE SYMPTOMS IN THE HANDLS COHORT THOUGH NOT DSM BASED DIAGNOSES OF DEPRESSION. >> THANK YOU. THE NEXT QUESTION IS FROM PAUL FROM NIDDK. THANKS FOR A WONDERFUL TALK, WHAT ARE THE IMPLICATIONS FOR INTERVENTIONS FROM THE DATA YOU HAVE SHOWN US? >> SOME OF THEM ARE SIMPLE THINGS. SOME DATA THAT I DIDN'T TALK ABOUT TODAY IS ARE SIMPLE THINGS LIKE LOOKING AT THE RED CELL DISTRIBUTION WITH ON THE CDC BECAUSE IT IS PREDICTIVE OF MORTALITY, NOT JUST IN THE POPULATION OF THE WORLD BUT PARTICULARLY AMONG AFRICAN AMERICAN MEN IN OUR COHORT. I -- SO THESE ARE PRACTICAL SHORT TERM THINGS IDENTIFYING THE PEOPLE AT RISK, SOME OF THE MOST IMPORTANT CHEAPEST THING TO DO, IDENTIFYING PEOPLE WHO WERE FRAIL FROM THE AGING POINT OF VIEW. IN OUR WORK I DIDN'T HAVE A CHANCE TO TALK ABOUT -- WORK TODAY ON FRAILTY IN THE COHORT, WE SEE FRAILTY VERY -- BEGINNING VERY EARLY IN THE COHORT AND INTERESTINGLY NOT AMONG AFRICAN AMERICANS IT IS AMONG THE WHITES IN THE COHORT. SO DOING A FROWN SCALE AS PART OF PHYSICAL EXAMINATION WOULD PICK OUT THOSE WHO HAVE FRAILTY IN THEIR LATE 40s, EARLY 50s BECAUSE WE SAW IN THAT AGE GROUP BETWEEN 47 TO 55 WE SAW A LOT OF FRAILTY. THAT WAS UNDIAGNOSED. SO INCLUSION OF FRAIL SCALE IN THE DOCTOR'S OFFICE VISIT COULD AT LEAST HIGHLIGHT WHO IS IMPORTANT. THESE ARE SHORT TERM BUT CHEAP INTERVENTIONS THAT -- AND I THINK PEOPLE DON'T OFTEN THINK ABOUT THAT BECAUSE THEY ARE LOOKING FOR THE BIG HOME RUN. WE ARE STILL AT THE STATUS WHERE CHANGING THE WAY PHYSICIANS LOOK AT CLINICAL VALUES THAT THEY CAN EASILY OBTAIN TO IDENTIFY THE RISK POOL THAT YOU NEED TO DO MORE THOROUGH INVESTIGATION ON, THAT'S NOT EVEN BEING DONE. ROUTINELY. >> ANOTHER QUESTION COMES FROM RACHEL SOLOMON. THE MESSAGE IS, HAVE OTHERS FOUND SIMILAR ASSOCIATION AS HANDLS FOR AFRICAN AMERICAN MEN LIVING IN POVERTY IN OTHER PARTS OF THE U.S.? IS THE ASSOCIATION IS CONSISTENT ACROSS U.S. COMMUNITIES OR SPECIFIC TO MEN LIVING IN BALTIMORE? ALSO WITH HYPERTENSION WHAT ROLE DOES DIET PLAY? I THINK YOU HAVE ANSWERED PART OF THAT QUESTION AND I ASKED THE FIRST ONE. >> AFRICAN AMERICAN MEN ACROSS THE COUNTRY WHO LIVE IN POVERTY, ARE AT INCREASE RISK FOR MORTALITY WHETHER 2.7 TIMES, 2.1 TIME, IT IS INCREASE RISK. IN BALTIMORE IN OUR STUDY IT WAS 2.7 TIMES THE RISK WHEN YOU ARE LOOKING AT AFRICAN AMERICAN MEN IT IS WITHIN RACE DIFFERENCE. THAT WAS THE IMPORTANCE OF THAT DATA IS NOT LOOKING AT AFRICAN AMERICAN MEN VERSUS WHITES WE ARE LOOKING AT EFFECT OF POVERTY WITHIN AFRICAN AMERICAN MEN THEMSELVES. NOW, I DON'T -- BECAUSE OF THE WAY OUR STUDY IS SET UP, THAT IS ONE OF THE VALUES OF HANDLS, WE HAVE SET IT UP SO THAT WE CAN TRY TO DISENTANGLE RACE AND SES AND THERE AREN'T MANY STUDIES OUT THERE THAT CAN DO THAT. SO I CAN'T TELL YOU THAT THAT DATA IS AVAILABLE IN DETROIT THOUGH I CAN TELL YOU THAT AFRICAN AMERICAN MEN BELOW POVERTY ARE INCREASE RISK OF MORTALITY IN DETROIT, I DON'T KNOW HOW IT COMPARES TO AFRICAN AMERICAN MEN ABOVE POVERTY. IN TERMS OF HYPERTENSION, NUTRITIONAL EPIDEMIOLOGIST AS WELL AS PART OF OUR NUTRITIONAL GROUP HAVE LOOKED AT HYPERTENSION AND CERTAINLY DIET PLAYS A ROLE IN HYPERTENSION BUT ONE OF THE IMPORTANT THINGS TO CONSIDER IS THE ROLE OF POVERTY BECAUSE OF THE HIGH LEVEL OF FOOD INSECURITY AND AVAILABILITY OF HEALTHY FOODS IN INNER CITY NEIGHBORHOODS PARTICULARLY PARTS OF BALTIMORE, THOSE THINGS ALSO SUBSTANTIALLY INFLUENCE THE DIETARY INTAKE OF THE HANDLS PARTICIPANT. THAT IS LIKELY PRESENT IN MANY URBAN CENTERS. >> THERE IS ANOTHER QUESTION FROM KIMBERLY, ACTUALLY JUST A COMMENT, THANK YOU VERY MUCH, DR. EVANS, YOUR WORK IS EXTREMELY INTERESTING. THANK YOU FOR TAKING IT. LET'S GO ON TO ANOTHER QUESTION. I DON'T SEE IT. OH. THANK YOU FROM PAUL KIMMO. I DON'T SEE ANY OTHER QUESTIONS COMING UP. IS THERE ANYONE ELSE THAT WOULD LIKE TO MAKE A COMMENT OR QUESTION? ONE JUST CAME IN. IT SAYS MICHELE FREEMA HUE FOR YOUR WORK, TO WHAT EXTENT ARE CHANGES SEEN IN BLACK INDIVIDUALS THE SAME AS WHITE INDIVIDUALS. THE CHANGES SIMPLY OCCUR EARLIER EARLIER. >> I THINK SOME OF THE CHANGES ARE THE SAME, IT IS A TIME LINE FACTOR, IS THAT SOME OF THE CHANGES ARE OCCURRING EARLIER RELATED I BELIEVE TO THE SOCIAL DETERMINANTS OF HEALTH. WHEN YOU LOOK AT FRAILTY, FRAILTY WAS BELIEVED TO BE HIGHER IN AFRICAN AMERICANS AND HIGHER IN LOW SES BUT MOST OF THOSE STUDIES HAVE BEEN DONE IN THOSE 65 AND OVER, IT IS NOT UNTIL YOU BACK IT UP AND START LOOKING EARLIER IN THE LIFETIME, THAT YOU CAN IDENTIFY THE EARLY RISK IN WHITE INDIVIDUALS IN BALTIMORE. SOME OF THAT IS RELATED TO WHAT WAS REPORTEDDED IN THE WORK OF CASE AND DEATON, THESE DEPTHS OF DESPAIR, SO WE DIDN'T HAVE PEOPLE NECESSARILY DYING BUT THEY WERE AFFECTED BY MANY OF THE SAME FACTORS THAT ARE DESCRIBED IN THE CASE IN DEATON WORK, OPIOID ADDICTION, HIGH RATES OF JOB LOSS, NEW POVERTY THAT THEY WERE EXPERIENCING THAT WE THINK LED TO THE HIGHER RISK OF FRAILTY AMONG YOUNGER WHITES COMPARED TO YOUNGER BLACKS. WE ALL AGE AND I THINK DEVELOPED MANY OF THE SAME CLINICAL MANIFESTATIONS, HOWEVER, IT OCCURS EARLIER I BELIEVE IN AFRICAN AMERICANS AND MORE SEVERELY. THAT'S LARGELY I THINK THE CAUSE OF THE SOCIAL DETERMINANTS OF HEALTH. >> THANK YOU. ARE WILL ANY FURTHER QUESTIONS FOR DR. EVANS? I WILL TAKE ANOTHER LOOK. ANOTHER CAME IN. IS FROM KIM. THANK YOU VERY MUCH FOR YOUR GREAT LECTURE. I'M INTERESTED AND WOULD LIKE TO READ YOUR RESEARCH IN DETAIL. WHERE CAN WE FIND THE PUBLICATIONS OF YOUR STUDY. WOULD IT BE REPLICABLE TO A CERTAIN POPULATION FOR FUTURE RESEARCH? >> YOU CAN GO TO THE HANDLS WEBSITE, HANDLS.NIH.GOV AND WE HAVE A LIST OF PUBLICATIONS SINCE THE BEGINNING OF THE STUDY THERE. AND I THINK THAT IS ONE QUESTION THAT WE CERTAINLY HAVE IN TERMS OF HOW DIFFERENT IS BALTIMORE FROM DETROIT, FROM MEMPHIS. THAT WE DON'T KNOW WHICH IS WHY WE TRY TO DEFINE WHAT WE ARE STUDYING WHAT IS HAPPENING IN BALTIMORE BUT IT PROVIDES HINTS WHAT MIGHT BE HAPPENING, WHY ARE THE SOCIAL DETERMINANTS OF HEALTH SO IMPORTANT IN HEALTH OUTCOMES. AND IT IS HOW THEY INTERACT BIOLOGICALLY AND DRIVE CHANGES THAT LEAD TO DISEASE. >> THANK YOU. I WILL ASK A QUESTION ABOUT WHETHER YOU HAVE SUBDIVIDED THE AFRICAN AMERICAN POPULATION, IN OTHER WORDS ARE THEY IMMIGRANTS FROM JAMAICA OR AFRICA AND SO ON WHETHER YOU FOUND ANY DIFFERENCES OR DID YOU LOOK AT THAT AT ALL? >> NO, WE DIDN'T LOOK AT THAT AT ALL. YOU ARE CORRECT TO BRING UP THAT THERE ARE CERTAINLY DIFFERENT INFLUENCES THAT COME FROM IM IMGRACE. SUMNER CERTAINLY DOES WORK THAT LOOKS AT AFRICANS AS WELL AS CARIBBEAN IMMIGRANTS BUT WE HAVE NOT DONE THAT IN THE HANDLS COHORT. >> OKAY. SO LET'S SEE, THERE IS ANOTHER QUESTION POPPED UP. >> OH THE SAME ONE AS FROM KIM. I DON'T SEE ANY OTHER QUESTIONS SO I'M SURE THAT EVERYBODY WOULD LIKE TO THANK DR. EVANS TREMENDOUSLY FOR A WONDERFUL TALK, IT'S GIVEN US A LOT OF FOOD FOR THOUGHT AND I THINK IT MADE ALL OF US CONSCIOUS ABOUT DISPARITIES ALTHOUGH WE HAVEN'T BEEN BUT I THINK THIS TALK HAS JUST MOTIVATED US TO REALLY DO A LOT MORE ABOUT IT. AND CONSCIOUS ABOUT THINGS LIKE DISCRIMINATION WHICH PEOPLE DON'T THINK CONSCIOUSLY ABOUT. I THINK IT HAS SENSITIZED ALL OF US I'M SURE WHO IS LISTENING TO THIS BEAUTIFUL TALK. THANK YOU AGAIN. >> ALL RIGHT. THANK YOU SO MUCH FOR THE -- I WILL CLOSE THIS LECTURE. AND AGAIN, CONGRATULATIONS. >> THANK YOU SO MUCH.