Ayana April Sanders, PhD – The Early Career Voice

Ayana April-Sanders is an epidemiologist and postdoctoral research fellow at Albert Einstein College of Medicine. Her research focuses on the impact of social determinants of health, health disparities, and early life stress on cardiometabolic and cardiovascular disease outcomes across the life course in minority and immigrant populations. She is a member of AHA Council on Lifestyle and Cardiometabolic Health and Council on Epidemiology and Prevention. She volunteers for the AHA FIT/Early Career Blogging program. You can follow her on twitter: @AApril_Sanders.

E-cigarette use is a health concern, but long-term consequences remain unknown

July 7, 2022June 30, 2022 Ayana April Sanders, PhD

Recently, I happened to take a route home that led me through my local high school as the students were dismissed for the day. There was some traffic because of dismissal as students traveled home in their vehicles or were picked up by parents/guardians. As I inched along the path to the main road, the car ahead of me was being driven by a student, and I noticed he was vaping. With two small kids, I don’t get the privilege of observing teenagers too often, so it made me pause a bit to witness this. When I think back to my high school days, cigarette smoking was one of the salient issues with youth and substance use, and there were huge campaigns to limit tobacco use among adolescents. I was all too familiar with the D.A.R.E (drug abuse resistance education) program at every step of my education as an adolescent! But today, cigarette smoking is less common among adolescents than nearly 20 years ago.

As a cardiovascular epidemiologist, I’m aware of the available evidence and conflicting messages we receive about the costs and benefits of e-cigarette use among adults. But what is the message for youth? Is vaping as addictive as cigarettes, and does it offer similar health threats? And if so, are there programs in place to limit vaping? One thing is for sure, compared with our knowledge and evidence on decades of cigarette smoking, e-cigarette use and vaping research are still in their infancy, but a more explicit message is making its way through all the vapors.

The increasing use of electronic cigarettes (e-cigarettes or electronic nicotine delivery systems (ENDS)) and vaping products among youth continues to be recognized as a significant public health challenge. Severe cardiopulmonary disease and related deaths have been associated with the use of electronic cigarettes. To emphasize the importance of stronger public health policies and guide therapeutic strategies on the short- and long-term risks of vaping, the recent AHA scientific statement provides background on the cardiopulmonary consequences of e-cigarette use (vaping) in adolescents. Vaping may pose longer-term health threats like nicotine addiction and cardiopulmonary damage.

Figure 1. What is in E-cigarette Aerosol? CDC: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

Vaping involves heating a liquid — typically containing nicotine or cannabis, flavorings, and other substances and additives — to produce an aerosol inhaled through a battery-powered device. E-cigarettes have grown into a multi-billion-dollar industry since entering the U.S. market in 2007 as a potential smoking cessation tool. Still, they also appealed to youth – with fruity flavor additives and nicotine salts, making it less harsh on the throat and easier to use by adolescents. Over the years, e-cigarette use among US teenagers showed a 19% increase between 2011 and 2018. Vaping is still prevalent among adolescents, but we have seen a decline in 2019, some of which may be due to reduced access or disease-related concerns during the COVID-19 pandemic. The Centers for Disease Control and Prevention (CDC) reports that in 2020, at least 3.6 million US youth, including about 1 in 5 high school students and about 1 in 20 middle school students, used e-cigarettes in the past 30 days. Notably, public health has made significant strides over the past decade in lowering the prevalence of cigarette smoking among adolescents to its lowest rates in history – fewer than 6% of high school students have smoked a cigarette in the past 30 days, and fewer than 3% report being daily users. Although the benefits won’t be realized for about 30 years, this accomplishment is enormous and portends reductions in smoking-related disabilities and death for generations to come.

On the other hand, the big question is whether e-cigarettes and vaping will have a deleterious effect on youth. In November 2019, we saw the impact of acute vaping-associated lung injuries and confirmed vaping-related deaths linked to vitamin E acetate – a chemical additive in the production of e-cigarette products. These events warned that additives could be involved in adverse health effects of vaping. Besides nicotine, vaping liquids contain vegetable glycerin and propylene glycol, which are on the FDA’s generally recognized as safe (GRAS) list. However, these components were not evaluated for inhalation toxicology. Like vitamin E acetate, these GRAS components may be associated with adverse health outcomes once inhaled. Thus, the long-term effects of vaping on the lungs in youth and young adults are worrisome and need to be better understood.

Studies have found higher rates of wheezing, greater prevalence of asthma, and increased incidence of respiratory disease in youth who were e-cigarette users. Among young adults, e-cigarette use is associated with higher arterial stiffness, impaired endothelial function, increased blood pressure, heart rate, and sympathetic tone, increased levels of oxidative stress biomarkers, and pro-inflammatory white blood cells that increase the risk of cardiovascular disease. Subclinical cardiopulmonary disease can likely start early in adolescence among youth who vape. Overall, lung development continues into the early 20s. Therefore, adolescents who vape are potentially stunting or altering their lung development, limiting their full lung function potential, and increasing their risk of pulmonary disorders.

Statistically, the population health risk of vaping-related disease among adolescents depends on the prevalence and frequency of vaping. Many adolescents experiment with vaping or may vape only occasionally or socially, conferring in possible low health risk. But as informed by evidence from cigarette use, vaping for 20+ days per month may suggest a degree of dependence and greater health risks. Youth may also multiply their risk by smoking other substances like marijuana. Collectively, continued research into the cardiopulmonary health consequences of vaping in youth needs to weigh the contribution of marijuana smoking or vaping with e-cigarette use.

Primary care and public health strategies should protect young people and limit unnecessary exposure.

The AHA scientific statement concludes with several major recommendations for reducing and preventing youth vaping:

Developing better measures to reduce youth access, including strict age verification at places of sale
Prohibiting the marketing of e-cigarettes to youth
Education of healthcare stakeholders, students, and their parents regarding realistic concerns about e-cigarette use

The recommendations do come with some controversy. Dr. Neal L. Benowitz mentions in his commentary of the scientific statement that “to limit access [among youth] could be even stronger if e-cigarette sales were limited to adult-only tobacco specialty stores.” He also offers that AHA’s recommendation to ban e-cigarette flavors, including menthol, is concerning because it would “reduce use by smokers wishing to switch, particularly since tobacco flavorings are constant reminders to former smokers of cigarette smoking.”

In conclusion, there is still plenty that we do not know yet about the effects of e-cigarettes and vaping on cardiopulmonary health. Evidence is building and suggests that efforts need to be taken to reduce possible long-term risks, especially for youth and those who were previous non-smokers. The evidence is not nearly as rich as the generations of work done to understand the harms of cigarette smoking. Still, clues taken from that long history help set the framework of the approaches and guidelines needed to protect public health. Although risk reduction is highly recommended, the evidence is still in its infancy. It is crucial to recognize that the science and guidelines regarding e-cigarettes and youth is a challenging process. The key to this process will be balancing the concerns about health risks to youth with the potential benefits of smoking cessation in adults.

References:

Wold LE, Tarran R, Crotty Alexander LE, Hamburg NM, Kheradmand F, St. Helen G, PhD; Wu JC; on behalf of the American Heart Association Council on Basic Cardiovascular Sciences; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Hypertension; and Stroke Council. Cardiopulmonary consequences of vaping in adolescents: a scientific statement from the American Heart Association [published online ahead of print June 21, 2022]. Circ Res. doi: 10.1161/RES.0000000000000544

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/OSH-E-Cigarettes-and-Youth-What-HCPs-Need-to-Know-508.pdf

https://professional.heart.org/en/science-news/cardiopulmonary-consequences-of-vaping-in-adolescents/Commentary

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/images/e-cigarette-aerosol-can-contain-harmful-ingredients-desktop-700.jpg?_=45193

Fadus, M. C., Smith, T. T. & Squeglia, L. M. The rise of e-cigarettes, pod mod devices, and JUUL among youth: Factors influencing use, health implications, and downstream effects. Drug Alcohol Depend. 201, 85–93 (2019).

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/OSH-E-Cigarettes-and-Youth-What-HCPs-Need-to-Know-508.pdf

https://www.uclahealth.org/vitalsigns/immediate-health-concerns-about-vaping-are-real-but-long-term-effects-are-not-yet-fully-understood

https://www.ajmc.com/view/review-highlights-need-for-stricter-health-policies-amid-rising-e-cigarette-use

Lyzwinski, L.N., Naslund, J.A., Miller, C.J. et al. Global youth vaping and respiratory health: epidemiology, interventions, and policies. npj Prim. Care Respir. Med. 32, 14 (2022). https://doi.org/10.1038/s41533-022-00277-9

“The views, opinions, and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness, and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions, or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”

Blood Pressure and Hypertension Control Matter for Young Adults

March 30, 2022March 30, 2022 Ayana April Sanders, PhD

Many young adults (18-39 year-olds) view themselves as physically healthy and may wonder why their doctor is concerned about their blood pressure. However, being young does not prevent you from developing elevated or high blood pressure. Uncontrolled blood pressure in young adults is a significant public health concern. In the U.S., 1 in 5 young men and 1 in 6 young women have hypertension. Hypertension control also varies by age group, with only 39% of U.S. young adults with hypertension having achieved control (blood pressure < 140/90 mmHg) compared with 58% of middle-aged adults (40-59 year-olds) and 54% of older adults (≥60 year-olds). Importantly, given that young adults with hypertension have more prolonged exposure to high blood pressure, they ultimately have a higher lifetime risk for cardiovascular disease. Early monitoring, diagnosis, and managed treatment are important to reduce the risk of serious medical conditions associated with uncontrolled hypertension.

Here’s a quick primer on blood pressure values and meanings and the effect of elevated blood pressure on cardiac structure and functioning:

Blood pressure is the force that blood applies to the walls of arteries as it’s pumped throughout the body.

Generally, your arteries can withstand some pressure, but there are limits to what the arteries can handle. For this reason, blood pressure is measured and monitored, and the values are categorized based on how the level of pressure affects our health. The four blood pressure categories are:

Normal: systolic less than 120, and diastolic less than 80
Elevated: 120 – 129, and less than 80
Hypertension (stage 1): 130 – 139, or 80 – 89
Hypertension (stage 2): 140 or higher, or 90 or higher
Hypertensive crisis: higher than 180, and/or higher than 120

Only normal blood pressure is considered healthy, while elevated or high blood pressure is associated with damaging the heart and arteries by forcing the heart to pump harder. When the heart works harder to pump blood, this can cause the heart muscles to thicken (altering the structure of the heart) and make it harder for the heart to fill with and pump blood (altering the functioning of the heart). The body’s arteries will also begin to narrow and harden, limiting the normal flow of blood.

Fortunately, high blood pressure is treatable and preventable. But uncontrolled hypertension affects nearly half of adults in the U.S., with many people unaware they even have the condition. The CDC recommends that knowing key facts about hypertension, getting your blood pressure checked regularly, and taking action to control your blood pressure if it is high is key to lowering your risk.

Source: “6 Facts About High Blood Pressure.” Venngage. https://venngage.net/pl/bVswgLzcpM

Since hypertension does not cause noticeable symptoms, it mustn’t be ignored. Over time, high blood pressure quietly damages the circulatory system and increases one’s risk of developing adverse health conditions – thus, hypertension is known as a silent killer. Additionally, high blood pressure is associated with poorer outcomes with COVID.

Steps to lower your blood pressure are often considered manageable and include common lifestyle modifications:

Smoking cessation
Maintaining a healthy weight
Consuming low levels of salt
Getting plenty of exercise
Limiting alcohol
Eating healthy

However, the patient experience among young adults with hypertension suggests significant barriers to receiving adequate blood pressure control management exist for this population. In a multi-center qualitative study, Johnson et al. (2016) identified unique emergent themes among young adults with hypertension that differed from prior hypertension qualitative studies in older age groups. Young adults voiced that the chronic disease diagnosis and the recommended lifestyle modifications made them feel older than their biological age. The participants also mentioned ongoing adverse psychological effects associated with their diagnosis and feeling a sense of self-blame and shame. This may be a critical point of intervention for healthcare teams to understand and address the negative emotional and mental health effects that a hypertension diagnosis has on young adults. Other emergent themes identified in the focus groups included the cost-benefit analysis performed by young adults when determining the necessity of recommended blood pressure treatment plan (e.g., lifestyle modifications, medication) and concern about experiencing negative social stigma based on their behavior choices reflecting new lifestyle modifications. Finally, most participants reported discarding hypertension education materials after leaving the clinic, citing that the materials were not tailored to young adults and their lifestyles.

These themes identified important barriers to young adult patients’ education on hypertension awareness and risks and opportunities for hypertension treatment non-adherence related to both medication and lifestyle modifications. Young adults with hypertension represent a unique population that could benefit from targeted interventions to improve hypertension control and cardiovascular disease prevention.

References:

Centers for Disease Control and Prevention. Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2013–2016. Atlanta, GA: US Department of Health and Human Services; 2019.
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 2020;141:e139-596.
Wall HK, Hannan JA, Wright JS. Patients with undiagnosed hypertension: Hiding in plain sight. JAMA2014;312(19):1973–1974.
Parcha V, Patel N, Kalra R, Arora G, Arora P. Prevalence, Awareness, Treatment, and Poor Control of Hypertension Among Young American Adults: Race-Stratified Analysis of the National Health and Nutrition Examination Survey. Mayo Clin Proc. 2020 Jul;95(7):1390-1403. doi: 10.1016/j.mayocp.2020.01.041. PMID: 32622447.
Johnson HM, Warner RC, LaMantia JN, Bowers BJ. “I have to live like I’m old.” Young adults’ perspectives on managing hypertension: a multi-center qualitative study. BMC Family Practice. 2016 Dec;17(1):1-9.
https://www.houstonmethodist.org/blog/articles/2020/jan/why-your-blood-pressure-matters-even-in-your-20s-and-30s/
https://www.cdc.gov/bloodpressure/5_surprising_facts.htm
“6 Facts About High Blood Pressure.” Venngage. https://venngage.net/pl/bVswgLzcpM

Sleep and Ideal Cardiovascular Health

February 4, 2022January 28, 2022 Ayana April Sanders, PhD

During the AHA’s Scientific Session 2021, heart health, defined by the Life’s Simple 7 metric, was often woven into health equity conversations.

Empirical evidence consistently supports AHA’s recognition of these seven risk factors that people can avoid or improve on through lifestyle changes to help achieve ideal cardiovascular health. Regardless of how challenging this goal is for the average American, Life’s Simple 7 is an essential benchmark for staying heart-healthy.

More attention is now being directed at the role of sleep in maintaining heart-healthy lifestyle practices. Sleep plays an important role in overall health and well-being. In-kind, there exists a reciprocal relationship between the quality of one’s diet, physical activity, and stress on the quality of sleep achieved. Ideally, sleep needs to be deep and restorative to support good cardiovascular health. Specifically, the Centers for Disease Control and Prevention recommend that adults between 18-65 years aim for at least seven hours of quality sleep per night. However, sleeping well is not common. 4 in 10 adults report consistently good sleep at night, and 50 million to 70 million American adults suffer from chronic sleep problems or sleep disorders.

As an early career epidemiologist, who was not too long ago a pre-doctoral candidate, I am familiar with several factors that contribute to trouble with sleep. These have included staying up late to work on an analysis or drafting a manuscript whose internal deadline was already past due; following up on emails while binging a popular streaming series and munching on some snacks; juggling a busy household with two young children that always find a reason to wake up sometime after midnight. Perhaps these experiences are relatable. Often lifestyle choices, poor sleep habits, stress, and medical conditions can play a role in why you can’t sleep.

Alcohol

A glass of wine before bed might not interfere with your ability to drift off but indulging in more servings of alcohol before bedtime may impair your sleep by interfering with your sleep cycle, especially REM sleep. This leads to fragmented, unrefreshing rest.

Poor Sleep Habits

Habits that make it harder to fall and stay asleep may include (1) staying up late, (2) watching television in bed, (3) playing or browsing on your phone in bed, (4) having an irregular sleep schedule. Simple lifestyle changes to your nightly routines could help to remedy these issues.

Bed Sharing

Whether with a partner, child, or pet, reduced sleep quality can be caused by sharing your bed. Anything that can make you uncomfortable (i.e., snores, crowding, pulled covers, or mismatched sleep condition preferences like temperature, light, or noise level) will disrupt your sleep.

Poor Sleep Environment

Sleeping environments that are too hot or too cool will disrupt your sleep. Sleep experts recommend a bedroom temperature at a moderate climate between 65 to 72 degrees Fahrenheit at night. The body needs to cool at night for the most refreshing sleep, but a too-cold room will cause you to wake up. Don’t forget about light exposure. Whether it’s from a reading lamp, television, streetlight, or even the glow from a device, this could be enough to signal your brain to wake up.

Caffeine

Some folks may argue that coffee has no effect on their ability to sleep at night and will enjoy a cup before bed. However, caffeine has a half-life of three to five hours, so even a late afternoon caffeinated beverage can disrupt your sleep later that night.

Stress

Often the events of the day that creep back into our minds at night are not the positive experiences but the ones that fill our minds with worry and stress. Stress is one of the most cited symptoms of sleep problems.

Exercise

Exercise, like an evening walk, is excellent for fostering better sleep. But intense, heart-pumping, and sweat-inducing cardio workouts within three hours of your bedtime may be too much. Both your body temperature and heart rate naturally drop as you fall asleep. Exercise stimulates your entire nervous system and raises these two body functions making it difficult to sleep.

Snack Choices

Snacks or meals high in fat or protein consumed right before bedtime can overstimulate your digestive system, cause heartburn and make it difficult to sleep. A late-night sugar rush can also lead to hunger pangs and drops in blood sugar, causing you to wake up.

Sleep Disorders and Mental Health

Importantly other factors like sleep disorders and mental health problems can make it difficult to sleep. You should talk with your doctor if you suspect that a medical or mental health condition may be contributing to your poor sleep.

Insufficient sleep and poor sleep quality, in addition to sleep disorders, are linked to a wide range of adverse health effects. Major physical and mental health consequences include anxiety, bipolar disorder, hormone imbalances, weakened immune system, cardiovascular disease, and major heart disease risk factors like obesity, inflammation, Type 2 diabetes, high blood pressure. Additionally, poor sleep is linked to overall decreased quality of life and increased mortality risk.

If good sleep habits are not currently part of your daily routine, consider some useful strategies to alleviate some of the factors that have interfered with your quality and quantity of sleep. Here in this infographic are a few tips and techniques developed by AHA to help those who do not have a sleep disorder make small daily changes to establish healthier sleep habits.

Working to alleviate factors that contribute to insufficient sleep and poor sleep quality may also be another critical metric for cardiovascular health. Preliminary findings presented at the AHA’s 2021 Epidemiology and Prevention/Lifestyle and Cardiometabolic Health Scientific Sessions recommended revising the AHA’s Life’s Simple 7 to include sleep as a metric creating a new “Simple 8 or Essential 8” metric measuring cardiovascular health. The study’s lead investigator, Nour Makarem, Ph.D., explained that while sleep is a health behavior that people engage in every day, like diet and exercise, it has received far less attention. However, increasing evidence links sleep to heart disease and risk factors for cardiovascular disease.

Along with her team of investigators, Dr. Makarem assessed whether a cardiovascular health score that includes the Life’s Simple 7 combined with sleep metrics would be more strongly associated with cardiovascular disease than the Life’s Simple 7 score. The study found that when at least one measure of sleep was added with the Life’s Simple 7 measures, the new heart health score was more strongly associated with cardiovascular disease than the traditional Life’s Simple 7. The results were compelling and showed, for example, that study participants who received seven to eight hours of sleep a night in addition to meeting Life’s Simple 7 guidelines had up to 61% lower odds of having heart disease. Those who got less than six hours of sleep scored lower for overall cardiovascular health and had a higher prevalence of overweight and obesity, Type 2 diabetes, and high blood pressure. Sleep duration and the other sleep metrics included in the study made the cardiovascular health scores more predictive of cardiovascular disease risk than the seven metrics alone.

Like several current Life’s Simple 7 measures, clocking 7-9 hours of sleep per day can be challenging. However, the traditional cardiovascular health metric may need to be revisited for a potential upgrade in providing yet another vital benchmark for predicting and promoting ideal cardiovascular health.

References:

Lloyd-Jones, Donald M., et al. “Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond.”Circulation 4 (2010): 586-613.
https://www.heart.org/en/health-topics/sleep-disorders/sleep-and-heart-health
https://www.heart.org/en/news/2020/03/06/sleep-should-be-added-as-measure-of-heart-health-study-says
https://www.verywellmind.com/reasons-for-not-sleeping-well-and-how-to-fix-350760
https://www.heart.org/en/healthy-living/healthy-lifestyle/sleep/sleep-well-infographic
https://www.ahajournals.org/doi/10.1161/circ.141.suppl_1.36

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

Highly Effective Scientists: Leading an effective research lab

December 20, 2021December 17, 2021 Ayana April Sanders, PhD

AHA Scientific Sessions 2021 was an exciting event with many educational opportunities to gain career development strategies to increase scientists’ productivity and effectiveness at work and in life. As an early career scientist, I often wonder how some of my colleagues, both early career and more seasoned investigators, can be so successful in their ability to publish papers or receive grants while maintaining a perfect balance with their personal lives. In a fantastic session titled “Strategies for Career Success by Highly Effective Scientists”, panelists, including Dr. Elizabeth McNally, Dr. Pilar Alcaide, Dr. Jil C. Tardiff, and Dr. Pradeep Natarajan, shared and discussed strategies that highly effective scientists use to increase efficiencies at work and at home to maximize productivity. This session offered a broad overview of strategies for early career scientists. However, in this first installment, I will present my perspective on leading an effective research lab, which applies to early career investigators (ECIs) in transition periods in their careers. I have detailed several guiding tips towards leading a successful research lab in the following.

Leading an effective team

For many transitioning from a graduate or postdoc role to their first academic appointment, the idea of launching your own lab can bring both feelings of excitement and uncertainty. We know there are many possibilities for success. Still, the path to a well-functioning and healthy lab can be overwhelming. Here are some tips on planning ahead and moving forward with your lab even when resources run low:

Make the most of your resources: Regardless of the resources that may have been available in your lab in graduate school or as a postdoc, opportunities afforded to you in your new environment may be very different, and your expectations may need adjustment. Importantly, before jumping in your work with a team, familiarize yourself with the elements in your new environment that mirror your previous setting and the factors that may challenge the work you intend to do. For instance, your start-up package may not allow you to recruit graduate students or postdocs, but you may find an excited group of undergraduates who may be ready to work with you. Importantly, you should move forward with the resources at your immediate use. Additionally, you may be able to position yourself with new colleagues and their labs to borrow equipment or tools that can help offset your limitations and avoid significant delays in building your lab and moving analyses forward. Finally, remember that both you and your students are on a clock; moving forward with available resources will ensure the success of all parties in your lab.

Recruiting: Choosing the best team will depend on the project’s needs and available resources. With each candidate, carefully read their resume/CV to access their availability timeline, degrees attained, and grades in relevant subjects. At every step of the recruitment process, foster diversity and inclusion to gain the best candidate who can offer a wide range of skills and experiences that can inform the team’s work. References are helpful but limited as the environments that may have garnered success or failure for the candidate in one group may differ in the next. Also, assess the candidate’s strengths and weaknesses, keeping in mind the projects that may be a good fit for the candidate. You may also want to include your team in the interview process with a new candidate and gain oral feedback on how they see the individual fitting with the project needs and the lab culture. Finally, even if a candidate accepts the position, try not to consider the person recruited until they arrive for their first shift. It’s not uncommon for candidates to show enthusiasm at the interview stage but fail to come to start the work. You will also want to be mindful that the first three months of work is a trial period where the new recruit will acclimate to the lab and demonstrate the quality of their work, which may or may not need to be adjusted to the expectations of the lab. This period is an excellent opportunity to learn more about the candidate’s skills and personality, perspectives, how quickly they overcome learning curves and establish fit within the group.

Avoid decision paralysis and get moving: Realistically, a mountain of decisions need to be made when starting a lab. New faculty are thrust into many firsts: first projects, first lab members, first major purchases, etc. Feeling completely unprepared at this level of independent responsibility is the norm. Regardless, the sheer number of decisions can be paralyzing, especially when combined with perfectionist personalities, common among scientists. In a letter to young scientists at Science.org, Somerville et al. recommend that ECIs just need to start doing something to overcome decision paralysis. It is the only way for the lab trainees and its leader to get moving. Additionally, in those moments of doing, you can build realistic expectations about the actual needs of your research and the team and what is feasible to be conducted in a given period. The lab will feel most successful when expectations are checked, and outcomes are realistic.

Setting your lab culture: The most successful labs are a product of the brilliant minds that share membership. Importantly, successful labs share a common understanding of how they can be an environment that will generate positive training experiences for all and productivity. Through shared vision and expectations, lab members are made to feel like they belong, that their work is valued, have a sense of autonomy, and know how to succeed. You may have had the opportunity to work with several labs before becoming independent, or you may only know one lab family. Whatever the experience, it is likely there were scenarios where things worked extremely well – you gained hands-on training, communication was well established, feedback on performance was constructive, you felt that your efforts lead to presentations or publications that would support your career advancement — and other experiences that could have used improvement. Drawing on your past experience can help define how you want to manage your lab and the expectations that your trainees expect from each other and you for overall success. At Nature.com, Hagerty et al. wrote about setting clear lab expectations. These could be a lab manual with values and daily expectations or periodic lab meetings discussing lab culture. Topics like socialization, conflict resolution, and inclusions can be presented with a plan for how expectations can be manifested daily. Setting the tone of lab culture should be deliberate and can build on your own experiences. As the leader, you should make your aspirations clear and be a regular example of your team’s expectations. Additionally, with regular assessments, you will notice what works and what doesn’t. You can revise your lab manual and adjust your culture with the inclusion of your team. Dr. McNally also provided some other excellent tips for growing a healthy lab:

Take care of yourself: Last but certainly not least, it’s important to state that while a lab can definitely run on its own (especially if established well), the lab leader must also set means for self-care and feedback. ECIs should utilize their own advisors/mentors to discuss the progress and nature of their labs and do so regularly. You should also engage with colleagues or other individuals outside the lab to discuss problems that may arise and have an external perspective on resolving issues. When something does go wrong, give yourself a break from the situation and allow the matter to breathe and dissipate before coming to firm solutions. Sometimes, firing people will have to happen, and it’s ok to recognize that it is a difficult decision to make. Remember that even as a leader, you are human and have emotions in many of your investments, especially your research lab. Finally, learning to say “No” to opportunities that may overextend or add little benefit to your team and yourself may be the best solution to maintain a healthy and well-functioning research lab.

I hope you found these guides useful for planning and building your future research lab. Perhaps these tips helped improve your current lab. Next time, I will touch on another valuable topic to ECIs and their success.

References:

https://www.science.org/content/article/three-keys-launching-your-own-lab

https://www.nature.com/articles/d41586-018-07383-0

Health Equity, the Forgotten Pillar

November 15, 2021November 15, 2021 Ayana April Sanders, PhD

This year’s AHA21 Scientific Session placed an intense spotlight on understanding and achieving health equity in cardiovascular health (CVH). AHA has a broad vision for being transformative in all of the ways that structural inequities influence health outcomes. Specifically, AHA’s 2024 Impact Goal states that: Every person deserves the opportunity for a full, healthy life. As champions for health equity, by 2024, the American Heart Association will advance cardiovascular health for all, including identifying and removing barriers to health care access and quality.

On Day 1 of AHA21, during the ‘Cardiovascular Health After 10 Years: What Have We Learned and What is the Future?’ session, we engaged with experts about the genesis of CVH, how it has been studied throughout the life span over the past decade, and methods for influencing CVH at critical life stages. Darwin Labarthe, MD, MPH, PhD, provided a historical review of the conceptual origins and definition of CVH, and the meaning of CVH in translation. CVH is defined by key features of AHA’s Life’s Simple 7, including assessments of diet, smoking status, physical activity, weight management, blood pressure, cholesterol, and blood glucose.

Ideal CVH is determined by the absence of clinically diagnosed CVD together with the presence of the 7 metrics. Longitudinal evidence has shown that maintaining ideal CVH is more cardioprotective than improving and achieving CVH from a lower CVH level. But US NHANES data shows that about 13% of adults meet 5 of the 7 criteria, 5% have 6 of 7, and virtually 0% have ideal CVH or meet 7 of 7 metrics. This begs the question of how do we attain and maintain a high level of CVH? Ideally, maintaining CVH by Life Simple 7 standards should be SIMPLE…just ensure that all 7 metrics are met, and you will have ideal CVH! But realistically, it is near impossible for individuals to achieve ideal CVH. It is more likely that both individual and population-level efforts are needed to achieve and maintain CVH.

From a life course perspective, high CVH in adulthood is more likely when high CVH is present in early life. But as the panelist continued to describe the state of CVH in America, we quickly learned that while high CVH is consistently associated with lower risk of cardiovascular disease (CVD), disparities in CVD rates vary by sociodemographic factors like age, sex, race/ethnicity, and educational attainment. A recent study by panelist Amanda Marma Perak, MD, MS, FAHA, FACC, and colleagues (2020) using data from the CARDIA study found that less than a third of young adult participants had high CVH, and this was lower for Blacks than Whites and those with lower than higher educational attainment. These results demonstrate that CVH is far from ideal even among younger cohorts. Over the last few decades, we have witnessed increasing rates of cardiovascular abnormalities and subclinical and overt CVD in adolescents and emerging or young adults. The low prevalence of ideal CVH in young adults suggests that factors contributing to CVD risk may be embedded at earlier life stages. The experiences that happen or do not happen in early life settings (i.e., family, households, schools, communities, etc.) are important opportunities to achieve or maintain high CVH. The drivers of health disparities, like social determinants of health (SDOH), structural racism, and rural health inequalities, are necessary to achieve sustainable health equity and well-being for all. One method is effectively developing culturally-tailored community-engaged partnerships to promote CVH. LaPrincess Brewer, MD, MPH, shared the phenomenal community-based interventions being conducted to intervene on low CVH in Black neighborhoods by addressing SDOH at the community-level. These included the Fostering African-American Improvement in Total Health CVH (FAITH!) CVH wellness program, Community Health Advocacy and Training (CHAT) program, and The Black Impact Program.

The conversation on CVH and health equity continued strong on Day 2 of AHA21 at the ‘Achieving Health Equity: Advancing to Solutions’ session. With a panel of leading experts in health equity research, calls for action rang out at each presentation. David Williams, PhD, argued that racial inequalities in health are fortified from centuries of established institutional/structural racism, individual discrimination, and cultural racism, which result in a significant cost to mental health and millions of African-American lives lost each year. Sonia Angell, MD, MPH built on the discussion with a call to action in investing in understudied and marginalized communities that experience poorer CVH. Importantly, as clinicians, research scholars, and policymakers, we need to consider the significant impact of spending more time addressing intervention areas with the largest impact on health, like the structural causes of health inequities. When we work to eliminate structural causes of health inequities, we can begin to spend less time and energy working on small impact areas like counseling, education, and referrals for emergency foods and housing. Ultimately, we can reduce the time and costs of mitigating health inequities when we focus on eliminating the structural causes of health inequities.

Finally, in a powerful video, Health Equity: Patients’ Perspectives, we were invited to hear the stories and experiences of those from Black and Hispanic/Latino communities who were significantly affected by health inequities and failed by their healthcare systems. The tales were jarring and left the audience and panel with a strong sense of remorse. The impact of inequalities in health has been a regular staple in marginalized communities across America for centuries. Collectively, from these voices, we recognize that patients and participants need to be treated as humans. In seeking to meet AHA’s 2024 Impact Goal, I want to echo the sentiments of Kirsten Bibbins-Domingo, PhD, MD, MAS, that equity was always an important pillar in health quality and safety, but it is the forgotten pillar. We must make health equity front and center. As such, we need to 1) actively make health equity a priority and place it front and center in our professional and personal work; 2) have respect for all of humanity from all social groups; and 3) we need better science to understand how risk and disease are being experienced.

References

Lloyd-Jones, Donald M., et al. “Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond.”Circulation 4 (2010): 586-613.
Enserro, Danielle M., Ramachandran S. Vasan, and Vanessa Xanthakis. “Twenty‐year trends in the American Heart Association cardiovascular health score and impact on subclinical and clinical cardiovascular disease: the Framingham Offspring Study.”Journal of the American Heart Association 11 (2018): e008741.
Benjamin, Emelia J., et al. “Heart disease and stroke statistics—2017 update: a report from the American Heart Association.”circulation 10 (2017): e146-e603.
Perak, Amanda M., et al. “Associations of late adolescent or young adult cardiovascular health with premature cardiovascular disease and mortality.”Journal of the American College of Cardiology 23 (2020): 2695-2707.
He, Jiang, et al. “Trends in Cardiovascular Risk Factors in US Adults by Race and Ethnicity and Socioeconomic Status, 1999-2018.”JAMA 13 (2021): 1286-1298.