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Equal Gender Representation in the News Media: How You Can Help

Last month, I wrote about gender representation in the scientific literature. This time, I’m taking a look at the popular press. Rather than look just at gender, I’m looking how nurses are represented (or not represented) as expert sources. I’m choosing to do this for several reasons; First, the public’s perception of nursing as a profession matters both to the future of nursing (who will pursue the profession?) and to the care we provide now (how do patients and other members of the health care team respond to us?). Second, there is an inherent gender bias in the under-representation of nurses as experts, since 90% of RNs are female1. Finally, the practice and science of nursing are distinct from other fields and are valuable to health – including cardiovascular health. (If you aren’t familiar with nursing research, there’s a list of nursing journals at the end of this post – have a look at what’s getting published). Increased public visibility is a gateway to broader funding, adoption of nursing-generated evidence, and professional respect.  This isn’t just good for nurses, it’s good for the health of the population.

Photo by Sam McGhee on Unsplash

Photo by Sam McGhee on Unsplash

Nursing has matured enormously as a profession and an academic field, but the public’s perception of nursing has not kept up. A seminal 1997 report, known as the Woodhull Study of Nursing in the Media2, found that nurses were identified as sources in only 4% of health news stories in national and regional newspapers, and even fewer in industry publications. Over 20 years later, we see some increased awareness, but not enough. A team at George Washington University recently investigated the current state of women and nursing in the media. They found that many journalists don’t have a clear idea of the scope of nursing expertise, and that news organizations are infrequently reaching out to nurses. Additionally, the authors reported that journalists don’t know how to find nurses, healthcare organizations aren’t offering them as experts, and nursing professional organizations aren’t effectively engaging the media. Women remain underrepresented as expert sources in news stories at just 36%3. That’s a lot of barriers to effective representation. Yet the public trusts nurses more than any other profession, including physicians4. The valuable voices of nurses represent a huge opportunity for health and science communication, if we can learn how to effectively promote them. This will take dedicated work and attention from all sides.

Photo by Matt Botsford on Unsplash

Photo by Matt Botsford on Unsplash

 

Here are some ways to work on this problem:

  • Women, recognize that your contributions are needed. Women will never be treated with full fairness and equality unless our voices are audible– this is as true in science and academia as it is in politics. Cultivate expertise and believe in your own status as an expert. (Fellow early career blogger Alison Webel shared some strategies to combat self-doubt.)
  • Nurses, engage with the media. Write letters to the editor. Tweet. Promote your work, both clinical and research. Talk to journalists when the opportunity arises (see my tips here). Find out if your organization has a blog, and offer to write a post. Often, PR folks run these blogs and are delighted to have volunteer contributors.
  • Leaders in adjacent professions, seek out and recommend nurses as experts. If you’re asked to provide a quote, or background, consider whether the best person for the job might actually be a nurse– don’t assume the interviewer will know that.
  • Writers, aim for balance. Are you quoting and citing diverse sources? Think about profession, age, gender, race, rank, and nationality when you’re evaluating your sources.

 

Can you choose a strategy to focus on for your next project?

 

References:

  1. National Council of State Boards of Nursing (2017). National Nursing Workforce Study. https://www.ncsbn.org/workforce.htm
  2. University of Rochester (1997). The Woodhull Study of Nursing in the Media. Indianapolis, IN: Sigma Theta Tau.
  3. Mason, D., Glickstein, B., Nixon, L., Westphaln, K., Han, S., & Acquaviva, K. (2018). Research Brief: The Woodhull Study Revisited: Nurses’ Representation in Health News Media. George Washington University. https://nursing.gwu.edu/woodhull-study-revisited
  4. Brenan, M. (2018). Nurses again outpace other professions for honesty, ethics. Gallup News. https://news.gallup.com/poll/245597/nurses-again-outpace-professions-honesty-ethics.aspx?g_source=link_NEWSV9&g_medium=NEWSFEED&g_campaign=item_&g_content=Nurses%2520Again%2520Outpace%2520Other%2520Professions%2520for%2520Honesty,%2520Ethics

 

Resources for nursing research:

Journal of Cardiovascular Nursing: https://journals.lww.com/jcnjournal/pages/default.aspx

Nursing Research:  https://journals.lww.com/nursingresearchonline/pages/currenttoc.aspx

Journal of Nursing Scholarship: https://sigmapubs.onlinelibrary.wiley.com/journal/15475069

 

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Anxiety, Food Security, & Beyoncé: Addressing Young Women’s Cardiovascular Health

What can you do to address gender disparities in health and health care? In my last post, I suggested working to identify your own bias by increasing your awareness. I’m walking this path, too. A few years ago, I made a concerted effort to diversity my reading habits after I noticed that a huge percentage of the work I was consuming was produced by white men. I spent a year choosing to read only books by women and people of color instead. I learned that it was not hard to do this, but it required that I pay attention. I read a lot of wonderful work that I might have otherwise overlooked, and I was exposed to much more diverse viewpoints. I continue to seek out broad representation, and I suggest a similar approach to reading scientific literature.

Start by paying attention to 1) study populations, and 2) authorship. Are you reading articles about (and by) underrepresented populations? In cardiovascular health, this includes women, who remain underrepresented in clinical trials (estimates as low as 34% of participants in trials supporting drugs for some CV conditions1), clinical practice (just 20% of cardiology fellow are women2), and academia (check out the #nomanels hashtag on Twitter).

Clearly, we need more cardiovascular research by and about women. In this post, I want to highlight some exciting research by and about women.

Evidence of the pervasive male bias: we've programmed our machines to assume patients are male.

Evidence of the pervasive male bias: we’ve programmed our machines to assume patients are male.

At the recent American Heart Association EPI/Lifestyle conference, a woman-led team from Boston Children’s Hospital presented their work on perceptions of cardiovascular risk among adolescent and young adult (AYA) women. The team recognized that young women didn’t seem particularly informed about or interested in their heart health. Based on this clinical insight, they designed a study to identify barriers to awareness and preventive behaviors among AYA women. I spoke with Courtney Brown, an early-career professional herself and the first author of the abstract3, who explained the team’s findings. First, noted Brown, AYA women have a low baseline knowledge of their cardiovascular risk— lower than expected. They also face competing demands to focusing on their cardiovascular health, such as limited time and financial resources. One key finding was the role of mental health concerns like depression and anxiety: it’s hard to care about something that might happen to you in thirty years when you’re worried about getting through your next few days. Some participants also noted that eating healthy seems too expensive, and sometimes healthy food just isn’t available. These barriers to healthy behaviors are real! Yet behaviors established in young adulthood tend to persist as we age, so AYA women are at a crucial time in their lives for their heart health.

A key point for intervention development, says Brown, is that lifestyle behaviors (including exercise and high-quality nutrition) that are good for mood are also good for heart health. So while cardiovascular health may not be this group’s priority, they will likely benefit from risk-reducing behaviors in multiple ways.

Delivering the message in the setting of competing demands is tricky— and important.  When asked what might facilitate their adoption of heart-healthy behaviors, participants in the study indicated that family was their biggest influence, followed by their health care providers and celebrities (favorites were Drake, the Kardashians, and Beyoncé). They also talked about using Facebook, Snapchat, and Instagram to get information and communicate. This is rich data, and it suggests that a “meet them where they’re at” approach is likely to be successful. “We’d love for more people to take up this work— we have more steps to take,” Brown says. “We’d love to create and test materials.” It’s encouraging to see rigorous science targeting the needs of a group that’s often overlooked in cardiovascular research. As the body of evidence grows, perhaps some of the disparities in women’s cardiovascular health will fade.

There are also some great lessons here from a methodological standpoint. This study utilized mixed methods, including online focus groups. Courtney Brown, the researcher from the AYA study, stressed that the qualitative component of the work is highly valuable because it can help researchers develop interventions that will effectively reach the population of interest. “It lets us dig deeper into responses to find out what the unique barriers are and how to reach this population, not just what to tell them”, she says. When so much of existing clinical practice is based on research that excluded women, this approach is very relevant. In a climate where the RCT is king and the p-value determines whether or not a finding is considered significant, qualitative work is often undervalued, but these kinds of studies are crucial in understanding the needs, values, and preferences of patient populations— especially those, such as young women, that have been previously understudied and undertreated.

 

Have you read (or authored!) any great women’s health studies lately? Try to add some to your reading list!

 

References:

  1. Scott, P, Unger, E., Jenkins, M. Southworth, M., McDowell, T., Geller, R., Elahi, M. Temple, R., & Woodcock, J. (2018). Participation of women in clinical trials supporting FDA approval of cardiovascular drugs. Journal of the American College of Cardiology, 71(18), 1960-9.
  2. Lau, E. & Wood, M. (2018). How to we attract and retain women in cardiology? Clinical Cardiology, 41(2), 264-268.
  3. Brown, C., Revette, A., de Ferranti, S., Liu, J., Stamoulis, C., & Gooding, H. (2019). Heart Healthy Behaviors in Young Women: What Prevents Teens from Going Red? Abstract presented at American Heart Association Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions, Houston, TX.

 

 

Who is writing what you're reading? Look at the great mix of people on the AHA early career blogging team!

Who is writing what you’re reading? Look at the great mix of people on the AHA early career blogging team!

 

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Women’s History Month: Cardiology Edition

Somehow it’s already March, which means it’s Women’s History Month, so I wanted to take this opportunity to highlight some of the many amazing cardiologists and researchers (who also happen to be women) who have shaped our field.

Last month, I wrote about the importance of science outreach, especially with regard to promoting science and cardiology to young girls and women, because women still make up around only a third of scientific researchers and only around 13% of cardiologists are women. To learn more, Renee P. Bullock-Palmer’s most recent blog is a great resource.

This month I wanted to highlight some of the women who paved the way for the rest of us.


Now, unsurprisingly, simple Google searches for things like “scientists who shaped cardiology” or “most famous cardiologists” provide results that are pretty male and pale. There weren’t that many pieces that included women in their lists of cardiologists/researchers, and there were only a handful of sources I found that focused specifically on women. Lucky for you, I’ve collected what I found here! I’m also going to highlight several of the brilliant women who shaped our field – this is by no means an exhaustive list of amazing women in cardiology (or their accomplishments) because there are too many to fit on one list.

 

Maude Abbott, MD was a Canadian physician who invented an international classification system for congenital heart disease in the 1930’s. Her work the Atlas of Congenital Heart Disease became the definitive reference guide on the subject.

 

Helen B. Taussig, MD, FACC is widely regarded as the Founder of Pediatric Cardiology. In the 1940’s she developed the operation to correct the congenital heart defect that causes “blue baby” syndrome. She received the Medal of Freedom from President Lyndon B. Johnson and was the first female president of the American Heart Association.

 

Myra Adele Logan, MD was the first woman (and only the 9th person!) to operate on a human heart in 1943.

 

Marie Maynard Daly, PhD was first African American woman to obtain a PhD in chemistry in the United States, whose research in the 1950’s was invaluable in demonstrating the relationship between high cholesterol levels and heart attacks.

 

Celia Mary Oakley, MD was one of the first women cardiologists in the United Kingdom and was part of the team that coined the term hypertrophic cardiomyopathy in the late 1950’s.

 

Sharon A. Hunt, MD was just one of seven women in her 1967 medical school class and she went on to revolutionize the field of heart transplantation by working to improve survival rates by identifying and treating rejection and determining how to reduce the side effects of the drugs.

 

Nanette Kass Wenger, MD, was among the first cardiologists to focus on heart disease in women, and to evaluate the different risk factors and manifestations of the condition, specifically coronary artery disease, in women and men. I was lucky enough to talk with her about her work at AHA Sessions 2018, which I wrote about here. You can also follow her on twitter @NanetteWenger.

 

Christine Seidman, MD, is a researcher who transformed the field of cardiovascular genetics with her research that uncovered the genetic basis of many human cardiovascular disorders, including cardiomyopathy, heart failure and even congenital heart malformations.

 

Elizabeth O. Ofili, MD, MPH, FACC is a clinical scientist who led the effort to implement the landmark African American Heart Failure Trial (AHEFT), whose findings improved the practice guidelines for the treatment of heart failure in African Americans. She also became the first woman president of the Association of Black Cardiologists in 2000.

 

Ileana Piña, MD, MPH, FACC is a nationally renowned cardiologist known for her work in heart failure and improving patient rehabilitation outcomes. Her work has also upturned preconceived notions about women in the medical community and she works tirelessly to get more women into clinical trials.

 

Rong Tian, MD, PhD is a leader in the field of cardiac metabolism whose work has been translated to clinical trials. Among her many contributions, she was the first to demonstrate that AMP-activated protein kinase (AMPK) acted to remodel cardiac energy metabolism, which critically informed the heart failure field. You can also follow her on twitter @Rongtian2.

 

I want to note, that these cardiologists and researchers are not important just because they are women – they are talented scientists and cardiologists who happen to also be women. But pieces like this are important because representation matters. It’s important for everyone, especially young girls and women, to see that it’s possible not just to be successful in this field, but also to revolutionize it.

 

Helpful sources & suggested reading:

 

 

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Winning Over The Hearts Of Future Scientists: My Experience With Go Red Goes STEM

On a chilly Thursday in late November, Loyola’s Women in Science group teamed up with The American Heart Association in Chicago to cohost their Go Red Goes STEM event. Young women from area high schools spent the day at Northwestern University’s Prentice Women’s Hospital, where they joined up with graduate assistants in biomedical sciences for a breakout session, “Healthy Habits for a Healthy Heart.”

The room held about 7 graduate assistants, a few tables of high schoolers, and an entire flock of sheep hearts – over 2 dozen of them, more than one for each student.  My MD/PhD candidate friend, Amanda, had meticulously sliced each sample to strategically showcase the anatomy. We distributed gloves, safety goggles, lab coats, hair ties, and hearts, and our future scientists were ready to learn.

Since Amanda and I are the cardiovascular pharmacologists of the bunch, we set out to explain the amazing organ that powers our entire circulatory system. The heart is divided into four chambers; two atria that pull blood into the heart, and two strong ventricles that push blood out of the heart.

We asked the students to pinch the thick, mighty walls of the left ventricle with their gloved hands. The left ventricle pumps oxygenated blood – about 5 liters of it – to the entire body. If an insult to the left ventricle thins or scars that muscle tissue, the heart can’t work as well as it should. We then called on the class to trace the left anterior descending coronary artery, which feeds the heart with its own supply of fresh blood. Imagine, we quizzed them, what might happen when that blood supply is blocked in a heart attack. 

As the young women held the hearts in front of them, turning them around and inspecting every angle, I circled the room to answer any questions about heart anatomy. The etymology associated with the coronary artery calls to mind how it wraps around the heart like a crown decorates the head of a queen. I wished I could tell every young woman in that room that she can be like a queen, too – a powerful, strong, intelligent, leader of her generation.

I navigated Twitter that evening by the event’s dedicated hashtag and discovered a wave of tweets about “girl power,” mentions of women in medicine, photos of our session, and a sprinkling of scientist emoji. Though the event was over, I felt hopeful that the students would carry the day’s enthusiasm for science with them into the world. 

In the following weeks, I found myself wondering about our next generation of scientists in the place where I do my deepest thinking: the aisles of Target. My mind wandered as I scanned the shelves. Did these young women have enough role models in our field when they were growing up? Were the toy manufacturers succeeding in making technological games gender-neutral? Were there were enough NASA tees in the girls’ section?

Our future female doctors and nurses, scientists and engineers are out there, and they are going to change the world someday. It’s my New Year’s wish that our community of early career professionals can help them to realize that passion for science and encourage them to pursue their dreams.

Annie Roessler Headshot

Annie Roessler is a PhD Candidate at Loyola University in Chicago, IL. Her research focuses on the neurobiology and molecular mechanisms of electrically-induced cardioprotection. She tweets @ThePilotStudy and blogs at flaskhalffull.com