by Lamario Williams, GS-2
“Sick and tired of being sick and tired…” Fannie Lou Hamer famously echoed these words in 1964, but this colloquialism is a common way of expressing the impact of stress in African American Vernacular English. Prolonged stress can negatively impact health outcomes, but this topic is not widely discussed in the context of medicine or science. Previous research indicates that Black women report higher stress than white women, so racial differences in perceived stress may contribute to health disparities. I was able to chat about this very issue with Dr. Tiffany L. Carson, who studies the effects of stress on health disparities.
Dr. Carson is an applied epidemiologist and Assistant Professor in the Division of Preventive Medicine at the UAB School of Medicine. She also holds appointments as an associate scientist in multiple UAB research centers, including the Comprehensive Cancer Center, Minority and Health Disparities Research Center, and the Nutrition Obesity Research Center. Dr. Carson’s current research focuses on identifying bio-behavioral contributors to health disparities of black and white women with a particular focus on how stress affects obesity and cancer disparities, potentially through changes in gut microbiota. She is a Birmingham native who earned her BS in Biology from Florida State University and her MPH and PhD in Epidemiology from UAB. She also completed a post-doctoral fellowship at the University of Arkansas for Medical Sciences.
The Interview: Lamario | Dr. Carson
I want to start broad and make sure we get everyone on the same page. What is stress?
Stress is the body’s response to a change in circumstances or the environment. To be clear, stress is not always a bad thing. Stress is a necessary reaction to help sustain the body in certain situations. Stress can make an individual more alert or ready to react to danger. Also, people tend to think of stressors as negative events. However, stress can also be caused by positive events. For example, relocating, starting a new job, and getting married within a 6-month time frame could make for a very stressful time despite each of the stressors being viewed as positive life events. Stress becomes harmful when it persists over an extended period of time. This is considered chronic stress and is most closely associated with adverse health outcomes. Stress also becomes harmful when individuals employ maladaptive coping strategies to deal with the stressors.
Last year, you published an article in JAMA1 about the intersection of stress, history, and culture in obesity disparities in Black women. Your comments about how “the adverse effects of family secrets” can lead to long-term health consequences really stood out to me. Why do you think Black families are more prone to creating and keeping these secrets?
The tendency for Black people to keep “family business” within the family is believed to have origins in slavery and has continued as a cultural norm due to continued systemic racism and a general mistrust of systems. As you might imagine, there was a high level of risk associated with sharing certain information outside of the trusted family circle during times of slavery. Experts believe that this culture of secrecy has been passed down throughout generations and is intended to be a form of safety and protection, although in some cases, it functions in the exact opposite way.
In didactic medical school education, we learn a lot about signaling pathways and pharmaceuticals but not as much about the healthcare institution itself. What are your suggestions to healthcare professionals for minimizing health disparities?
Minimizing health disparities is a challenging and complex task because it is a multifactorial problem, much of which is outside the scope of what healthcare professionals can control. However, there are still some things that healthcare professionals can do. Increasing cultural competence, recognizing and working to minimize implicit bias, addressing health literacy, ending racism, and continuing support/advocacy for universal health care are all things that healthcare professionals can do.
You study the microbiome (a recently hot topic) and stress in health disparities. What is your take on the field, and what are common misconceptions about the microbiome we should be wary of?
There is certainly a lot of recent interest in the microbiome. The microbiome offers a new and exciting area of research with the potential to unlock novel strategies for preventive and therapeutic approaches for a range of chronic diseases. The microbiome has been associated with conditions like obesity and some cancers. However, there is still much to be clarified about these associations. I would caution people to remember that association does not equal causation. Thus, more research is needed to understand when microbial perturbations cause certain health outcomes and when they occur as a result of certain health conditions. We are still learning a lot about the microbiome and mechanisms linking the microbiome to health outcomes. My work is also trying to understand behavioral strategies to modify the microbiome and the resiliency of an established host microbiome. While I am optimistic that we will be able to leverage the microbiome to improve health outcomes, I still think we have a long way to go before our understanding is developed enough to truly impact health care and population health outcomes.
How does eliminating health disparities for Black women benefit society as a whole?
Reducing health disparities by improving outcomes among underserved and marginalized groups including Black women benefits society as a whole because all people of society are interconnected. As long as any group suffers, our society can never reach its full potential. Improving health leads to a less burdened health care system, less time lost from work, better quality of life, and a greater capability to make continued contributions to society. Thus, there are social, economic, and moral implications for focusing attention on minimizing health disparities for Black women.
Why is treating chronic diseases like obesity and cancer important for benefitting society as a whole?
Chronic diseases like obesity and cancer continue to create a great public health and economic burden on our society. Additionally, chronic diseases impact productivity and quality of life of members of society. The greater societal benefit of treating chronic illnesses goes back to the concept of interconnectedness and understanding that healthier individuals lead to vibrant and productive communities.
So let’s switch gears a little and talk about disparities that exist in academia, such as the “Minority Tax” (additional labor and expectations that come with being underrepresented in the Academy). What is your advice to young adults seeking careers in science and medicine for preventing ourselves from overcommitting to service?
Professional service is an important part of community in academic medicine and individuals from underrepresented backgrounds are particularly important for bringing diverse perspectives to service activities. At the same time, overcommitting to service is a common challenge experienced by early career scientists from underrepresented groups. My first piece of advice is to learn how to say “no”. This can be very difficult to know when and how to say no as a young professional. So, seek a mentor to help you successfully navigate this dynamic. I led a paper2 published in Academic Medicine with colleagues from around the country on this topic. I would advise early career individuals to remember that saying “yes” to something means saying “no” to something else. Thus, you must balance what you agree to do while recognizing that it means you will not be able to do something else because time is finite. I would encourage everyone to prioritize his or her scholarship first! These are the things that you will truly be evaluated on for promotion and tenure. Next, when possible, try to engage in service activities that align with your scholarship (e.g., chairing a health equity committee as a health disparities researcher) and/or allow you to have agency or influence something that you care about (e.g., serving on an admissions board). Lastly, try to serve in ways that align with your personal passion. Again, time is a limited commodity. Each individual should work to align his or her time with things that are prioritized as most important to achieve his or her professional and personal goals.
What is your advice to future physician-scientists for finding quality mentors to help with career trajectory?
When seeking a mentor, it is important to identify exactly what is needed from a particular mentoring relationship. For example, one individual may provide quality mentorship on a specific content area while another may be more appropriate for general career development. Thus, the more clear the trainee is on what is needed, the more targeted and productive the relationship is likely to be. Individuals seeking mentors can use several methods to identify potential mentors. For example, it can be helpful to identify an individual whose career you want to emulate. This person may serve as a good mentor or connect you to others. Conversations and networking provide another good option for identifying mentors. It is also helpful if you can leverage existing relationships to connect you with potential mentors. For the earliest part of my career, each mentor personally connected me with additional mentors as I identified gaps in my mentoring team.
1. Carson TL. Heavy Hunger-Managing Weight and Obesity in Black American Communities. JAMA. 2019;322(16):1534-1536.
2. Carson TL, Aguilera A, Brown SD, et al. A Seat at the Table: Strategic Engagement in Service Activities for Early-Career Faculty From Underrepresented Groups in the Academy. Acad Med. 2019;94(8):1089-1093.
Like this content? Look out for more like this in a special edition of the MSTP Newsletter on diversity, race, and intersectionality currently in production!