The National Institutes of Health (NIH) has awarded more than $6.5 million to the University of Minnesota Medical School Department of Family Medicine and Community Health to fund two five-year studies designed to build greater understanding of the links between psychosocial stress and heightened risk of cardiovascular disease among children in diverse populations.
Led by principal investigator Jerica Berge, professor of family medicine and public health, the simultaneous studies, known jointly by the name of “Family Matters,” involve in-depth research with children from 1,307 Twin Cities families. The studies will, Berge explained, “examine how, as we say, stress ‘gets under the skin,’ to understand how different stressors get to the point of manifesting in higher cardiovascular risk.”
While running two studies at the same time is a monumental task, Berge said that her team — and their funders — agreed that it was the best way to tackle the subject. “These are five-year studies,” she said. “It does take time, but because we have two studies running, we will get done in five years what might have otherwise taken us 10.”
Families participating in the study have been working with University of Minnesota researchers since their children were 5 years old, Berge said. The children are patients in family medicine clinics run by the university.
“We originally connected with these families through primary care clinics via a letter,” Berge explained. The young subjects range in age from 5 to 16 years old. “We’ve followed them over time.”
NIH funders were excited to work with such an extensive, long-range study, with participants from a range of cultural and ethnic backgrounds, Berge said. “The fact that we have these families already involved means we can move a little quicker to get to intervention. If you go over a longer period of time, this allows you to stick with the same families and learn with these really diverse groups.”
Study subjects represent the full range of ethnicities living in the Twin Cities, she added, with equal groups of Black, Hispanic, Native, immigrant and refugee and white subjects: “This allows us to look across different experiences to understand what are the risks and protective factors for families.”
While the Family Matters studies focus on the current health of families, Berge said, there is also a focus on building interventions that can be implemented in real time. By working with subjects and their families over time, she and her colleagues believe they can develop ways to help improve their long-term health. “What we’re trying to do with these studies is if we can understand how that risk trajectory happens we can build interventions to reduce that risk,” Berge said.
With an academic background in behavioral health, Berge is particularly interested in finding connections between mental and physical health. “Across my career I noticed this common thread in most problems,” she said. “It’s that link between mental health and physical health. Studies like these are bringing together how mental health stressors can lead to physical health issues, and we hope to be able to highlight effective interventions.”
Conducting these two studies is no small task. Families participating in Family Matters agree to regular visits from Berge’s team of researchers, some virtual, some in-clinic and many in their own homes.
“It is a huge team,” Berge said. “Other co-investigators are faculty like myself, then we hire a lot of staff from the communities that we are partnering in.”
Some visits are focused on measuring different levels of psychosocial stress, including neighborhood safety, food insecurity, the parent-child relationship and the impact of structural racism. Other visits are focused on taking physical measurements. “We monitor traditional measures of heart health, including weight, blood pressure, arterial stiffness, height,” Berge said.
While the studies are ongoing, Berge said that she and her team are constantly thinking of ways to expand their research with the goal of improving participants’ health outlook. If they uncover an intervention that appears to be making a positive impact, she explained, “We can build small pilot studies to test things out. I don’t think it is useful for families for us to say, ‘We’ll get back to you in 10 years.’ As we learn things with our participants, we try out the next stage to see if it does help to reduce cardiovascular disease risk.”
This approach includes participants in the study, respecting families’ approach to maintaining their children’s health, rather than seeing it in a negative light as something that is broken and needs to be fixed. “We’re not just trying to call out the negative things that are happening in these families or blaming them,” Berge said. “It doesn’t always help to call out the negative. We also call out the positive and see how we can replicate that.”
Berge believes that in the end the Family Matters studies will reveal that multiple sources of psychosocial stress add up to increased cardiovascular risk. “As you look at those biological and psychosocial factors, how do they contribute to key measures of cardiovascular risk that you can see over time?” she asked. “Which of those levels of stress had the bigger impact?”