September 7, 2023 • 20 mins
Drs. Allyson Redhunt and Heather Burris discuss their article, "Resilience as a potential modifier of racial inequities in preterm birth,” published in the July 2023 issue (Vol. 83) of Annals of Epidemiology. In this study, the researchers investigate the potential protective effect of individual resilience on preterm birth risk.
Read the full article here:
https://www.sciencedirect.com/science/article/pii/S1047279723000753
Episode Credits:
- Executive Producer: Sabrina Debas
- Technical Producer: Paula Burrows
- Annals of Epidemiology is published by Elsevier.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Patrick Sullivan (00:10):
Hi, you're listening to EPITalk
Paper, a monthly podcast fromthe Annals of Epidemiology.
I'm Patrick Sullivan,Editor-in-Chief of the journal,
and in this series we take youbehind the scenes of some of the
latest publications featured inour journal.
Today, we're joined by DrAllyson Redhunt and her mentor
(00:36):
and co-author, Dr Heather Burris, to talk about their article
"Resilience as a potentialmodifier of racial inequities in
preterm birth.
" You can find the full articleonline in the July 2023 issue of
Annals at www.
annalsofepidemiology.
org.
I want to introduce our guests.
Dr Redhunt graduated from TuftsUniversity School of Medicine
(00:58):
and will begin her internship inObstetrics and Gynecology at
Albany Medical College in July.
Dr Burris is an attendingneonatologist at the Children's
Hospital of Philadelphia andAssociate Professor of
Pediatrics at the University ofPennsylvania Perelman School of
Medicine.
She studies social andenvironmental factors that
contribute to perinatal healthinequities.
(01:19):
Welcome, Drs Redhunt and Burris.
Heather Burris (01:22):
Thank you.
We're happy to be here.
Thank you.
Patrick Sullivan (01:25):
So we're going to talk some about your paper
that recently came out, focusingon racial inequities in preterm
birth, and I wonder if youcould start out just by talking
a little bit about the questionthat you wanted to ask and how
you came to that researchquestion.
Heather Burris (01:41):
Sure.
So I think for a long time youknow, maybe decades ago folks
thought that some of thedifferences in preterm birth
outcomes by race and ethnicitywere somehow innate.
And I think the last severaldecades have kind of disproven
that hypothesis and reallyhighlighted that a lot of the
(02:03):
lifetime exposures that folkshave in the United States that
can differ by race and ethnicity, as well as socioeconomic
position and other factors,really contribute to differences
in birth outcomes, includingpreterm birth.
And recently there's been areal focus on, you know, are
there ways to kind of buffersome of these adverse exposures
(02:26):
that lead to differences inbirth outcomes?
And for a little while therewas a focus on individuals'
ability to be resilient to theseexposures.
So I'm going to refer to Dr.
Redh unt as Allyson.
Allyson came to us first as acollege student and then did a
few years working as a researchassistant in our group up in
(02:49):
Boston when I was there with ourcolleague Dr.
Michelle Hacker, anotherepidemiologist who focuses on
reproductive epidemiology, andAllyson really was asking the
question could individual levelresilience modify the
association between race orethnicity and preterm birth?
And with the hypothesis thatpotentially folks with a higher
(03:12):
level of resilience might beable to kind of overcome those
adverse exposures.
Yeah, so I think that's themain way in which we came about
this question.
Patrick Sullivan (03:22):
Then you had access to this prospective
cohort study that actually hadsome of the data elements that
you needed.
Was that planned in the studyor was that just a fortunate
availability of data?
Heather Burris (03:34):
Great question.
The primary purpose of thespontaneous prematurity and
epigenetics of the cervixproject, which I was one of the
two principal investigators ofthat study with Dr.
Michelle Hacker, was to look atthe cervical epigenetic
biomarkers and whether theycould predict spontaneous
preterm birth.
And we enrolled nearly 1200women or pregnant people into
(03:56):
that study and followed them andwaited to see if people ended
up having spontaneous pretermbirth or term births.
And then we did a matchednested case control study and
those results were recentlypublished in a different journal
.
But when a student comes to uslooking for a project we think,
ok, what data are available inthis data set?
(04:17):
And because Dr.
Hacker and I were so focused onsocial and physical
environmental determinants ofspontaneous preterm birth, in
addition to these biomarkers wehad also proposed to look at
some psychosocial measures andpartway through the study we
added resilience, and so you cansee in Dr.
Redh unt's flow chart that fora little while we didn't collect
any resilience measures andthen partway through the study
(04:38):
we started to offer theresilience scoring to
participants.
Patrick Sullivan (04:42):
Thanks for the information about the context
for the study, and now I wonderif you could just summarize what
are the major findings of thepaper in your analysis.
Heather Burris (04:52):
Dr.
Redh unt really did not findthat resilience modified the
association between race andpreterm birth in our study and
really then makes the case thatjust bolstering.
Even if we knew how to do sucha thing, bolstering individual
level resilience may not beenough to overcome inequities or
disparities in preterm birth.
Patrick Sullivan (05:13):
I want to pick up on that because I think it's
a really interesting questionto ask, it's a really
interesting hypothesis and it'sa really pretty clear answer, I
think, from your data.
But I think the idea and Iguess maybe I'll ask if it's
surprising to you that it didn'tmitigate this effect or this
association.
Heather Burris (05:30):
I think originally we might have been a
little bit surprised, but thenwe started reconceptualizing.
We're not the only folks tohave done so.
Lots of people arereconceptualizing resilience.
That resilience can often be aresponse.
We don't know that people'sresilience is kind of a stagnant
state or a trait that you haveyour whole life.
(05:51):
But if you have experiencesthroughout your life, maybe some
adversities and other factorsthat could lead to needing to
build resilience, those sameexposures might be the
antecedents of preterm birth andthey might also lead to
increased resilience.
And so maybe this resilience asa modifier of the association
(06:12):
between race and adverse birthoutcomes may not be as clear as
we initially hypothesized.
Patrick Sullivan (06:19):
Yeah, and I think that that's so insightful
because we're talking aboutexposures that probably happen
over the life force to shaperisk in biological, behavioral
and sort of environmental ways.
And so I think in some waysit's a great question to ask,
but also maybe kind of a highbar to think that individual
(06:40):
resilience can really overcome alot of inequities that grow out
of structural inequities,inequities in access to health
care, potentially earlier in thelife course, and so I think
it's an important question toask, but in that context, that
these are really problems thatgrow out of really structural
and long term inequities in oursociety.
Heather Burris (07:02):
Absolutely.
It also highlights that raceitself, and I wanted to make
sure we said this in thispodcast, that race itself is not
some sort of construct.
That is also completely it'snot really a biologic factor,
right it?
Folks who identify with certainraces or ethnicities have
different life experiences andso, in this study, identifying
(07:23):
with this particular race orethnicity it's probably a proxy
for lots of exposures thathappen throughout the life
course, as you say.
Patrick Sullivan (07:30):
Right, yeah, you have this note in the paper
that you know resilience mightonly play a minor role in this
relationship because really it'sfactors beyond individual
characteristics that areresponsible for the inequities.
And you mentioned things likeredlining access to prenatal
care and employmentopportunities and so I think
redlining, literally speaking tothat, you know, sort of
(07:52):
structural built environmentcomponent and all the things
that travel along with wherepeople live, all those exposures
.
So thanks for that thought.
So I want to just get one morequestion, in which is where do
you think this leaves us?
You sort of ask a question.
You didn't reject your nullhypothesis, which is fine.
(08:13):
I actually love at Annals thatwe sort of have the perspective
that sometimes null findings areas impactful as rejecting the
null.
But where do you think thisleaves the field, or what's sort
of the next question thatfollows on around understanding
these inequities?
Heather Burris (08:30):
Yeah, well, I appreciate that the journalist
is open to null findings, and Ithink again.
We think about mentoring,students and trainees and
projects.
It's so important that eitherway, the answer is interesting
and important, and so we hopethat that would be the case for
this project as well.
Most of my work at this point isfocused on trying to understand
(08:53):
the totality of exposures thatlead to differences in outcome,
both by finding structuralinterventions that can improve
population health.
So we have a study on greenspace exposure during pregnancy
and hypertensive disorders ofpregnancy with a colleague of
mine named Dr.
South, Eugenia South.
She's an emergency medicinephysician at Penn, so the two of
(09:15):
us are running that study workwith others focused on exposures
that are highly relevant, atleast in the Northeast over the
last few weeks air pollution,also rising temperatures,
changes in climate and so arethere ways that we can bolster
not just an individual'slikelihood of a healthy
pregnancy but a whole populationright, and how can we narrow
(09:36):
gaps?
And I think it's reallyimportant and what Allyson has
highlighted is that it's reallyimportant that just improving
the world for all may not alwayswork to diminish disparities,
and so we need to be mindful ofthat as we're thinking about
these interventions at thepopulation level and keeping an
eye on inequities.
Patrick Sullivan (09:54):
Yeah, I think.
I mean, I think it's going tohave to be a both and approach
doing what we can in ways thatraise all boats and then
recognizing that there may beparticular interventions or
different kinds of resourcesthat are needed to address
historical and currentinequities that rise above that
level of individual behavior orgenetics or, you know, that
shape the environments in whichour health is formed.
(10:14):
Great.
So I want to turn a little bitinto a section that we call
Behind the Paper, because Ithink it's fascinating how
papers come to be, and I thinkit's especially important here
to hear both of your voicesabout this sort of mentor-mentee
relationship, which are sospecial for all of us.
We've all been mentored and weall grow into mentors, and so
(10:37):
it's a critical part of ouracademic process.
So I might start, Dr.
Redhunt, by asking you justabout you know how you came to
work with Dr.
Burris on this and what thatmentoring relationship was like
during the course of doing thisanalysis and writing the paper.
Allyson Redhunt (10:53):
So when I was a college student I was searching
for a summer internship workingin research and I at the time
really didn't know that muchabout what my future would look
like or what my future interestswould be, just kind of had this
concept but I thought I mightbe interested in like maternal
and child health and outcomes,and so I went with that and I
(11:15):
was fortunate enough to beinterviewed by Dr.
Burris as well as Dr.
Hacker and some other people upin Boston, and so I started
working as a research student,mostly doing enrollment for the
study, and then that is how Imet Dr.
Burris and then, in terms ofmentorship, I really felt like
(11:38):
she not only was a wonderfulsupervisor for that internship
but also really just had so muchinsight about how to start a
career as a physician andresearcher.
And we have continued thisrelationship now not quite 10
years, maybe eight years, soit's been a long time and she's
really helped me kind of throughall these different transitions
(11:59):
that I've had from college toworking to medical school and
now as I begin residency.
Patrick Sullivan (12:04):
What a wonderful story and I think
these long-term relationshipsbetween mentees and mentors are
so rewarding for both, on bothsides.
Dr.
Burris, you just want to maybereflect on.
You know from your perspective.
You met an enthusiastic eager,you know, earlier I say earlier
career colleague and you knowwhat's the experience been
really being a mentor throughthese stages and seeing where Dr
(12:28):
.
Redhunt has landed and whatshe's doing now?
Heather Burris (12:31):
Yeah, well, clearly I was the lucky one in
this relationship, but when youhave a summer student who is so
outstanding, you just hope thatthey might consider coming and
working with you for a few yearsbefore going on to the next
phase, whether that be a PhDprogram or a medical school
program or any other future lifethat folks want to do, and so
we were really excited whenAllyson wanted to take a couple
(12:53):
of gap years and work with us inBoston on the study, and so it
is really satisfying, as I'msure all the mentors on this
call can understand or on thispodcast can understand.
When you have a student start aproject enrolling the same
participants, that then at theend of the study she then
analyzes the data, writes thepaper and gets it over the
finish line, that's reallywinning.
(13:15):
And then when your mentees canteach you something that you
don't maybe know upfront I meanagain, most people on this
podcast would understand thatthe landscape around studying
inequities in health generallyhas really changed in the last
few years and our language haschanged over time.
The way in which we considervariables has changed over time,
(13:39):
and so Allyson was really upand reading all of the latest
and greatest guidance on how tothoughtfully consider asking and
answering this question, whichI think you know, if we had
started the project 10 years ago, we specifically on resilience
and analyzing resilience we maynot have used exactly the same
methods that Allyson broughtforth in this study.
Patrick Sullivan (13:59):
Yeah, thank you so much for that, and just
this.
I really want to pick up onthis idea that when we mentor,
if we go into that with humility, then we learn as much as we
share.
Just because you know menteescome, I think it even works at
the level of mentees have beenin school.
You know, in my case you know20 years more recently than I
(14:20):
have and things change.
So I think there is this realmutuality about what later
career mentors can share andwhat earlier career mentors
bring to that relationship andin the best of cases it really
is a two-way street as far asyou know, as far as learning.
So thanks for reflecting onthat.
Back to Dr.
Redhunt, I just wonder, likehaving been through this process
(14:43):
yourself and having theopportunity to work with great
mentors and landing where youare now, what advice would you
give to current and futurestudents about mentorship or
about the idea of integratingsome research experience into
your training pathway?
Allyson Redhunt (14:58):
In terms of integrating research experience.
I think probably especiallytalking to my medical classmates
like research is not somethingthat everyone's super excited
about, but I found that,although it is something I want
to continue to do for my careereven if I didn't have that plan
working on a research study andunderstanding the way that data
is collected and the way thatit's analyzed and all the people
(15:18):
who go into that and the waysthat you're asking the questions
and reconsidering yourquestions, makes me a much more
critical consumer of medicalinformation and it makes me
think a lot more carefully.
When there's a new study, isthis something that I would want
to integrate into my practice?
Does it apply to only part ofmy practice?
And it really helps me bringthat critical lens, and so I
(15:40):
have found it really invaluable.
I think that, in general,medical schools are moving
towards also emphasizing that aspart of the curriculum, and
it's something that I reallyappreciated in my curriculum.
In terms of mentorship, I thinkthat what makes Dr.
Burris such a- There are manythings that make her a wonderful
mentor, but something that I'vebeen thinking about is she is
(16:00):
really fearless about kind oftackling all of the hard
questions, and I have memoriesof her talking to me about
finances in medical school andwhat it's like to be a friend
and a family member as you growinto being a physician.
Those are the things that are alittle bit harder to look up
online or ask classmates about,whereas the science you can
(16:21):
sometimes pick up from yourpeers and from self-study.
But I think that in mentorshipthose hard conversations that
are especially hard for someonewho feels young in the
profession to ask I feel like Dr.
Burris was always ready tobring those things up and really
tackle them head on.
Patrick Sullivan (16:38):
Great.
I want to thank you both forsharing about these.
Mentor-mentee relationships arepart of our professional world,
but they're also, as you sortof alluded to, quite personal
and sort of help us along ourjourneys.
Again for both, for both thementor and the mentee.
So thanks for both of you forbeing open to sharing about that
.
I guess I'd like to just askbefore we wrap up are there any
last thoughts or points thatyou'd like to share with Annals
(17:00):
readers and the listeners to thepodcast?
Heather Burris (17:03):
Yeah, I wanted to highlight something that I
think many folks probably had ashared experience.
But one of the things that madeDr.
Redh unt's experience richerwas having really two mentors.
So I think maybe in thetraditional laboratory setting
there might have been more of asingle mentor of a big lab and
then that's your mentor andyou're the mentee, and that is a
(17:23):
very formal relationship and Ithink many of us have adopted
different ways in which tomentor and so, especially when
you're asking medical questionsusing epidemiologic methods, I
think it's so important to havean epidemiologist, maybe, and a
physician potentially.
Sure, there are many ways to doresearch, but I feel like that
(17:44):
gave Allyson a way in which toanalyze data rigorously, while
also considering the kind ofgeneral day-to-day practice and
how you enroll in the setting ofan antinatal clinic, and so
really kind of gave her optionsand some of our mentees.
So Dr.
Hacker and I have shared manymentees at this point.
Some have gone on to do theirPhDs in epidemiology or public
health and others have gone onto medicine or nursing, and I
(18:07):
think there are many paths totake, but having a diversity of
mentors who can bring differentprofessional and lived
experiences can be very, veryhelpful.
Patrick Sullivan (18:16):
Yes, thanks for that, and the idea of sort
of multidisciplinary teams totackle these questions is key.
So thanks for acknowledgingthat, although I will say, Dr.
Burris, I know that you're aclinician, but you were talking
like an epidemiologist when youtalk about the sort of
historical factors and the builtenvironments, and the
structural framework throughwhich some of these inequities
(18:38):
arise is right on the nose.
Heather Burris (18:40):
So I've learned from some of the best.
Patrick Sullivan (18:42):
I think so yeah, I mean just not to belabor
the point, but the language ofour disciplines.
Meaning, how do you reallyinternalize this stuff?
I think we can read about it,we can read journals, but for me
it's in discussions with peoplewho have complementary
expertise where we're generatingideas and in a way that's not
even that tension or conscious,I think we internalize the
(19:04):
language around these things andlanguage is ideas, right, that
kind of language that we'retalking about is really
reflective of the theoreticalframeworks.
So I think that's the reasonthat even in this age, we're
recording over Zoom.
So I shouldn't throw stones,but like, as we move more
towards text messaging andmessaging back and forth and
platforms, that conversation, Ithink, develops shared
(19:27):
vocabulary, which is the stuffthat shapes our research concept
.
So agreed aboutmultidisciplinary teams and
sharing this language.
So that brings us to the end ofthis episode.
I want to thank you again, Dr.
Redh unt and Dr.
Burris, for joining us today.
It was a pleasure to have youon the podcast.
Thanks for the work that you doand we'll look forward to
(19:48):
reading more of your work andmaybe having you again at a
later point in your careers toreflect on the work that you're
doing and how you've reallyaccomplished this piece of work
together.
Heather Burris (19:57):
Thank you so much for having us.
Patrick Sullivan (20:07):
I'm your host, Patrick Sullivan.
Thanks for tuning in to thisepisode and see you next time on
EPI Talk (20:12):
Behind the Paper.
EPI Talk is brought to you byAnnals of Epidemiology, the
official journal of the AmericanCollege of Epidemiology.
For a transcript of thispodcast or to read the article
featured on this episode andmore from the journal, you can
visit us online at www.
annalsofepidemiology.
org.
Hi, you're listening to EPITalk
Paper, a monthly podcast fromthe Annals of Epidemiology.
I'm Patrick Sullivan,Editor-in-Chief of the journal,
and in this series we take youbehind the scenes of some of the
latest publications featured inour journal.
Today, we're joined by DrAllyson Redhunt and her mentor
(00:36):
and co-author, Dr Heather Burris, to talk about their article
"Resilience as a potentialmodifier of racial inequities in
preterm birth.
" You can find the full articleonline in the July 2023 issue of
Annals at www.
annalsofepidemiology.
org.
I want to introduce our guests.
Dr Redhunt graduated from TuftsUniversity School of Medicine
(00:58):
and will begin her internship inObstetrics and Gynecology at
Albany Medical College in July.
Dr Burris is an attendingneonatologist at the Children's
Hospital of Philadelphia andAssociate Professor of
Pediatrics at the University ofPennsylvania Perelman School of
Medicine.
She studies social andenvironmental factors that
contribute to perinatal healthinequities.
(01:19):
Welcome, Drs Redhunt and Burris.
Heather Burris (01:22):
Thank you.
We're happy to be here.
Thank you.
Patrick Sullivan (01:25):
So we're going to talk some about your paper
that recently came out, focusingon racial inequities in preterm
birth, and I wonder if youcould start out just by talking
a little bit about the questionthat you wanted to ask and how
you came to that researchquestion.
Heather Burris (01:41):
Sure.
So I think for a long time youknow, maybe decades ago folks
thought that some of thedifferences in preterm birth
outcomes by race and ethnicitywere somehow innate.
And I think the last severaldecades have kind of disproven
that hypothesis and reallyhighlighted that a lot of the
(02:03):
lifetime exposures that folkshave in the United States that
can differ by race and ethnicity, as well as socioeconomic
position and other factors,really contribute to differences
in birth outcomes, includingpreterm birth.
And recently there's been areal focus on, you know, are
there ways to kind of buffersome of these adverse exposures
(02:26):
that lead to differences inbirth outcomes?
And for a little while therewas a focus on individuals'
ability to be resilient to theseexposures.
So I'm going to refer to Dr.
Redh unt as Allyson.
Allyson came to us first as acollege student and then did a
few years working as a researchassistant in our group up in
(02:49):
Boston when I was there with ourcolleague Dr.
Michelle Hacker, anotherepidemiologist who focuses on
reproductive epidemiology, andAllyson really was asking the
question could individual levelresilience modify the
association between race orethnicity and preterm birth?
And with the hypothesis thatpotentially folks with a higher
(03:12):
level of resilience might beable to kind of overcome those
adverse exposures.
Yeah, so I think that's themain way in which we came about
this question.
Patrick Sullivan (03:22):
Then you had access to this prospective
cohort study that actually hadsome of the data elements that
you needed.
Was that planned in the studyor was that just a fortunate
availability of data?
Heather Burris (03:34):
Great question.
The primary purpose of thespontaneous prematurity and
epigenetics of the cervixproject, which I was one of the
two principal investigators ofthat study with Dr.
Michelle Hacker, was to look atthe cervical epigenetic
biomarkers and whether theycould predict spontaneous
preterm birth.
And we enrolled nearly 1200women or pregnant people into
(03:56):
that study and followed them andwaited to see if people ended
up having spontaneous pretermbirth or term births.
And then we did a matchednested case control study and
those results were recentlypublished in a different journal
.
But when a student comes to uslooking for a project we think,
ok, what data are available inthis data set?
(04:17):
And because Dr.
Hacker and I were so focused onsocial and physical
environmental determinants ofspontaneous preterm birth, in
addition to these biomarkers wehad also proposed to look at
some psychosocial measures andpartway through the study we
added resilience, and so you cansee in Dr.
Redh unt's flow chart that fora little while we didn't collect
any resilience measures andthen partway through the study
(04:38):
we started to offer theresilience scoring to
participants.
Patrick Sullivan (04:42):
Thanks for the information about the context
for the study, and now I wonderif you could just summarize what
are the major findings of thepaper in your analysis.
Heather Burris (04:52):
Dr.
Redh unt really did not findthat resilience modified the
association between race andpreterm birth in our study and
really then makes the case thatjust bolstering.
Even if we knew how to do sucha thing, bolstering individual
level resilience may not beenough to overcome inequities or
disparities in preterm birth.
Patrick Sullivan (05:13):
I want to pick up on that because I think it's
a really interesting questionto ask, it's a really
interesting hypothesis and it'sa really pretty clear answer, I
think, from your data.
But I think the idea and Iguess maybe I'll ask if it's
surprising to you that it didn'tmitigate this effect or this
association.
Heather Burris (05:30):
I think originally we might have been a
little bit surprised, but thenwe started reconceptualizing.
We're not the only folks tohave done so.
Lots of people arereconceptualizing resilience.
That resilience can often be aresponse.
We don't know that people'sresilience is kind of a stagnant
state or a trait that you haveyour whole life.
(05:51):
But if you have experiencesthroughout your life, maybe some
adversities and other factorsthat could lead to needing to
build resilience, those sameexposures might be the
antecedents of preterm birth andthey might also lead to
increased resilience.
And so maybe this resilience asa modifier of the association
(06:12):
between race and adverse birthoutcomes may not be as clear as
we initially hypothesized.
Patrick Sullivan (06:19):
Yeah, and I think that that's so insightful
because we're talking aboutexposures that probably happen
over the life force to shaperisk in biological, behavioral
and sort of environmental ways.
And so I think in some waysit's a great question to ask,
but also maybe kind of a highbar to think that individual
(06:40):
resilience can really overcome alot of inequities that grow out
of structural inequities,inequities in access to health
care, potentially earlier in thelife course, and so I think
it's an important question toask, but in that context, that
these are really problems thatgrow out of really structural
and long term inequities in oursociety.
Heather Burris (07:02):
Absolutely.
It also highlights that raceitself, and I wanted to make
sure we said this in thispodcast, that race itself is not
some sort of construct.
That is also completely it'snot really a biologic factor,
right it?
Folks who identify with certainraces or ethnicities have
different life experiences andso, in this study, identifying
(07:23):
with this particular race orethnicity it's probably a proxy
for lots of exposures thathappen throughout the life
course, as you say.
Patrick Sullivan (07:30):
Right, yeah, you have this note in the paper
that you know resilience mightonly play a minor role in this
relationship because really it'sfactors beyond individual
characteristics that areresponsible for the inequities.
And you mentioned things likeredlining access to prenatal
care and employmentopportunities and so I think
redlining, literally speaking tothat, you know, sort of
(07:52):
structural built environmentcomponent and all the things
that travel along with wherepeople live, all those exposures
.
So thanks for that thought.
So I want to just get one morequestion, in which is where do
you think this leaves us?
You sort of ask a question.
You didn't reject your nullhypothesis, which is fine.
(08:13):
I actually love at Annals thatwe sort of have the perspective
that sometimes null findings areas impactful as rejecting the
null.
But where do you think thisleaves the field, or what's sort
of the next question thatfollows on around understanding
these inequities?
Heather Burris (08:30):
Yeah, well, I appreciate that the journalist
is open to null findings, and Ithink again.
We think about mentoring,students and trainees and
projects.
It's so important that eitherway, the answer is interesting
and important, and so we hopethat that would be the case for
this project as well.
Most of my work at this point isfocused on trying to understand
(08:53):
the totality of exposures thatlead to differences in outcome,
both by finding structuralinterventions that can improve
population health.
So we have a study on greenspace exposure during pregnancy
and hypertensive disorders ofpregnancy with a colleague of
mine named Dr.
South, Eugenia South.
She's an emergency medicinephysician at Penn, so the two of
(09:15):
us are running that study workwith others focused on exposures
that are highly relevant, atleast in the Northeast over the
last few weeks air pollution,also rising temperatures,
changes in climate and so arethere ways that we can bolster
not just an individual'slikelihood of a healthy
pregnancy but a whole populationright, and how can we narrow
(09:36):
gaps?
And I think it's reallyimportant and what Allyson has
highlighted is that it's reallyimportant that just improving
the world for all may not alwayswork to diminish disparities,
and so we need to be mindful ofthat as we're thinking about
these interventions at thepopulation level and keeping an
eye on inequities.
Patrick Sullivan (09:54):
Yeah, I think.
I mean, I think it's going tohave to be a both and approach
doing what we can in ways thatraise all boats and then
recognizing that there may beparticular interventions or
different kinds of resourcesthat are needed to address
historical and currentinequities that rise above that
level of individual behavior orgenetics or, you know, that
shape the environments in whichour health is formed.
(10:14):
Great.
So I want to turn a little bitinto a section that we call
Behind the Paper, because Ithink it's fascinating how
papers come to be, and I thinkit's especially important here
to hear both of your voicesabout this sort of mentor-mentee
relationship, which are sospecial for all of us.
We've all been mentored and weall grow into mentors, and so
(10:37):
it's a critical part of ouracademic process.
So I might start, Dr.
Redhunt, by asking you justabout you know how you came to
work with Dr.
Burris on this and what thatmentoring relationship was like
during the course of doing thisanalysis and writing the paper.
Allyson Redhunt (10:53):
So when I was a college student I was searching
for a summer internship workingin research and I at the time
really didn't know that muchabout what my future would look
like or what my future interestswould be, just kind of had this
concept but I thought I mightbe interested in like maternal
and child health and outcomes,and so I went with that and I
(11:15):
was fortunate enough to beinterviewed by Dr.
Burris as well as Dr.
Hacker and some other people upin Boston, and so I started
working as a research student,mostly doing enrollment for the
study, and then that is how Imet Dr.
Burris and then, in terms ofmentorship, I really felt like
(11:38):
she not only was a wonderfulsupervisor for that internship
but also really just had so muchinsight about how to start a
career as a physician andresearcher.
And we have continued thisrelationship now not quite 10
years, maybe eight years, soit's been a long time and she's
really helped me kind of throughall these different transitions
(11:59):
that I've had from college toworking to medical school and
now as I begin residency.
Patrick Sullivan (12:04):
What a wonderful story and I think
these long-term relationshipsbetween mentees and mentors are
so rewarding for both, on bothsides.
Dr.
Burris, you just want to maybereflect on.
You know from your perspective.
You met an enthusiastic eager,you know, earlier I say earlier
career colleague and you knowwhat's the experience been
really being a mentor throughthese stages and seeing where Dr
(12:28):
.
Redhunt has landed and whatshe's doing now?
Heather Burris (12:31):
Yeah, well, clearly I was the lucky one in
this relationship, but when youhave a summer student who is so
outstanding, you just hope thatthey might consider coming and
working with you for a few yearsbefore going on to the next
phase, whether that be a PhDprogram or a medical school
program or any other future lifethat folks want to do, and so
we were really excited whenAllyson wanted to take a couple
(12:53):
of gap years and work with us inBoston on the study, and so it
is really satisfying, as I'msure all the mentors on this
call can understand or on thispodcast can understand.
When you have a student start aproject enrolling the same
participants, that then at theend of the study she then
analyzes the data, writes thepaper and gets it over the
finish line, that's reallywinning.
(13:15):
And then when your mentees canteach you something that you
don't maybe know upfront I meanagain, most people on this
podcast would understand thatthe landscape around studying
inequities in health generallyhas really changed in the last
few years and our language haschanged over time.
The way in which we considervariables has changed over time,
(13:39):
and so Allyson was really upand reading all of the latest
and greatest guidance on how tothoughtfully consider asking and
answering this question, whichI think you know, if we had
started the project 10 years ago, we specifically on resilience
and analyzing resilience we maynot have used exactly the same
methods that Allyson broughtforth in this study.
Patrick Sullivan (13:59):
Yeah, thank you so much for that, and just
this.
I really want to pick up onthis idea that when we mentor,
if we go into that with humility, then we learn as much as we
share.
Just because you know menteescome, I think it even works at
the level of mentees have beenin school.
You know, in my case you know20 years more recently than I
(14:20):
have and things change.
So I think there is this realmutuality about what later
career mentors can share andwhat earlier career mentors
bring to that relationship andin the best of cases it really
is a two-way street as far asyou know, as far as learning.
So thanks for reflecting onthat.
Back to Dr.
Redhunt, I just wonder, likehaving been through this process
(14:43):
yourself and having theopportunity to work with great
mentors and landing where youare now, what advice would you
give to current and futurestudents about mentorship or
about the idea of integratingsome research experience into
your training pathway?
Allyson Redhunt (14:58):
In terms of integrating research experience.
I think probably especiallytalking to my medical classmates
like research is not somethingthat everyone's super excited
about, but I found that,although it is something I want
to continue to do for my careereven if I didn't have that plan
working on a research study andunderstanding the way that data
is collected and the way thatit's analyzed and all the people
(15:18):
who go into that and the waysthat you're asking the questions
and reconsidering yourquestions, makes me a much more
critical consumer of medicalinformation and it makes me
think a lot more carefully.
When there's a new study, isthis something that I would want
to integrate into my practice?
Does it apply to only part ofmy practice?
And it really helps me bringthat critical lens, and so I
(15:40):
have found it really invaluable.
I think that, in general,medical schools are moving
towards also emphasizing that aspart of the curriculum, and
it's something that I reallyappreciated in my curriculum.
In terms of mentorship, I thinkthat what makes Dr.
Burris such a- There are manythings that make her a wonderful
mentor, but something that I'vebeen thinking about is she is
(16:00):
really fearless about kind oftackling all of the hard
questions, and I have memoriesof her talking to me about
finances in medical school andwhat it's like to be a friend
and a family member as you growinto being a physician.
Those are the things that are alittle bit harder to look up
online or ask classmates about,whereas the science you can
(16:21):
sometimes pick up from yourpeers and from self-study.
But I think that in mentorshipthose hard conversations that
are especially hard for someonewho feels young in the
profession to ask I feel like Dr.
Burris was always ready tobring those things up and really
tackle them head on.
Patrick Sullivan (16:38):
Great.
I want to thank you both forsharing about these.
Mentor-mentee relationships arepart of our professional world,
but they're also, as you sortof alluded to, quite personal
and sort of help us along ourjourneys.
Again for both, for both thementor and the mentee.
So thanks for both of you forbeing open to sharing about that
.
I guess I'd like to just askbefore we wrap up are there any
last thoughts or points thatyou'd like to share with Annals
(17:00):
readers and the listeners to thepodcast?
Heather Burris (17:03):
Yeah, I wanted to highlight something that I
think many folks probably had ashared experience.
But one of the things that madeDr.
Redh unt's experience richerwas having really two mentors.
So I think maybe in thetraditional laboratory setting
there might have been more of asingle mentor of a big lab and
then that's your mentor andyou're the mentee, and that is a
(17:23):
very formal relationship and Ithink many of us have adopted
different ways in which tomentor and so, especially when
you're asking medical questionsusing epidemiologic methods, I
think it's so important to havean epidemiologist, maybe, and a
physician potentially.
Sure, there are many ways to doresearch, but I feel like that
(17:44):
gave Allyson a way in which toanalyze data rigorously, while
also considering the kind ofgeneral day-to-day practice and
how you enroll in the setting ofan antinatal clinic, and so
really kind of gave her optionsand some of our mentees.
So Dr.
Hacker and I have shared manymentees at this point.
Some have gone on to do theirPhDs in epidemiology or public
health and others have gone onto medicine or nursing, and I
(18:07):
think there are many paths totake, but having a diversity of
mentors who can bring differentprofessional and lived
experiences can be very, veryhelpful.
Patrick Sullivan (18:16):
Yes, thanks for that, and the idea of sort
of multidisciplinary teams totackle these questions is key.
So thanks for acknowledgingthat, although I will say, Dr.
Burris, I know that you're aclinician, but you were talking
like an epidemiologist when youtalk about the sort of
historical factors and the builtenvironments, and the
structural framework throughwhich some of these inequities
(18:38):
arise is right on the nose.
Heather Burris (18:40):
So I've learned from some of the best.
Patrick Sullivan (18:42):
I think so yeah, I mean just not to belabor
the point, but the language ofour disciplines.
Meaning, how do you reallyinternalize this stuff?
I think we can read about it,we can read journals, but for me
it's in discussions with peoplewho have complementary
expertise where we're generatingideas and in a way that's not
even that tension or conscious,I think we internalize the
(19:04):
language around these things andlanguage is ideas, right, that
kind of language that we'retalking about is really
reflective of the theoreticalframeworks.
So I think that's the reasonthat even in this age, we're
recording over Zoom.
So I shouldn't throw stones,but like, as we move more
towards text messaging andmessaging back and forth and
platforms, that conversation, Ithink, develops shared
(19:27):
vocabulary, which is the stuffthat shapes our research concept
.
So agreed aboutmultidisciplinary teams and
sharing this language.
So that brings us to the end ofthis episode.
I want to thank you again, Dr.
Redh unt and Dr.
Burris, for joining us today.
It was a pleasure to have youon the podcast.
Thanks for the work that you doand we'll look forward to
(19:48):
reading more of your work andmaybe having you again at a
later point in your careers toreflect on the work that you're
doing and how you've reallyaccomplished this piece of work
together.
Heather Burris (19:57):
Thank you so much for having us.
Patrick Sullivan (20:07):
I'm your host, Patrick Sullivan.
Thanks for tuning in to thisepisode and see you next time on
EPI Talk (20:12):
Behind the Paper.
EPI Talk is brought to you byAnnals of Epidemiology, the
official journal of the AmericanCollege of Epidemiology.
For a transcript of thispodcast or to read the article
featured on this episode andmore from the journal, you can
visit us online at www.
annalsofepidemiology.
org.
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