From Carolina Nursing Magazine: When Health Disparities Hit Home

Jada L. Brooks, PhD, MPSH, RN, was an undergraduate student at UNC Pembroke when she realized the health of her community was in danger. She was shadowing a local pediatrician in Pembroke, North Carolina, when she recognized an alarming disparity in children’s health from the Lumbee Indian Tribe – her tribe.

“So many of the American Indian children in the clinic had ear infections, many more than any other racial group, and there didn’t seem to be a clear explanation for the difference,” says Brooks, an assistant professor at the School of Nursing. “It was difficult to ignore the obvious discrepancy I observed.”

The Lumbee Tribe of North Carolina includes approximately 60,000 enrolled members, including Brooks. Most members of the tribe live in Robeson County and surrounding areas in Eastern North Carolina. According to census records, 89 percent of Pembroke’s population and 40 percent of Robeson County’s population are American Indian.

Something was impacting the health of tribal members, and she didn’t know what, only that they had the right to be as healthy as any other group. The physician she shadowed was Dr. Joseph Bell, the first Lumbee pediatrician and first American Indian pediatrician in North Carolina. She had seen the excellent care he provided for their community, so she decided first to be a doctor.

Then, a conversation with Ronny Bell, an epidemiologist and Bell’s brother, changed her mind.

“We discussed the field of epidemiology, and that piqued my interests – to explain disparities in health outcomes by better understanding their causes in this population. I felt that I needed to study public health,” she says.

After graduation, Brooks got her Master of Science in Public Health at UNC’s Gillings School of Global Public Health. Her original plans included staying for a PhD in the field, but she longed to get back to patient care and the people for whom she began this journey.

Brooks again considered medical school, as well as a physician’s assistant degree. But when she found nursing, she found her fit. It was versatile, research-based, hands-on. She attended Duke University’s accelerated BSN program and worked as a nurse in a health department, NICU, newborn nursery and outpatient pediatric clinic as she worked toward a PhD in nursing. And it was nursing that eventually brought her to Southeastern Regional Medical Center in Lumberton, North Carolina, where the health disparities she saw in the American Indian community continued to hit home.

In Robeson County, American Indian women experience particularly high mortality and morbidity from cardiovascular disease, more so than any other group, including African-American women. Brooks is interested in how environmental pollutant exposures relate to cardiovascular-associated inflammatory markers, as well as how psychosocial factors experienced in the American Indian community can impact the body’s ability to protect itself from the negative effects of exposure. She believes more positive well-being could help lower inflammation and buffer the inflammatory effects of environmental pollutant exposures.

As faculty at the School of Nursing since Fall 2013, Brooks has been able to coexist in two worlds to bring the academic resources of a leading nursing school to the Lumbee tribe.

“Continuing to interact with the Lumbee community and keep my residence there has provided me enormous insight into the hardships people endure, the obstacles they face and sources of stress they deal with,” she says. “In some sense, this community-based laboratory allows me to remain connected to the needs of the community through observations and input from community members that I can then experimentally test. Reliable data on American Indian health is limited, which makes it difficult to study health disparities and improve the health of this population. It’s very challenging to find statistics to support what I’ve been observing anecdotally among Lumbee Indians.”

As a Lumbee nurse scientist, Brooks is committed to helping American Indian women create better environments for themselves and their families that lead to healthier and happier lives. In 2016, she received a five-year grant from the National Institutes of Health for a cross-sectional study, “The Hazardous Air Pollutants, Positivity, and Inflammation (HAPPI) Study,” to observe how air quality and the environment impact inflammatory processes that lead to heart disease, as well as how psychological well-being and mental health play a role in placing this population of women at greater risk for – or protecting them from – this disease. She aims to enroll 150 women over five years to observe their experiences with depression, positivity, life satisfaction and mental health, along with physical measurements related to heart disease, such as blood pressure, weight and heart rate variability.

Brooks says environmental health equity for these women could possibly be improved if the psychosocial factors that impact their immune systems are addressed. Rural counties often have higher rates of poverty, low educational attainment, widespread unemployment, and a lack of resources in general. The study includes women who are between the ages of 18 and 50, which is a critical time to intervene and make a difference in long-term cardiovascular health outcomes.

“Life can be challenging for these women. Higher stress levels raise cortisol, which has been linked to inflammatory responses in the body,” she says. “Because of the overlap in the immune and cardiovascular systems, we can’t ignore how chronic stress impacts health. If women are overweight or obese and they also have poor psychological well-being or depression, they are even more vulnerable to developing heart disease.”

Brooks was not alone in her mission to address cardiovascular disparities. The response from women in the Lumbee community has been remarkable. Brooks had planned to enroll 30 women each year in the study, but in the first year alone, 110 Lumbee women signed up to participate.

The volume of interest was a surprise, says Brooks. But it was the pervasiveness of depressive and posttraumatic stress symptoms among women in her community that, for her, was truly telling.

“I’ve been alarmed by the number of women who have scored high on both the depression and post-traumatic stress scales that we use. A number of the Lumbee Indian women already have predisposing factors that put them at risk for cardiovascular disease. Compromised psychological well-being in combination with other risk factors can lead to metabolic disorders or cardiovascular disease or both.”

Brooks’ ultimate goal to develop culturally relevant interventions that can change how American Indian women respond to environmental pollutants is personal. As a member of the Lumbee community, she is trusted, and that has affirmed for her that, as long as she can give back to her community and bring them the health equity they deserve, she’s on the right path.

“Women have expressed what it means to them that someone from their community is doing this kind of research alongside them,” she says. “American Indian women are concerned about their health based on their own family histories of poor health outcomes and are curious now about environmental pollutants. Becoming informed can lead to empowerment and more active involvement in their health.”


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