PROGRAM TARGETS HEALTH DISPARITIES IN WOMEN BY TRAINING RESEARCHERS TO PINPOINT UNANSWERED QUESTIONS
By training researchers to pinpoint unanswered questions
Only in recent years have physicians understood that women experiencing heart attacks present with different symptoms than men. However, those same physicians might be surprised to learn that their female patients are less likely to undergo knee replacement surgery than men, even though they are more likely to suffer more debilitating disease. They likewise might be unaware that foreignborn Hispanic females eat healthier diets and get more exercise than Hispanic women whose families have been in the United States for generations.
UC Davis researchers Lorena Garcia and Barton Wise are exploring these lesser-understood issues in women's health as scholars in the UC Davis School of Medicine's Building Interdisciplinary Research Careers in Women's Health (BIRCWH). BIRCWH is a mentored careerdevelopment program for junior Ph.D. and M.D. faculty.
Funded by the National Institutes of Health, the program is aimed at developing a new generation of researchers who focus on discovering more about women's health in an effort to reduce health disparities.
"When it comes to women's health research, many questions remain unanswered," says Ellen Gold, professor and chair of the Department of Public Health Sciences. Gold is co-director of UC Davis' BIRCWH program, along with Nancy Lane, director of the Center for Healthy Aging and Endowed Chair of Healthy Aging and Geriatrics.
In the past, women have not been included as participants in research trials and studies, much less been the focus of them, Gold explains. That meant that few investigators interested in women's health could find research opportunities and mentors equipped to train them to do that kind of work.
"This program plays a critical role in permitting us to build up the skills and training of junior research personnel interested in women's health so as to grow the pipeline of qualified women's health researchers to help meet the unmet needs in women's health."
NIH has created 29 BIRCWH programs nationally to offer multidisciplinary training and opportunities that encourage non-traditional interdisciplinary collaborations. Now in its fourth year, the UC Davis program underwrites a substantial portion of time for each of its five scholars so that they can develop research programs in women's health.
Mentorship is also a key part of the program, says Wise, an assistant professor at the Center for Healthy Aging who studies health disparities related to osteoarthritis.
"Many people try to make a stab at careers in research, but without good mentors, they are far more likely to fail in achieving their research goals," Wise says. BIRCWH co-director Lane is his mentor in the program – and the reason he came to UC Davis from Boston.
"She is a renowned expert in osteoarthritis who has been invaluable to me and my growth as a researcher."
Garcia echoes Wise, calling mentorship key in her research of health disparities and Latinos.
"My mentor, Dr. Gold, has enhanced my academic and professional development," Garcia says. "Every month, we meet to discuss my progress and any other areas I may need guidance on. It's been extremely beneficial to me to have a mentor of her standing make time to share her broad knowledge so that I may succeed."
Osteoarthritis in women
Wise's research focuses on why women with osteoarthritis are less likely to choose total knee replacements
as an effective treatment even though they are more likely to have the disease and experience it with greater severity than men.
He is testing the hypothesis that the disparity between women and men in choosing the procedure is related to gender differences in the experience or the reporting of osteoarthritis pain, function and physiological measures, such as muscle strength.
His epidemiological study uses data from the Multicenter Osteoarthritis Study, an NIH longitudinal study of about 3,000 people who either have osteoarthritis of the knee or are at high risk for developing it.
"There are a whole lot of things that we don't understand about the disease process – why some people feel more or less pain and what makes them decide to have joint replacement surgery," Wise says.
Obesity in different cultures
Garcia's project focuses on health disparities among women of Mexican descent, Caucasian women and African American women. Using data from the National Health and Nutrition Examination Survey, she is comparing the relationships among obesity, pre-diabetes, diabetes and health-related complications in these racial and ethnic groups.
According to Garcia, the rates of obesity and diabetes are not decreasing in Latina and African American women as compared to white women.
"They don't seek health care, especially preventive care, in the same numbers as white women," explains Garcia, an assistant professor of public health sciences.
Garcia also is interested in distinguishing among Latinas from different countries of origin, as well as those with different rates of acculturation.
"They share the same language but have big differences in their rates of obesity."
This topic has been of interest to Garcia since her days as an undergraduate.
"I noticed how my professors talked about how unhealthy Mexican Americans were," recalls Garcia, herself the child of Mexican immigrants. "I knew that wasn't true for my family."
Although Garcia and Wise are both using epidemiology to address women's health issues, the BIRCWH program includes basic and clinical scholars as well.
For example, Elizabeth Miller is a UC Davis assistant professor of pediatrics studying a clinical intervention to prevent teen-partner violence. Wei Yao, assistant professor in the UC Davis Center for Healthy Aging, is conducting basic research into the signaling pathways involved in osteoporosis. The newest scholar, assistant research microbiologist Sumathi Sankaran, is an immunologist in the Department of Medical Microbiology and Immunology. She is looking at the effect of aging and menopause in women with AIDS.
BIRCWH co-director Gold says that as the list of junior faculty focused on women's health research grows, UC Davis gets closer to achieving a critical mass of researchers who can really make a difference in alleviating health disparities between the genders.
"A lot of work is waiting to be performed out there, waiting to be performed by talented well-equipped researchers. That's what we're hoping to nurture here in the UC Davis BIRCWH program."