Illustration by Tequitia Andrews
Anika Hines is stressed about stress. As an assistant professor at Virginia Commonwealth University’s School of Population Health, Hines works to learn what stresses out different groups, classes and communities. “People tell me not to study stress, because stress is hard. It’s complicated and very individual,” she says. But looking into stress, and how it affects the health of hundreds of thousands of people, could help improve health equity and design solutions to combat the illnesses she’s been around her whole life.
Hines, in collaboration with researchers from Johns Hopkins School of Medicine, the University of Alabama and other institutions, recently shared findings that show how stress from living conditions can worsen disparities in heart health among racial groups. Published in September in the JAMA Network Open medical journal, the study investigates how stress over neighborhood safety and quality, social interactions, and discrimination connects to higher instances of cardiovascular risk factors and disease. It finds that Black adults who face more stress from those living conditions have poorer health outcomes than white adults.
With a Ph.D. in health policy, Hines mostly works on the big picture, but her interest in health inequity started young and close to home. “It seemed to me, as a child, that Black people had shorter, sicker lives than other groups,” she says. “There’s a term called ‘resilience’ that people always say, ‘Oh, you know, Black people are resilient to mental health conditions.’ I was wondering, if we’re so resilient, then why do we have these terrible health outcomes?
“Since then, the research question has sort of remained the same but become refined through my training and acquired skills,” Hines says.
After entering academia, Hines’ youthful observations were compounded by population health research that shows how disparities in health across races, genders and other social groupings are affected by differences in health systems and treatments.
Hines saw research like this as her opportunity to change the world around her. “I thought, ‘Hey, if I could influence policy, then I could change communities, and I could change some of these broader issues that were affecting not just my family, but other families like and unlike mine,’” Hines says.
In Virginia and many states in the U.S., cardiovascular diseases have been a leading cause of death for years across age, sex and race. Risk factors for these diseases are equally common: The Centers for Disease Control and Prevention estimates that about half of all Americans have at least one of three major risk factors for heart disease.
Anika Hines, assistant professor at Virginia Commonwealth University’s School of Population Health (Photo by DeAudrea ‘Sha’ Aguado courtesy VCU School of Medicine)
Cardiologists measure someone’s risk for heart disease by eight key behaviors that are familiar to anyone who’s had a general checkup: eating well, exercising, not smoking tobacco, sleeping well, and managing your weight, blood pressure, cholesterol and blood sugar.
“Basically, if you had these things all in order, then you’re going to have good cardiovascular health later in life. If you don’t have these things in order, you’re going to have poorer cardiovascular health later in life,” Hines notes.
Despite the prevalence across racial lines, Black adults have earlier onset of these risk factors and poorer overall heart health compared with white adults. Using data from the Reasons for Geographic and Racial Differences in Stroke (aka REGARDS) project — a large-scale study on stroke risks conducted across the U.S. but centered on the Southeast — Hines wanted to see how stress plays a role in this disparity.
If [Black people] are so resilient, then why do we have these terrible health outcomes?
—Anika Hines, assistant professor at Virginia Commonwealth University’s School of Population Health
Hines and other study collaborators narrowed the participants down to a group of over 7,700 Black and white adults and looked at the potential impacts of neighborhood-level risk factors, breaking the results down by race and gender.
The findings revealed associations between exterior factors that Black people experience more often than white people — such as discrimination, poor neighborhood social cohesion and more — and a higher prevalence of poor heart health. For example, perceived discrimination — or the perception of unfairness or negative treatment based on their race, which was one of the study’s main measurements — explained 11% of the racial difference in ideal cardiovascular health between Black and white people overall, but it was a major issue for Black women more so than Black men.
Neighborhood safety, another issue that includes concerns about local violence, accounted for about a 6% difference between Black and white people’s overall cardiovascular health, but the percentage doubled when compared between Black and white males.
“That tells us that people’s lives and social experiences within the context of neighborhoods and stress are different by gender, which is not something that we didn’t know, but I think is something new in the context of this work,” Hines says. “Maybe we need to be thinking about policies on a different level and a different way; it’s all informative.”
This kind of research — taking large swaths of data and parsing trends from it — is not new, but the perspective Hines brings to the table is. “I would say 20 years ago, 30 years ago, most researchers and most clinicians were not thinking about physical environments, exposure to racism and social experiences as risk factors for hypertension or heart disease,” says Jessica LaRose, interim chair of the Department of Health Behavior and Policy in the VCU School of Population Health. “She really is bringing just tremendous expertise in this area.”
Source: “Neighborhood Factors, Individual Stressors, and Cardiovascular Health Among Black and White Adults in the U.S.,” by Anika L. Hines, Ph.D., et. al.
Digging into these stresses doesn’t stop with Hines’ recent study. As the head of the Equity in Cardiovascular Health Outcomes Lab at the Department of Health Behavior and Policy, she follows threads like these not just to better understand health inequity, but to propose and develop solutions. “We’re understanding, then we’re doing [something about it],” Hines says.
Hines’ independent lab uses student and faculty researchers to investigate the causes of heart health inequities. A past project of the lab, Arts for Hearts, measured how effective art therapy, specifically group painting classes, can be to decrease blood pressure and lower risks of heart disease in Black women in Richmond. The goal was not only to collect blood pressure data, but to model a well-rounded solution to improving well-being and heart health education in high-risk communities.
In the broader picture, Hines’ findings in the recent study and in her lab are aimed at making meaningful changes in public policy. “We talk a lot about social determinants and drivers of health,” she says. “Basically, those are the manifestations of various policies on different levels that have created living conditions that disadvantage a certain proportion of the population, while simultaneously giving advantages to other parts of the population.”
To change these structures, Hines wants to take the fight from the doctor’s office to the legislature. “If people created these circumstances, then we can counter-create,” she says. “We can think of policies that will work to course-correct, perhaps, some of the past disadvantages that have subsequently marginalized certain groups.”
Hines acknowledges changing policy is a slow process, but that can be a grounding force to remain focused on the health of the people most at risk. “Let’s change the structural issues while simultaneously addressing the fact that there are people whose lives are on the line every day as a result of these structural issues,” Hines says. “But hopefully, with this increased focus on stress and people’s lived experiences and considerations for marginalized groups ... we might have a prime opportunity, with the right data, to move the needle more quickly than we would have in the past.”
