Johns Hopkins Bloomberg School of Public Health, Center for Health Equity, Baltimore, MD
This summer, I had the opportunity to intern at the Johns Hopkins Center for Health Equity. The Center is comprised of Johns Hopkins Medicine and Bloomberg School of Public Health faculty that have a special focus on identifying and eliminating health disparities. This is accomplished in part through clinical trials that test disease interventions. I worked directly with the 5+ Nuts and Beans for Kidneys study, which aims to address the disproportionate burden of chronic kidney disease (CKD) on low-income African Americans. This group is more likely to have CKD and also more likely to progress into end stage renal disease (ESRD), necessitating more costly and difficult treatments such as dialysis and kidney transplants. The higher incidence of CKD is in part associated with dietary habits. Low-income African Americans are more likely to live in food deserts, where they do not have easy or affordable access to healthy food. A poor diet worsens kidney function, increases blood pressure, and puts further strain on the kidneys. Conversely, it has been found that a healthy diet, high in potassium and low in sodium, can decrease blood pressure and improve kidney function. The 5+ Nuts and Beans study is designed to increase the amount of kidney-healthy food that the participants eat by providing a $30 weekly stipend and directed coaching on food items to buy.
The first part of my work with the study was a data analysis project that explored the purchasing patterns of the usual care group of the trial. This group served as a comparison to the intervention group; the participants received the weekly food stipend, but were not specifically instructed on which foods they should purchase. I worked alongside another intern to evaluate the grocery store receipts of the usual care group and classify their food purchases into categories that reflected the food’s level of adherence to an ideal, kidney-healthy diet. We found that the purchases of this group were largely non-adherent, or generally unhealthy, foods. However, the nuances of the categorization system allowed us to see that many participants were buying foods that are often perceived as healthy, but are not ideal for kidney health. For example, many people default to buying canned vegetables, but these have added sodium that can increase blood pressure. Working on this data analysis project taught me new technical skills for working with large data sets. I was also able to explore the wealth of information that can come from analyzing these data sets. The coding system and data set that I helped to create will be expanded as the study continues and will serve as an infrastructure to facilitate understanding the purchasing trends of different sub-groups in the study.
I also contributed to the 5+ Nuts and Beans study as a research assistant for an ancillary study. This side study, known as the Photovoice study, aims to understand the food environment in Baltimore, specifically the facilitators and barriers to eating a healthy diet, from residents’ perspectives. This information will help determine specific areas that can be addressed to improve access to health food in Baltimore. Photovoice studies are a specific type of community-based participatory study that utilizes photography as a method of communication and story-telling. For our Photovoice study, we had participants take pictures of anything related to their food experience and then discuss their photos in a series of group sessions. This serves to create a narrative about the food environment in Baltimore entirely from the residents’ perspectives and also empowers them to identify and lead the change needed in their community. When the study concludes, there will be a gallery show with the participants’ photos and testimonies to share with policymakers and community leaders. It is our hope that this will be compelling and contribute to concrete and targeted change.
As the primary research assistant for the Photovoice study, I was involved in all aspects of the study from recruitment to data collection. I learned that public health studies, especially with disadvantaged populations, face unique challenges difficulty in achieving scientific integrity with an appropriate amount of participants. The same issues that put individuals at risk for diseases such as CKD, also make it difficult for them to participate in research. For example, the most common barriers for participants in the study was finding transportation and managing other health conditions. However, the need for an appropriate number of participants to produce meaningful data, must be balanced with respect and care for individual participants. This is especially true of the Photovoice study because the results are based in the opinions and experiences of the participants. Our study only had around 50% retention of recruited individuals, but our participants were amazingly dedicated and passionate. The participants cared about making a difference in their community and were open to sharing their personal experiences to achieve this. The Photovoice study is still ongoing and I am excited to remain involved and see how it progresses.
I am deeply grateful for the opportunity to work at the Johns Hopkins Center for Health Equity. Not only was it fulfilling to contribute to a project that is creating positive change in Baltimore, but the skills, knowledge, and connections I have gained will be invaluable as I move forward to a career in medicine and public health. I would like to thank the ’68 Center for Career Exploration and William L. Chapman ’64 for this opportunity and Dr. Anika Hines, Dr. Deidra Crews, and everyone at the Center for Health Equity for their thoughtful guidance. This would not have been possible without them.