Investigating Heart Health for Lumbee Women

By Catherine Clabby

When Tona Jacobs, the vibrant principal of Pembroke Elementary School, fainted twice at work five years ago, she figured she was just weak from giving blood earlier that day.

But no.

After her staff insisted she take an ambulance to a local hospital, an ultrasound revealed waxy plaque narrowing the arteries in her carotid arteries, connecting her brain to the rest of her body. That’s serious business, a symptom of atherosclerosis, which can lead to stroke, heart attack or death.

“That was a scare. I may not have known that until it was too late. I thought I was healthy,” said Jacobs, 56, a health-conscious member of the Lumbee Indian tribe clustered in and near Robeson County.

As it turns out, simply being an American Indian puts Jacobs and other Lumbee woman at increased risk of developing cardiovascular disease, or even prematurely dying from it.

Death rates from the disorder among Indian women in southeastern North Carolina are among the highest in the country, said Jada Lynn Brooks, an assistant professor of nursing at UNC-Chapel Hill.

Brooks, who is also Lumbee, wants to find out why.

Brooks suspects one problem could be people’s environmental exposures, possibly from minute particles emitted from the tail pipes of the gas- and diesel-powered vehicles traveling up and down Interstate 95 in Robeson County.

Psychological factors could be in play, too.

If Brooks cracks the mystery, she wants to then help reduce the scourge, something that could extend the lives of Lubee woman.

“I’m always looking for solutions to a problem,” said Brooks, who landed a $741,355 National Institute of Environmental Health Sciences grant and help from more senior scientists at UNC to tackle her query.

Loyal to home

Brooks, who is 37, grew up in the Lumbee Prospect Community, not far from UNC-Pembroke, where she enrolled to study science straight out of high school.

When she peppered a pediatrician she shadowed at that time about root causes of the many asthma cases he saw among patients, he recommended she get graduate training in public health to help her find out. She did, at the elite Gillings School of Global Public Health at UNC Chapel Hill.

As her interests in clinical care and the bigger picture grew, she earned a second bachelor’s in nursing and then a doctorate, too, at Duke University, working with premature babies back home in Robeson County and, eventually, having three children of her own.

Already a veteran health researcher, Brooks has worked on projects to improve mammogram screening rates among minorities, expand access to smoking-reduction program for similar populations, and better understand the challenges faced by mothers whose babies are born premature.

“All of my research has been aimed at understanding health disparities and trying to figure out what we can do to address them,” Brooks said.

There’s plenty to do. Significant numbers of Lumbee people historically have grappled with poverty, high rates of obesity and chronic illness—diabetes and depression among them—at rates higher than white North Carolinians. As recently as 10 years ago, Lumbee people were, on average, less likely to have health insurance and access to affordable health care.

But the statistics don’t fully explain the disproportionate burden of disease among Lumbee women, said Brooks, who will recruit 120 tribal women ages 28 to 45 to help her find answers.

The project aims to take blood samples from each woman and use EPA air pollution measurements to look for any correlation between a woman’s exposure to particulates in the air and biomarkers in blood associated with atherosclerosis. In addition, Brooks and her research team want to explore whether a woman’s positivity, or lack there of, is associated with higher or lower inflammation markers.

The women will be queried about how frequently they feel interest in their lives. She’ll also ask about love and pride, and how often they feel contempt, embarrassment and guilt.

To help her conduct studies that are culturally appropriate, Brooks has solicited advice from leaders within the community, including Jacobs, the elementary school principal.

Those advisors have nudged Brooks to inquire about religious beliefs and practices when probing mood, since so many Christian churches steeples — mostly Methodist and Baptist — are found in Lumbee communities.

During a phone meeting earlier this week, some members also questioned her closely about what she planned to do with the blood samples after her study is finished, about five years from now. Brooks said she may destroy them, though she is not sure. No matter what the plan, her consent form for the study will put research subjects in charge of how the samples are used.

“You have to be careful with consent so that people know what they are giving permission for signing up for,” Brooks said.

A link in a chain

Martin Luther Brooks, a Lumbee physician with a general medicine practice in Pembroke since 1958, is also on Jada Lynn Brooks’ advisory team.

He has long observed gaps in the medical care Lumbee women receive. One example from early in his practice was his discovery that there were no statistics on cervical cancer among North Carolina Indian women in state records.

They were not immune. They were just not getting the pap smears that detect that cancer, a deficit he worked hard to reverse, despite opposition from his patients due to modesty, lack of funds and ignorance about the risks they faced.

“We’re still aren’t getting women enough basic fundamental information about their own health. Self care has to predate health care. If it does not, when health care arrives, it gets there too late,” said Brooks, who is not related to the UNC researcher.

Jacobs, the principal, says she thinks wider cultural forces could play a role in Lumbee women’s higher rates of cardiovascular disease. Possibly like women in many communities, they focus more on others – parents, children and spouses – than they do on themselves.

“We don’t focus on ourselves. You are considered the backbone. You can’t be sick,”  Jacobs said.  “You have to take care of all these other things.”

The cardiovascular study that Jada Lynn Brooks is launching could help women understand why they must work harder to look after themselves too, Jacobs said.

“There is so much that could come from this study — to help people my age but also to better educate our children,” she said. “We need to put things in place to help our children.”