Thirty years ago, Bernadette Boden-Albala tried to find out how many strokes occurred in racial or ethnic groups.
People would say to tabulate the number of strokes in a hospital setting, Boden-Albala recalled. But, not everyone goes to the hospital. Some go to a doctor and others to a nurse.
“I realized early on that to understand disease, you have to understand the community context — where people live, what their environment is and all of those things that affect how they experience disease,” said Boden-Albala, who is now director of UC Irvine’s Public Health Program and future founding dean of UCI’s School of Population and Public Health.
The only way to really understand disease and its risk factors, as an academic researcher, she said, is to go into the community, build relationships with residents and spend time with them – a “community-diverse” model.
At UCI, these are the principles she uses to reach out to the public while researching cardiovascular intervention with the goal of preventing hypertension or high blood pressure.
From their offices in El Centro Cultural de México in downtown Santa Ana, Boden-Albala and her research team are partnering with community health workers and volunteers to reach out to Latinx and Vietnamese families to participate in cardiovascular research called Skills-Based Education Strategies to Reduce Vascular Events in Orange County.
And in addition to research, SERVE OC staff provide residents with multilingual resources on how socioeconomic conditions may affect health.
Cardiovascular disease is the leading cause of death in all but adults it disproportionately affects communities of color.
According to the SERVE OC program website, stroke and cardiovascular disease account for one in four deaths among Latinos in the US, and heart disease is the second leading cause of death for Latinos. Locally, the Vietnamese population in Southern California has persistently high rates of hypertension linked to elevated rates of stroke, according to SERVE OC.
To understand this disparity, Boden-Albala and her team are looking at health through a social and socioeconomic lens—the neighborhoods people live in, health insurance coverage, educational attainment and income levels—and how these can create gaps in health and well-being.
Since a long history of systemic racism can lead minority communities to distrust academia, Boden-Albala said, researchers must continually engage with minority groups.
“The first thing we did was find a space in the community,” she said.
With a location in a predominantly Latino city like Santa Ana, the UCI research team began creating and building two-way relationships in late 2022. In addition to Santa Ana residents, the team has reached out to people in Garden Grove and Westminster.
UCI partners with local organizations—like Latino Health Access, Radiate Consulting and the Vietnamese American Cancer Foundation—by setting up booths at events to talk to residents about health issues, providing free checkups and talking about the relationship between health and the environment while recruiting them to the SERVE OC study.
And in turn, these local groups and community interactions help researchers think about potential risk factors, Boden-Albala said.
Boden-Albala gave an example of how this model works: Say people have difficulties sleeping because trucks are passing their house at night, because they are shift workers or because there are 10 people living in two rooms.
“Sleep is a huge risk factor, for example, for cardiovascular disease,” said Boden-Albala. “And if I was sitting in the ivory tower, without going into the community, how would I know that there are a lot of trucks, noise pollution, air pollution, traffic congestion in this area?”
By combining health checks with recruitment, SERVE OC was able to attract more members of the public to the study “because they want to improve their heart health and the heart health of their families,” said Desiree Gutierrez, research coordinator with the UCI Program in Public Health.
To date, 217 people have been enrolled in the research (focusing on communities in Garden Grove, Santa Ana and Westminster), including children as young as 5. Since it is a family study, UCI is also tracking enrollment at the family level and 85 families are enrolled.
Since the long-term goal is to reduce blood pressure to help prevent cardiovascular disease, short-term success appears to be sticking to remote blood pressure monitoring, said Emily Drum, research manager with the UCI Program in Public Health.
Every family is given a free blood pressure monitor that automatically sends their blood pressure readings to the SERVE OC research platform. All adults are asked to take their blood pressure at least once a week, and researchers can track if they are doing so.
Drum said community health workers and UCI research staff also regularly check in with the families to see how they are doing. “We’ve just started rolling out the first intervention sessions, so we don’t have much to measure right now,” Drum said.