Tobacco-Related Health Disparities, with Monica Webb-Hooper Artwork

Buffalo HealthCast

The official health equity podcast of the University at Buffalo’s School of Public Health and Health Professions.

Buffalo HealthCast

Tobacco-Related Health Disparities, with Monica Webb-Hooper

May 19, 2022 • University at Buffalo Public Health and Health Professions • Season 1 • Episode 16

Tobacco-related health disparities are a pressing issue in the area of tobacco prevention and cessation. Schuyler Lawson sits down with Dr. Monica Webb-Hooper of the NIMHD to discuss the implications of tobacco on communities of color, and why these disparities exist in the first place.
Dr. Monica Webb Hooper is Deputy Director of the National Institute on Minority Health and Health Disparities (NIMHD). She is an internationally recognized translational behavioral scientist and clinical health psychologist. She has dedicated her career to the scientific study of minority health and racial/ethnic disparities, focusing on chronic illness prevention and health behavior change. Her program of community engaged research focuses on understanding multilevel factors and biopsychosocial mechanisms underlying modifiable risk factors, such as tobacco use and stress processes, and the development of community responsive and culturally specific interventions. Her goal is to contribute to the body of scientific knowledge and disseminate findings into communities with high need.

Teaching Notes

Resources:

Credits:
Host/Writer/Researcher - Schuyler Lawson, MA
Guest - Dr. Monica Webb-Hooper, PhD
Audio Editor - Omar Brown
Production Assistant - Sarah Robinson

Intro 0:00
Hello and welcome to Buffalo HealthCast, a podcast by students, faculty, and staff of the University at Buffalo's School of Public Health and Health Professions. We are your cohosts, Tia Palermo, Jessica Kruger, and Schuyler Lawson, and in this podcast, we cover topics related to health equity here in Buffalo, around the US, and globally. In this first semester of the podcast, we're taking a deeper look at racism and health. We'll be talking to experts around the US, as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population health and wellbeing. You'll hear from practitioners, researchers, students and faculty from other universities who have made positive changes to improve health equity and inclusion.

Schuyler Lawson 0:47
Alright. Hello, everyone and welcome to another episode of Buffalo HealthCast, the University at Buffalo's premier public health podcast. I'm your host, Schuyler Lawson, a second year PhD student in the Department of Community Health and Health Behavior. With us today is Dr. Monica Webb-Hooper, the Deputy Director of the National Institute on Minority Health and Health Disparities. Thank you very much for your time to speak with us today.

Dr. Monica Webb-Hooper 1:08
Absolutely, happy to be here.

Schuyler Lawson 1:09
Alright, so I'll begin by having you tell us about yourself and a little about your own education background too.

Dr. Monica Webb-Hooper 1:16
Sure. Well, I am originally from South Florida, from Miami, Florida. And I attended undergrad at the University of Miami in Coral Gables, Florida. And then I earned a PhD in clinical health psychology from the University of South Florida in Tampa, in the Moffitt Cancer Center. And then I completed a clinical internship in medical psychology at the University of Florida. And after that, I had faculty positions. My first one was at Syracuse University. Then I returned home and I was at the University of Miami as a faculty member in the Department of Psychology. And before I joined NIH, I was at Case Western Reserve University, where I directed an Office of Cancer Disparities Research, in addition to being a professor.

Schuyler Lawson 2:07
Seems like you have quite the illustrious background, and that kind of segues into a question about NIH. As the Deputy Director of the National Institute on Minority Health and Health Disparities, what are your work duties?

Dr. Monica Webb-Hooper 2:22
It's an interesting question, what my work duties are, because every day looks a little bit different, which I think keeps it fun. But if I were to discuss it in broad categories, I would say that first, I am one of the senior leaders. I work closely with our director to sort of oversee all aspects of the Institute and everything that we do in terms of how we advance our mission, which is about reducing health disparities, improving minority health, and the promotion of health equity. So that's just really broad. I also work on developing scientific initiatives that fall within our scope, and NIMHD funds research focused on this topic, or these topics, and they're disease agnostic. So we also have partnerships, and we are mandated congressionally to work across all of the NIH institutes to coordinate activities around health disparities and minority health. And then, of course, across the Department of Health and Human Services more generally, I also supervise and oversee the directors of several of our offices, like our Office of Communication, our Policy and Evaluation Office. I also work on just general issues around the climate within our institutes. So I have a set of of areas and tasks that I focus on with what's happening in our institute. So that's separate from the science that we are promoting. And then I work on NIH-wide initiatives, NIH-wide efforts. So I serve as an ambassador, and leading several committees and task forces within NIH more broadly.

Schuyler Lawson 3:59
I have a follow up question to that. Since the 2020 social justice movements after the murder of George Floyd, has there been any kind of increased interest in health disparities or more funding for health disparities based research?

Dr. Monica Webb-Hooper 4:17
I'd say yes, I think that 2020 - I call it the collision of 2020, the collision of events that led to an increased emphasis on the reality around structural racism, discrimination, how it affects health, COVID-19, social justice issues, such as police brutality, and you know, we saw many organizations, including NIH, writing a letter or making a statement standing in solidarity, etc. And I think one of the questions that many of us who've been focused on this, not just in the past two years, but for many years, or live it every day, wondered was, how long is this going to remain a part of the conversation? Is this going to stay a significant issue, or is it going to fall apart? I think that what I've observed, and I'm interested in if you see this differently, is that the momentum around this topic and the focus on it has remained. And it's two plus years later in terms of into the pandemic, and we're still concerned about it. I do think that this Institute does receive elevated attention, because this is what we focus on. And so they turn to our institute to look at how do you advance science in this area? With the most recent president's budget, the budget for the country, NIMHD did receive its largest increase since its inception, or becoming an institute, which is with the passage of the Affordable Care Act. And so we did have an increase in our budget, which is pretty sizable, and just allows us to invest more resources into the best science that addresses the areas of greatest interest to us.

Schuyler Lawson 5:51
From my perspective, I noticed a similar trend, I would say yes. Recent conferences I attended at the Society for Research on Nicotine and Tobacco, there was a heightened focus on tobacco-related health disparities, more than what I was seeing in previous conferences. So I think that there's still the momentum there.

Dr. Monica Webb-Hooper 6:09
I think so.

Schuyler Lawson 6:10
So I do have another question for you. What are your specific research interests?

Dr. Monica Webb-Hooper 6:16
So I am interested broadly, in clinical health psychology, biobehavioral research, health behavior change, all the work I've done, has had the backdrop, for the majority of the work, I would say, the backdrop of Minority Health and Health Disparities within the areas that I'm interested in. I'm also interested in cancer prevention and control, a lot of focus on tobacco use, and smoking and smoking cessation, weight management, obesity reduction. So cancer risk behavior in general, but the types of behaviors that I'm interested in, health behaviors, have implications not only for cancer, but you know, heart disease, and stroke. And so it's really kind of transdiagnostic in a sense, of things that I'm interested in. And I think I've always been interested also, in broadly this category of, that you also hear a lot about now, which is social determinants of health, and how the social determinants of health impact our health in a number of ways.

Schuyler Lawson 7:18
So for our listeners, could you define what the social determinants of health are?

Dr. Monica Webb-Hooper 7:22
Sure. Social determinants of health is a term that you see if you look at the Healthy People 2010, 2020, now 2030 effort, and it's really about the conditions in which people live, where you're born, where you work, where you play, where you experience life, and how those conditions have a direct impact on health. So a few examples of those could be the neighborhood that you live in, the access to transportation, the access to healthy food, the access to not only health care, but high quality health care, access to not only education, but school systems with quality education - those are social determinants of health. And it is that these are different from health disparities. And sometimes I hear people kind of use these words almost interchangeably. Health disparities is about differences rooted in disadvantage. Social determinants, they're often discussed in a negative way. So likening them to, and they can be drivers of health disparities, but not necessarily, they also can be drivers of really good health, if you live in neighborhoods and communities where you have plenty of green space, and people are out jogging and walking their dog and with low crime, and everybody has nice cars and great school systems. So those are also social determinants of health, but they lead in a different direction.

Schuyler Lawson 8:42
Okay. Thank you for that definition. So, getting back to it, you mentioned your research interest in tobacco. So in your view, what drives tobacco-related health disparities experienced by African Americans, because from what I understand African Americans, they bear the disproportionate disease burden when it comes to tobacco-related illnesses.

Dr. Monica Webb-Hooper 9:04
That's true. And a large part of my work focused on tobacco related disparities, specifically among African American adults. And I think it remains a critical problem to address, I have to say, we need more scientists who are focused on this community because African American people certainly suffer the great undue burden of tobacco-related illnesses. And actually, when you look at it - if you just look at the prevalence of any tobacco use, the prevalence of smoking by race/ethnicity in the United States, you don't see that there is a disparity when you compare white and African American adults, and actually, there was a disparity there. And in the early 2000s, 2000-2001, we saw an elimination of that disparity. That doesn't, however, account for the greater prevalence of smoking menthol brands, among African American adults, which is, 80-90%. I mean, many times at least 90% of my participants were menthol brand - their preference was for menthol brands, compared to about 30% of white adults. But I think the most persistent disparity, if you compare African American males and females to their white male and female counterparts, it's the difference in cessation, that ability to quit successfully over the long term. And we see that in national epidemiologic surveys, we see it in clinical trials. And the difficulty quitting is partly what leads to health disparities. If you can't quit, then you have more years of exposure to smoking, even with a lower number of cigarettes smoked per day, you have the longer exposure because you haven't been able to quit. But I have to also just say that the difficulty quitting that many African American adults experience is not due to just our individual failures, why can't you just quit? It's much more complex than that. There are multiple levels of factors that contribute to why it is so hard for African American people to quit smoking. But certainly, this has to be a priority if we want to save lives and reduce disparities.

Schuyler Lawson 11:14
I love that you mentioned that it emphasizes not individual failing, and it's actually kind of ties in nicely to publication you had in 2019, when you examined the reasons for exclusion from smoking cessation trials. From my understanding those studies are ways that people can actually get access to free smoking cessation treatments like nicotine replacement therapy or prescription medications like Chantix or Wellbutrin. So could you summarize the findings of that study? And initially, do you think that the findings factor into tobacco-related health disparities in African Americans?

Dr. Monica Webb-Hooper 11:54
Sure, I think that study, the reason that we conducted that analysis is it was part of a randomized controlled trial, where we were wanting to kind of look at in the larger study, whether or not a cognitive behavioral therapy intervention could eliminate cessation disparities by race and ethnicity. And so we wanted to recruit an equal number, for the most part, of white adults, African American or Black adults, and Hispanic or Latino adults. And so it provided an opportunity to look at, well, we're recruiting these numbers, but are we excluding people based on race, ethnicity, and what would be the reasons for that? There is an act that was passed in 1993. It's called the NIH Revitalization Act. And in that act, it specified that grant proposals are required to include people who are identified or identify as racial ethnic minority persons as participants. And then you also have to describe your planned distribution of enrollment by race/ethnicity, at the end of your grant, you have to report how well you did. So in this study, we weren't able to recruit the numbers that we were looking for. But what we found, when we looked at our screening data, we found that about a third of the sample, a little bit more than a third of the sample, were deemed ineligible. And we had a long list of criteria. This was a group based face-to-face study. So this happened, the study actually ended just before the pandemic. So this was people coming in for face-to-face intervention. So we looked at all the reasons why people weren't eligible. The most frequent reason was serious mental illness. Second was alcohol dependence or drug use, and then barriers to attendance, like they couldn't come in person, would be an example. And what we found overall, was that the ineligibility or being excluded from the study was actually greatest among African American adults, and then second, about 42%. And then Hispanic individuals, 37%, white individuals were excluded at about 24%. So we were significantly more likely to exclude people who expressed interest in the study, but didn't meet the criteria that happened to be African American or Latino. And then we looked at the reasons why. And we found that the white individuals who expressed interest were more likely to be excluded for just one reason, like maybe they had an attendance barrier, or they had a medical condition that would preclude them from using nicotine replacement therapy. When you looked at African American adults, however, this group was more than twice as likely as our white individuals who expressed interest, to be excluded for three or more reasons. So people were being excluded for lots of reasons. And what it highlighted to me, among other things was that it's necessary for some trials to set exclusion criteria because of the study, you have to have inclusion/exclusion criteria, but I think the point is that those criteria may have unintended consequences where certain groups of interested potential participants are being excluded by design. And that might be one reason that this act, the NIH Revitalization Act, still, we have progress to be made in this space. So I think it potentially has implications for health disparities, because, as you mentioned, it's an opportunity for people to have access to state of the art, cutting edge medication, or treatment of whatever kind it is. I also think that when it comes to implementation, and we saw this with COVID in the vaccine trials, it's a bit different. But people are interested in knowing whether there were people like me in the study. And so it also, I think, has implications for implementation and uptake, if we can make that statement that the findings seem to generalize across populations. And I think that's important for reducing disparities and just assuring equity,

Schuyler Lawson 15:53
Thank you for your answer. So now we're gonna talk about another publication that you had in 2021. And this was a study that tested a Video Text tobacco cessation prevention intervention among economically disadvantaged African American adults. Could you summarize the findings of that and explain their public health applications?

Dr. Monica Webb-Hooper 16:16
Sure, this was a foray by our research group into mobile health interventions. And so we developed a video text tobacco cessation intervention. And so it was sending individuals, instead of just texts about quitting smoking, or education about why you should, or motivational messages, we actually had developed a video that's called Pathways to Freedom, Leading the Way to a Smoke Free Community. And we used that video, and we segmented it into smaller sections that would send out messages via the videos, parts of the video. So it was video text. And so we compared that in a pilot randomized trial. We call our intervention "Path to Quit", and we compared it to "Smoke Free Text", which is the standard text messaging program that NCI uses, and Path to Quit was based on Pathways to Freedom, so it's culturally specific to address the unique concerns of African American individuals such as the menthol smoking, the smoking of little cigars - things that you don't talk about, or you wouldn't receive in a text message from NCI's Smoke Free texts. And essentially, in this randomized trial, where people received one of these two interventions, plus nicotine replacement therapy, what we found was that at the end of the intervention - it was a first study, so it was a pilot - we looked at people right at the end of the intervention, which was six weeks later, and we found a pretty high proportion of the sample was biochemically confirmed as abstinence at the end of the intervention, which was 38%. And then we did find, and we didn't really expect to see this, that carbon monoxide confirmed abstinence was significantly greater for people who received the Path to Quit Video Text intervention, compared with NCI Smoke Free texts. As a matter of fact, the rate of quitting was 3.5 times greater in the Path to Quit condition compared with Smoke Free Text. And I think for me, when we talk about technology-based interventions, digital health, telemedicine, telehealth, it's really just imperative that all populations have access, can benefit equitably, know how to use the technology. Otherwise, you risk widening disparities, as technology-based interventions become the way of the future. So I think that some of the public health implications are that not only technology might be a way to disseminate interventions across the population, which is really important for increasing reach. But the culturally specific version was better in this case. And in addition to that, something we didn't really expect, but we found when we looked at our data, so in an ex post facto kind of way, that we did have some feasibility challenges. So again, I'm always interested in from an equity lens - who didn't have the opportunity to benefit from this intervention? That's what health equity is about, making sure everyone can benefit. So I'm interested in well, who didn't? And what we found was that, of the people who were ineligible, mostly they were ineligible because they did not have the phones that would be necessary to allow them to draw from the internet. 98% of the participants who were excluded, had Android phones and 80% had no contract Pay As You Go phones from the small carriers. Then of the ineligible respondents about 39% just didn't have the stable Internet access to get onto the internet, which you needed to be able to pull those videos. So I think this study, it shows that you can develop and disseminate a high - an acceptable, scalable tobacco cessation intervention that addresses key community concerns and needs, but you have to be careful about the ability for people to engage and not be left behind as you move toward technology.

Schuyler Lawson 20:03
I was going to ask about the digital divide, and whether or not there were any kind of differences in effectiveness as a function of age, for example.

Dr. Monica Webb-Hooper 20:10
So, we didn't analyze the differences stratified by age, but we did find just initially, that age was different when we randomize participants. So we sort of just controlled for age and age did not emerge in our regression analyses as a significant predictor of outcomes. But we didn't actually compare, in a stratified way, to look at whether age made a difference in this sample. But looking in the overall regression, it didn't emerge as an overall predictor of abstinence with either of these interventions. And both, of course, are technology based.

Schuyler Lawson 20:44
So this is very novel and promising really, because it's a nice improvement with what you described in the 2019 paper about African Americans being systematically screened out in some ways by the kind of existing status quo smoking cessation trial criteria. But what it seems like with studies like this that are more tailored, you can have sort of a broader reach and kind of be able to provide more help, in that kind of scalable and customizable way with technology. You just have to be careful not to exclude people, which is always going to be a challenge.

Dr. Monica Webb-Hooper 21:19
Exactly.

Schuyler Lawson 21:21
Okay. This one's pretty pressing, because it's recent news. So what are your thoughts about the Food and Drug Administration's recent rule proposals prohibiting menthol cigarettes and flavored cigars? And also, could you give context to our listeners about why menthol in cigarettes and flavors in cigars are significant tobacco control issues?

Dr. Monica Webb-Hooper 21:46
Sure. Based on my experience, conducting research and with treating individuals who prefer methylated tobacco products, this rule, if it becomes official, has the potential for strong, positive impact on reducing tobacco use among African American adolescents and adults. Among women and adolescents in general, menthol was the only flavor still allowed in tobacco products in the Family Smoking Prevention and Tobacco Control Act that was passed in June of 2009 by President Barack Obama. And what was troubling for many about that act, although it was a huge step forward in tobacco control, because it banned flavorings and allowed the FDA to regulate tobacco products for the first time ever, that menthol was still allowed. It was the only flavor that remained there, and that are still allowed in these products. There have been many - tobacco control leaders, advocates, scientists, and community organizations have really been pushing for this, for many years, for this ban. And I think there's empirical evidence that a significant number of people who smoke menthol brands would quit if menthol was not in the product, or at least that's what they report. And if that did happen, it would have a major effect on the health of individuals who smoke menthol tobacco products, it would prevent illness, and it would save lives. And isn't that what we all want?

Schuyler Lawson 23:18
And what about removing the flavors from from cigars?

Dr. Monica Webb-Hooper 23:23
I think, again, is that that is important because we know that especially among adolescents, many African American adolescents in particular, not smoking cigarettes, not even menthol cigarettes - they're smoking things like black and mild, little cigars, flavored cigars. And so this could be important for prevention among young people, if you don't have flavors that make it more attractive. I mean, I think it's the same reason why other flavors from other products were removed and why you can't buy candy cigarettes, like we used to puff on when when I was a kid, and you could have these little gum packages that looks exactly like cigarettes - the same reason and that's why it's important not to flavor cigars, and mostly our youth, African American youth, are those who smoke little cigars, and they're flavored, you know?

Schuyler Lawson 24:10
They're flavored. And from what I understand, they're relatively inexpensive, and they're taxed differently than cigarettes, right?

Dr. Monica Webb-Hooper 24:16
That's right, and you can buy them in smaller packages. They're definitely not the same as buying an $8 pack of cigarettes. So, I think the point of these kinds of policy changes are about how do we move public health forward? Some people have argued that this is punitive, because they're concerned about the criminalization potential for this, if in fact, it is difficult for people to quit smoking and they are concerned about some sort of menthol cigarette or flavored cigar black market comeabout, but I think most people are on board with this and want to see it become successful, which would be more likely a huge win for tobacco control and for addressing minority health.

Schuyler Lawson 25:05
Thanks for that background about public health significance of removing menthol from cigarettes and cigars. So I remember earlier in this interview, you mentioned that African Americans disproportionately use menthol cigarettes. Do you know why that is?

Dr. Monica Webb-Hooper 25:22
Well, I think the main reason is because of targeted tobacco product marketing. When you just - if you're observant at all, and you drive through a neighborhood that has predominantly black or African American residents, particularly a lower income neighborhood with predominantly black residents, and you drive past corner stores, gas stations, billboards, you still see advertisements for menthol cigarette brands. I mean, you see outside the corner stores, you see advertisement for three things: menthol cigarettes, alcohol, and the lottery. And so these kinds of targeted messages have been in the black community for decades, and if you look at the tobacco industry document, and one of my good colleagues, Dr. Valerie Yerger, has written a lot about this and really looked at those documents. And you see the way the tobacco industry referred to, spoke about, and thought of, in African American individuals. So this has been very intentional on their part. And part of the thing about menthol cigarettes, and this is what many of my participants and patients would say is that they taste much better, it's minty, it's smooth, that goes down more easily. So you create a product that allows people to become addicted much quicker, it only takes about three cigarettes to become addicted and you make it taste better and go down more smoothly, you can hook more people quickly. And that's been a major concern with how the targeted marketing has been so successful.

Schuyler Lawson 26:54
So given that menthol cigarettes and flavored cigars have been on the market for decades, what do you think inspired the Food and Drug Administration's proposal to prohibit them?

Dr. Monica Webb-Hooper 27:04
Well, I'm not an FDA employee, so I can only speculate like everyone else. I would like to think that this proposed rule finally occurred with the mounting evidence pointing in the same direction of menthol cigarettes being harder to quit. And as we talked about earlier, with this emphasis on equity that we've observed since 2020, maybe that had something to do with it. And I think, you know, assuring equity is about doing what is just and fair. And that's been the emphasis about equity since 2020, is correcting social injustices. And so it gives everyone that optimal opportunity to literally live their best lives. And I hope that that is partly what this, that people have advocated for a long time, seems to be possible.

Schuyler Lawson 27:09
I have another question. So if it were up to you, if it was within your power, what type of tobacco control measures would you implement to address these tobacco-related health disparities?

Dr. Monica Webb-Hooper 28:05
One of the most effective interventions or tobacco control measures that you can implement is around policy. Policy change has demonstrated positive effects on promoting smoking cessation, and encouraging people to smoke fewer cigarettes per day, things like increased taxes, making it more expensive to smoke. We also are seeing positive effects from tobacco 21 laws that are now passed in an increasing number of locations - cities, counties - and those prohibit people under 21 years of age to purchase tobacco products. And because of the policies, in terms of thinking about why and how they're effective, because of these kinds of policies, that's why we're not able to smoke in restaurants in most states, some states still don't have full Clean Indoor Air Acts. But we're not allowed to smoke on airplanes and in many public places, so that exposure gets reduced, especially exposure among young people who don't smoke and also children. So I think policies that have equity in the lens from the beginning would be important in any intervention that you're working on, including policy. Who's likely to be punished by this policy, who's likely to benefit? Is anyone likely to be left out? So I would want to look at policies, go back and look at current policies, and develop new policies that would only promote health and not leave someone behind. I think other important measures are in the space of prevention. How do we prevent people from starting to smoke in the first place? I mean, you know the saying, "an ounce of prevention is worth a pound of cure". It's a true statement. It's very true. So should we go back and rethink? Should smoking prevention be part of the curriculum and health courses as early as elementary school, middle school? Should hard hitting campaigns like the Truth Campaign that showed some success be brought back in full force? And then of course, where I've focused my efforts are really around comprehensive tobacco cessation programs that need to be widely available at no cost or low cost, and in communities with high need high smoking prevalence that also include medication, and that are culturally appropriate or culturally specific, because it's certainly one size does not fit all. And we need to think about all of these things given the strength of this addiction, which is really unlike any other addiction.

Schuyler Lawson 30:26
Very detailed answer. Is there anything else you'd like to share with listeners about your research or about tobacco-related health disparities?

Dr. Monica Webb-Hooper 30:40
I'd like to say one other thing, or a couple of things about this topic of disparities. It's that health disparities, by definition, are modifiable, and they don't have to exist. The reason that we study health disparities, and we need to continue to do that is because there have been so many significant scientific treatment advances, and they have just not benefited all populations. So it's beyond time that we really hit the gas and move into the third and fourth generation of health disparities science and research where we really are looking at interventions that have the potential or population level implementation uptake outcomes, applying that health equity lens from the start of the process. And tobacco related health disparities, like other disparities are not based on one's genetics, genomics, or biology. It's not about an inherent deficit. These disparities happen, not by accident, because when you look across populations that experience health disparities, they are disadvantaged, and that's the link between all of them, so it's rooted in disadvantage, versus being rooted in differences due to biological or genetic factors.

Schuyler Lawson 31:55
It is a very important distinction to make. Thank you for making that clarification. Again, thank you so much for taking the time to be interviewed for the podcast. We hope to have you on again to discuss future issues, and also future publications, I'm pretty sure that's gonna happen. And is there a way that listeners can learn more about your research?

Dr. Monica Webb-Hooper 32:17
Sure. So I certainly encourage everyone to follow NIMHD. We have a listserv that everyone can join by going to the NIH listserv website, and you can sign up and find out all the things that we're doing that have to do with health disparities in general, and also the things that we support that are in the Tobacco Control Space. My own research can, of course, just be tracked through, you know, PubMed and other things. If I publish a new article, sometimes we push it out through NIMHD, depending on what it is, and then I'm also on Twitter. Let's see if I remember my Twitter handle. It's @DrMWHooper. So certainly invite anyone to follow what I'm talking about there, which isn't a whole lot, but mostly the work that we're doing

Schuyler Lawson 33:06
Will do. I'm pretty sure quite a few of our listeners are on Twitter, so it'll be great. It's good to see scientists promoting their research and their focus on Twitter. That's a good dissemination tool, I think.

Dr. Monica Webb-Hooper 33:17
Yeah, I agree.

Schuyler Lawson 33:18
All right, so I'm Schuyler Lawson. Thank you for listening to another episode of Buffalo HealthCast. Take care and be well.

Outro 33:25
This has been another episode of Buffalo HealthCast. Tune in next time to hear more about health equity in Buffalo, the US, and around the globe.