Leslie McClure is Professor & Chair of the Department of Epidemiology and Biostatistics and Associate Dean for Faculty Affairs at the Dornsife School of Public Health at Drexel University. Dr. McClure does work to try to understand disparities in health, particularly racial and geographic disparities, and the role that the environment plays in them. Her methodological expertise is in the design and analysis of multicenter trials, as well as issues of multiplicity in clinical trials. She is currently the Director of the Coordinating Center for the Diabetes LEAD Network, and the Director of the Data Coordinating Center for the Connecting the Dots: Autism Center of Excellence.
Episode Description
After over a year of being stuck in our houses. A lot of us are appreciating the outdoors on our planet a little bit more healthy environment and more our focus on this episode of Stats and Stories with guest Leslie McClure.
+Full Transcript
John Bailer: After over a year of being stuck in our houses, a lot of us are appreciating the outdoors on our planet, a little bit more healthy environment and more our focus on this episode of Stats and Stories, where we explore the statistics behind the stories and the stories behind this statistics. I'm John Bailer. Stats and Stories is a production of Miami University's departments of statistics in media journalism and film, as well as the American Statistical Association. Joining me as regular panelist Richard Campbell, former chair Media journalism and film Rosemary Pennington is away. Our guest today is Leslie McClure, Professor and Chair of the Department of Epidemiology and Biostatistics and associated Dean for Faculty Affairs at the Dornsife School of Public Health at Drexel University. Dr. McClure does work to try to understand disparities in health, particularly racial and geographic disparities and the role that the environment plays in them. Her methodological expertise is in the design and analysis of multicenter trials as well as issues and what most simplicity of clinic trials what that might mean she is currently the director of the Coordinating Center for the diabetes led network and the director of the Data Coordinating Center for the connecting the dots on Center of Excellence. Leslie, thank you for being here.
Leslie McClure: Thank you so much for having me.
Bailer: Oh, It's a delight. I've been hoping to have you joining us for a while, so it's really a pleasure to have you here. You've done such a great breadth of work. I mean I've really enjoyed just reading about some of the stuff that you've done ranging from studying use sports like injuries and soccer to using virtual reality to study texting and walking it bad I got to hear more about later but initially we want to talk little bit about your work in this Regards. Where are you doing reasons for geographic and racial differences in strokes? So can you give us just a little bit of context for that?
McClure: Sure. So Regards was a cohort study of 30,000 people recruited across The United States between 2003 and 2007 All black America and white Americans who you've been following for a little over 10 years on average to try understand why people who live in the south die from higher risk of stroke than people who live in other parts of the country, why black people die from higher rates of stroke than than their white counterparts. In addition over time, we've exceeded and added it to look at things like cognitive functioning and to look at heart disease, and we have a lot of risk factors for these folks that we're studying. So we've been able to characterize them very well. And it's led to a lot of interesting science.
Bailer: Well, that's that that you're leaving us here. Hang in here. Now we got to know more about this. So you know, we got to unpack a little bit. So when you say you know we have some people that may not know what study is, that's listening. So if you could just say a little bit about, so you're tracking these people over time as well. So it has this longitudinal aspect. Could you tell us a little bit more about how these cohorts were defined and what that means? Then a little bit about, you mentioned the cognitive functioning and heart disease. Some of the endpoints that you're measuring yo u said you've got some really great variables you're considering good. Tell us a little bit more about those as well. Please.
McClure: Yeah, so cohort studies, one where you collect a lot of information at the beginning and then you follow people to see what happens to them. We've been really fortunate to be able to follow a good proportion of those 30,000 people for quite a bit of time and so we're essentially calling them every six months on the phone and say, Hey, how are you? How are you doing? Have you had a stroke? Have you had a heart attack? Have you experienced some other symptoms? And then every year, we have asked them questions about their cognitive abilities. So we have a short screener where we ask them about remember three words. And then we also ask them about where they are, what day of the week it is, what month it is, to test their mettle. The other question you asked was about the fun variables we have.
Bailer: Some of the things that you've measured that you're going to be using to try to predict These different outcomes.
McClure: Yeah, so when we started the study, we measured a lot of sort of traditional cardiovascular risk factors like that. Body Mass Index, their cholesterol, their blood pressure, But we also have the head ability because we know where everyone lives. To incorporate a lot of other interesting things such that are related to where they live. So by knowing where someone lives we can look at their neighborhood and some characteristics of their neighborhood including the levels of public they might be exposed to, but also other things like we can look at risk eventual segregation and we can look at measures of its of, of disaster preparedness and those sorts of things that different groups characterize. We can look at things like the process. 72 healthy food outlets or the public Somebody's to parks and see Further see whether those are related. to their risk of getting to getting diseases like stroke or cardiovascular disease or whether it's related to their memory or other cognitive measures
Richard Campbell: In doing this work, what surprised you the most so far in terms of what you're looking at?
McClure: So I think you're going to be surprised by what surprised me the most. To me, the most is that 30,000 people were willing to participate for a check for $30. So that's all that they got at the beginning and they did a 45 minute interview and then they’re on the phone and then they allow a health care worker to come into their home and collect height and weight to take their blood, to collect a urine sample and to do an electrocardiogram, so, to me that's surprising. I don't know that I would be willing to let a researcher take that much of my time. And also do that kind of data collection. And over time so many people continue to be engaged with the study and that surprises me. In terms of our research findings, what surprised me? That's a hard question. I think not a lot has been surprising. I think what's fascinating to me is that the traditional risk factors that we think about like blood pressure and cholesterol, and those biological variables only account for the proportion of the disease we see and only account for a small proportion of the differences we see between different groups. One thing that's been surprising to me is that diet plays such a large role which we know might be related. To those, but things like proximity to healthy food stores don't play as large of a role as we would expect.
Bailer: I wanted to follow up to this second hand smoking. Is that part of this study or is it that the I was kind of interested in Matt for a personal level so my father smoked when I was growing up, but he quit when he was 50 years old. Until he was 89. So what are my chances? Well I loved smelling the smoke. I never was a smoker But I loved when my day was good I found it so my dad Smoked growing up.
McClure: Well so, It's interesting we found mixed associations between being exposed to secondhand smoke as a child with adult disease. So we looked at cardiovascular disease and stroke and we found that there was an association with stroke later in life, but not with cardiovascular disease. However, that's popular on a population level, right? So it's hard to say what that means for you individually because there's so many other risk factors that play a role and I think that that's the challenge of these types of cohort studies where it's really difficult to look for causal associations. It's really hard to say that That secondhand smoke exposure is what caused someone to have this Later in life
Campbell: We did a Study. We didn't do a study. We had a guest a while ago who studied ideas of food deserts and communities and they were trying to think about trying to systematically do some studies and it seems like that's a really hard question. I mean, it's sort of they're things that have face validity when you look at them and you think Gosh, I grew It just makes a lot of sense. That that would that be It might matter but then you realize Boys, you know, that's Just it's it's too It's too accrue to measure it doesn't.
McClure: Right, the personal. We can put a grocery store in a neighborhood that doesn't have a lot of healthy food outlets, but we can't guarantee that people will buy healthy foods. But it's there. And so it's really hard to get at that. What we're really the crux of what we're Trying to measure
Bailer: Have you started with 30,000, how many still participating?
McClure: Out 11,000 And so in the average age when we recruited people was about 65. Oh, so you know some of that is sort of natural attrition if you will. People aging out because they've passed away or they're no longer a bit able to answer the questions. But some of that is you know, people move and we lose track of them or people simply don't want to participate anymore. But the retention has been much higher than expected over time.
Campbell: That's great. I was shocked when you said that, you know, 30 bucks to get to sign up and continue. That's, that really is very impressive. It's very impressive.
Bailer: You mentioned disaster prep. preparedness as being one of the components of this. Can you talk a little bit about you know what, what, how do you measure that and why did you think that might be relevant for thinking about cognitive functioning or heart disease?
McClure: So some of our colleagues at the CDC have measured what they call the social vulnerability index and so it's not actually something we've measured and not something we've incorporated in Regards yet but it is something we're looking at and it's a measure. They discovered or they developed, excuse me, to try to think about when disasters occur, what populations what areas in the population might be most vulnerable to those disasters and so there is some evidence, and I just worked with a colleague of mine here at Drexel to us Submit a grant to look at disasters and the impact on people's cognition over time because there's a lot of ways that disasters, like weather disasters for instance, can impact people's health so we did some research in so our regard sample over sample the southern part of the United States so we have a lot of participants in the southeast. During the United States, and after Hurricane Katrina, we had a good portion of participants that left Louisiana and so we were able to do some before and after types of analyses in the cohort. Part of our team looked at that and found that there might be some changes in perceived stress, depression. So you know that those sorts of natural disasters that have a huge impact on people's lives also impact their health. The question is, again, what's the actual causal factor there? So we don't really know. It's not the disaster itself. It's not the hurricane but it's the stress It's the inability to access health care, inability to get your prescriptions, it's the you know, inability to even interact with your family, right perhaps you can't get to your parents who are Elderly you're or your, you know so there's a lot of factors factors that impact people's health that are sort of similar praising you asked about what's surprising that we've Found in regards And I should add that all of this work is is part of a huge team of investigators who are who are collaborating and different ways and that you know, I only play a small role in regards and there's That group of people across the country who are helping to answer all of these questions.
Campbell: So the focus of it was, you know, you had racial and geographic components that were, you know, you build it into the name. So that was Clearly has very, very key interest to you. But could you kind of know at this point of the study this Given what you've learned over time What are some of the conflicts that relate to the title you know? What kind of things have you learned about racial differences and about geographic differences that you would you've learned from this effort?
McClure: So we've definitely learned that there's differences in Some access to care variables And we think that may Influence some of these differences we've been able to. So first and foremost, we were able to reproduce that these differences exist and so they 're important so we definitely see higher stroke mortality. rates in the south. southeastern United As we definitely see Higher strict mortality rates. among black Americans Relative to waiting Americans we haven't found The magic bullet that explains these different Associate We're still You know, trying to peace away at it. Through novel types of analyses and novel types of exposures. We did find like there were some some primary questions about were southerners or black Americans not being reported as having strokes as frequently or more frequently, and maybe it was just maybe it was a reporting issue, or perhaps that that there weren't more strokes occurring among black people or among southerners, but, but more people were dying from strokes in those groups. And so we did eliminate that as a possible source of these differences in stroke mortality. And we have been able to show that some differences in traditional risk factors, as I mentioned, explain some of this, but not all of these disparities.
Campbell: What about diet and study?
McClure: So my colleague, Dr. Suzanne Judd, who is currently the PI regards study, she has done a lot of work looking at diet. She's a nutritional epidemiologist by training. And she has found that in her work that she's led that diet does explain some of these disparities. And it's funny, when we started regards, when you would talk to people in the study, they would say, Oh, I know, it's gonna be because we eat a lot more fried fish in this region of the country, or, you know, we use we use this kind of oil to fry our foods or so. So I think a lot of our participants expected that diet would play a large role. And we found that it does play some role in these disparities.
Bailer: You're listening to Stats and Stories. And today we're talking with Leslie McClure, Chair of the Department of Epidemiology and Biostatistics at Drexel University. So Leslie, do you report back to the participants some of the results? Did they get kind of interim, you know, kind of this is what we've learned to date?
McClure: We do. So that's, I think one of the reasons why this cohort has been so engaged over time. So we've done a lot of creative things, we sent a newsletter, they sent birthday cards for part of the study, we sent holiday cards. And we have a website where we keep up to date, both for other researchers and for regards participants. And so we do try to share with them what we're finding and you know, of course, we acknowledge their there, their participation, because without them, obviously, we wouldn't be able to advance the science.
Bailer: So I met with Richard's permission, I'm going to change gears just a little bit. I mean, you've done too many other cool things to not talk about some of them. I mean, I agree. I got to learn a little bit more about this, particularly the vert using virtual reality to study texting and walking. I mean, I know, I've seen enough reality of people not being able to text and walk. So I'm interested about what was it that you were trying to study there and what did what, what was the way that you studied it was the question that motivated it and what did you learn?
McClure: Well, the first thing I want to say is that one of the things that I love about being a statistician is I have a set of tools, right and I can use those tools in a lot of different ways. And so I might have, I might be hammering a different kind of nail in different areas if I'm building a swing set versus if I'm building a house, but I'm still using a hammer, and I still get to use those tools. And so you know, I'm gonna I'm going to quote my academic grandfather who said that the best thing about being a statistician is that you get to play in everyone's backyard. And it's really true. I've been really fortunate to get to play in a lot of different backyards, and that's because I've had amazing collaboration. readers. And so you asked about the virtual reality experiments and this is something I've worked on with a collaborator David schwebel and The University of Alabama at Birmingham, who I've known for many years, and He started off Trying to understand Just tell we can teach children to cross the street more safely So So obviously you can't just stand in a room and say okay, cross when you think it's safe, right? ethically, that's just not okay. So he worked with some programming folks in Iowa to develop A virtual environment, a virtual street environment and so he created this virtual environment that he originally was using to help teach kids to cross safely. Okay, so all that to get to your original question about walking in tech.
Yeah so once we found that Virtual Environment worked. We were curious about what other questions we could answer. And so one of the things that we've done is to bring college students into the virtual environment and tell them Okay, why don't you text and see what happens and now don't text and we'll see what happens and a lot of it is attention to what's going on in the environment right and so now we have kids act like kids and see what happens in a safe and vironment to do so and so that's been really Actually that research Now has even taken a step further away. We're looking at Using Google Glass And so Now we have the virtual environment on itself. Phone And we're doing it You know With a with a headset So, so now we are looking at dissemination Can we more broadly disseminate this in a way that doesn't require these giant computer monitors that have to be lugged around and so it's been a really great collaboration and a really fun Project a fun set of projects to work on over time.
Bailer: Got it. So so the the result of this work I mean so as people have been walking and texting I you know what what have what have you seen You know, and may is part of it just to sensitize the people that here's how much loss of concentration or loss of focus you have when you're if you're texting while you're walking.
McClure: Yeah, I think there's other research that shows that texting And driving is equivalent to drinking and driving. And so we were. We had a hard time thinking about the study design and that's my fault because I'm the statistician for the study design. presented some chat challenges to really be able to show differences but we Were able to show that people who were texting were more distracted. Okay,
Campbell: So after I add The second question General have forgotten what I asked you for So I might as the journalist on the program along with rosemary, I always like to ask what you Think of the way journalists cover your work and stats in general The second point That in Maybe one day Do better what you because you're you're doing the kind of work that's going to get translated to the public through journalists. The second question is What can statisticians do to better communicate to the public? Because they're your works company Works You and there's a lot of uncertainty involved. And people don't like uncertainty, right? So those are the two parts. And if I forget John, I'll remember the two that I know are great questions.
McClure: They are great questions and Actually we are doing a lot of work in our classes now with our students to talk about the importance of being able to talk about Your work and I think if if COVID pandemic has highlighted anything. It's definitely the need for better science communication. And I'll be honest I get nervous when I get asked to do an interview and i i did For bloomberg news that was live during COVID and i think i don't know that i We'll ever do a live interview again. It really was terrifying. Because I am really Worried about Now Being able to Express What I need to express in a way that makes The public and I think that there's a real danger of doing more harm by not being able to communicate well about what We're doing a set of sessions and so you know in terms of what Journalists can do better at Always, always makes me more comfortable. If the journalists provide me with questions ahead of time and then I can think about You know, step one, how would I answer that? Okay, now step two, how would I answer that if I was talking to a set position versus the general They're all public and that gives me time to collect my thoughts and think that Through a little more carefully in terms of statisticians Do you know we as CEO Your people john and i, you know, working with our students and our, our junior people to learn to communicate better do media trainings. Think about the idea that what we're doing may be complex and that those complexities aren't working. People want to hear about that. You need to be able to translate what we're doing. into a clear concise message And I can tell you During COVID I've seen which statisticians can do that very well..
Bailer: A follow up to Question But which of the which of your projects Have panic There's a great Just the amount of kind of coverage general interest in the pie for the press
McClure: It's definitely the work I've done around the environment I think I think The Particularly Looking at this environmental exposures. cognition. I have garnered the most media attention in terms of my own specific research, but I did get as many, many more interviews in the media in the last year. than I ever had before. related to your work are just awesome. Have some decoded. related to COVID I was I had several opportunities many of them I passed along to people more knowledgeable than I am about COVID or people who To have had more experience doing them, but I did talk to person about How to read how as a lay person To read scientific literature and you know what sorts of lessons to take from it. I mentioned the Bloomberg Quint, but much more, much more. My expertise as the chair of the department of epidemiology Then Then the research I'm doing
Bailer: You know That That's, that's amazing. That's really cool. I'm curious about the you know, I'm going to take a little bit different these because I as a soccer coach, as you know and I had three of my three of my kids play sport And, you know injury is part of that and I saw that you were injured. In a study of youth sport and injuries in youth sport And I just was curious if you could, could talk a little bit about this and, and, you know, use this idea of a case crossover. You know that there's the idea that there are special study designs that people might use that are employed For certain things particularly like injury, could you tell us a little bit about that work and what motivated it and some of the things Learned.
McClure: Sure so this is work again with Same collaborator who's interested in teaching kids to cross the street safely. So he's a psychologist who's interested in injury prevention and He had done some work before looking at youth sports and I haven't remembered exactly how this conversation went but it came. I think it was because our Kids were both playing soccer at the time and we started thinking about this transition point at different ages. Where more referees are on the field. And what is the role of those referees and doesn't make the game safer. And so that was really The question we were trying to answer was in those younger age groups where there aren't Three referees. on the field Will the addition of referees Create a safe environment so if there's More Pete. More people are looking to see if penalties are happening. Perhaps there are fewer penalties. Use and And thus perhaps fewer injuries. And so that was the thought process behind that and we thought a long time about how we can design a study to try to get at that. And in this case crossover was this idea well is actually a crossover. It wasn't really a case crossover because we weren't looking at like a case of disease and then what happened before after it but we were looking at the same pairings of soccer teams because we wanted to try to account for That if you're playing a team at a certain skill level, how you interact on the field be different than a team at a different skill level. And so we wanted to look at this crossover where Team A would play Team B with three referees on the field and without freerun For us on the field and what we learned Was that it's really, really challenging. Going to implement this kind of Study in a real World setting because there were so many variables that we couldn't control like rainouts or referees having to cancel or schedules getting changed. And so just not even related to our hypothesis. But just the world around us that couldn't control although we did see that there was some slight advantage to having multiple referees on the field. Interesting in the end. Yeah,
Bailer: I was gonna be curious to see how that played out just because you know If you get more referees, it tends to be older kids, and they're sort of flying around the field. And I just I was thinking that's, you know, that's a whole the whole idea of confounding seems to come out. And then, you know, experience matters in terms of officiating too. So There's some that's a hard problem. That's
McClure: That Is there we're not A lot of injuries that occurred In the younger age groups and so then we We're looking at Things that might be related to injuries So then we're even one step further down the chain there and it was really difficult
Bailer: You know what, let's I'm afraid that's all the time we Today I spent just Delighted to chat with you
McClure: It's been my pleasure and I am really Speaking with you both.
Bailer: Stats and Stories is a partnership between Miami University’s Departments of Statistics, and Media, Journalism and Film, and the American Statistical Association. You can follow us on Twitter, Apple podcasts, or other places you can find podcasts. If you’d like to share your thoughts on the program send your email to statsandstories@miamioh.edu or check us out at statsandstories.net, and be sure to listen for future editions of Stats and Stories, where we discuss the statistics behind the stories and the stories behind the statistics.