Like most teens who consider themselves invincible, adolescent women typically don’t consider how their unhealthy eating and exercise habits will impact their future heart and maternal health risks.
During American Heart Month, adolescent medicine doctors at Children’s Healthcare of Atlanta and OB-GYNs at Grady Health System who work with reproductive-age teens are using a pilot heart health digital tool to encourage conversations with their patients.
The new app was the brainchild of Dr. Holly Gooding, medical director of adolescent medicine at Children’s and associate dean for professional development and education at Emory University School of Medicine.
“Heart disease is the No. 1 cause of death among women. Most young women do not know that,” Gooding said. Many of her young female patients at Children’s exhibit risk factors for heart disease such as low physical activity, poor diet, early onset hypertension and diabetes, she said. “I want to raise awareness about heart disease at younger ages.”
Credit: Emory University
Credit: Emory University
Heart disease also is a leading cause of pregnancy complications, including preterm births and maternal mortality. Georgia’s rate of preterm births, infant and maternal mortality are higher than the national average, according to the March of Dimes.
Based on Gooding’s vision, two graduate students at Georgia Tech developed the HerHeart website with mentors from the Georgia Clinical & Translational Science Alliance. The alliance of clinicians and scientists from area health care academic research centers create digital apps to improve patient care. HerHeart was adapted from a cardiovascular risk assessment tool, the Healthy Heart Score, developed by Harvard University for adult women.
Credit: Emory University
Credit: Emory University
As part of their latest research, which began in 2021, the Georgia Tech students created colorful mock-up screens for the potential app, similar to BuzzFeed’s quizzes, that asked short questions with “snappy language” and animated responses to answers about diet and exercise habits, explained Santiago Arconada Alvarez, co-director of Emory’s AppHatchery and associate director of apps, digital platforms and technology development.
The app’s design had to be aesthetically and culturally appropriate for the target demographic and age group, he said.
Credit: Emory University
Credit: Emory University
The students gained feedback about the mock-ups by interviewing 60 young Black women ages 13 to 21 with a median age of 17 at adolescent health clinics at Children’s and Grady, mostly serving low-income populations, according to an article on the pilot risk assessment tool published last year in the Journal of Pediatric and Adolescent Gynecology.
The participants rated the tool’s ease of use high and reported their perceived 10-year and lifetime risk of cardiovascular disease, both low, said Gooding, scientific lead and principal investigator of the study. They overestimated their 10-year risks and underestimated their lifetime risk, Gooding said. Participants repeated the assessment three months after enrollment. About half the participants chose to set a behavioral goal and 12 participants returned to follow up with their health care provider.
Those who stayed for the three-month period increased their physical activity by the end of the trial, Gooding said. Some participants also reduced how much processed meat they ate and increased their servings of vegetables, she said.
“The first step was even if we can get adolescents and young adults to engage in the topic,” Gooding said. “The majority were interested in the (pilot) test. Eight out of 10 said they would recommend it to a friend.”
In a previous phase of the study, only 10% of 67 young women surveyed correctly identified cardiovascular disease as the leading cause of death among women in the United States. Few respondents, 6%, reported having discussed their personal risk with a health care provider and 12% their family history of cardiovascular disease, according to a 2022 report in Journal of Medical Internet Research publications. During those interviews, young women reported better cardiovascular disease awareness and knowledge after completing the adult risk assessment tool.
Less than half of the participants were aware that low physical activity, diabetes, smoking and high cholesterol contribute to heart disease. More than half the participants, though, identified high blood pressure and being overweight as major contributors.
Participants were recruited from the Grady adolescent reproductive health clinic in addition to the primary care clinic at Children’s because many young women seek reproductive health care, and the researchers thought that was a good time to promote cardiovascular heath as it relates to future pregnancies, the JMIR report stated.
The majority of homes served by the two practices in southeast Atlanta, where more than 70% of the population is Black, report annual income of less than $50,000, according to the report.
During Heart Month, doctors at Children’s and Grady are encouraging teens to use HerHeart in the waiting rooms and continue the discussion during their office visit.
Though the app is available online, research teams are not monitoring the responses, and the website isn’t ready for commercial use, Gooding said. She added that she will discuss next steps with the AppHatchery and other research investigators. Eventually she plans to partner with large health care systems to further develop the risk assessment tool with incentives to keep more young women engaged longer to improve their heart health. “I think it’s important to get the message out to health care providers that young women are willing to have a conversation.”
Consulted by The Atlanta Journal-Constitution, Cleveland Clinic pediatric cardiologist Christina Fink said she was excited about a potential app that could raise awareness about cardiovascular disease and heart health at a younger age to reduce risks later in life.
Credit: Cleveland Clinic
Credit: Cleveland Clinic
“As children transition as adolescence and young adults, it’s important for them to be aware about their heart health. They can improve it as an adolescent or young adult before it becomes a problem,” said Fink, who specializes in cholesterol and obesity management. “It’s important for them to make healthy choices now.” She cited connections between obesity and hundreds of medical conditions, including diabetes, high blood pressure and high cholesterol. “Obesity can strain your heart over time. … I don’t think it’s too young to start (prevention) as adolescents.”
Even without an app, Fink believes parents can talk to their children’s doctors to assess their risks. They can also find ways to build in exercise and improve their diets food choices to ensure better heart and body health, to achieve wellness and to maintain longevity. “Being aware is half the challenge.”
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