Shireen: Podcasting from Dallas, Texas, I am Shireen and this is the Yumlish podcast. Yumlish Is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Dr. Nazanin Heydarian will be discussing the effects on our health associated with biological and sociological factors, as well as discuss how health specialists can create a better relationship with their patients.

Dr. Nazanin Heydarian is a social health psychologist who examines disparities in chronic disease self management and outcomes experienced by persons with disabilities and their caregivers. On the weekends, Dr. Heydarian enjoys dropping on her roller skates and hits the skate park. Welcome Dr. Heydarian, how are you?

Heydarian:  I'm well Shireen. Thank you.

Shireen: So an absolute pleasure to have you on, can you tell us a little bit more about your background and what led you to this field?

Heydarian: Sure. And the, the pleasures all mine. It's great to be here talking about these things. So yeah, a bit about my background. I'm a social health psychologist by training.

And that basically means that I deal with all the sort of behavioral and social cognitive aspects that drive health, and avoid basically the absence of health or sickness and disease. I'm particularly interested in studying health disparities. So the differences in that, that minority populations and marginalized populations experience in the quality of their health.

And I'm a I guess, I like to do the accessibility sort of introductions. And especially now, since my video's off, that's especially helpful to people. So I'm a Persian-American woman. I have light brown skin and I'm wearing my hair up in a bun and I'm wearing this sea foam greenish top. I'm part of the low vision and blind community.

And that's sort of the, the, the more personal part of why I'm interested in the particular population that I'm interested in. So I've sort of seen in my community firsthand, the health disparities experienced. And so I'm interested in, in helping address those health disparities.

Shireen:  Thank you so much for sharing sharing that Dr. Heydarian. In an interest of, of doing the same, I have, you know, light brown skin as well. I have long, very messy curly hair and I'm wearing a black top. And so with that, Dr. Heydarian, tell us a little bit more about sort of what are some biological and even sociological factors that can affect our health and cause severe illnesses.

Heydarian: Sure. So I'll just focus on and there's still going to be a bunch. But the ones that I tend to focus on in my research are behavioral health factors. So nutrition, physical activities, sleep, medication management, risk reduction, problem solving. So behavioral things that are pretty rooted in biological aspects that affect our health, also social cognitive factors. So this is sort of the social psychologist in me. I'm interested in issues of identity, group relationships, efficacy, so like a person's belief that they can carry out a health behavior, for example. Group membership and identity.

So what are the benefits for example, of identifying with the marginalized community? Sort of buffering effects, do they have on the impact of stress on health, on health and stereotypes and prejudice. So intergroup relations, how are people within the group internalizing stereotypes and prejudices and how do those things affect their health?

And also how are they being perceived by other people, such as healthcare professionals, that would have a very direct impact on health. And also social determinants of health and these sort of overlap with the behavioral aspects and the social cognitive aspects. But these are sort of the the healthy peoples seven determinants of health.

So the access to quality education, access to high quality healthcare, economic stability, neighborhood, access to a safe neighborhood and community and social contexts.

Shireen: Okay. And what long term effects have you found in your research, are associated with socioeconomic backgrounds specifically when talking about low income communities?

Heydarian: Sure. And I had to ponder with this question a while cuz it, and a lot of these there's such they're very thought provoking questions. Like I haven't, I don't normally think about my research in this way, so I appreciate like the, sort of the thought exercise that these questions posed, but as far as long term effects I found, and I haven't done much.

I guess I shouldn't like say I haven't done what I should start with what I have done.  So I found that there are greater prevalences of chronic and acute health conditions experienced by, and I'm broadly interested in the disability population, but. Very much interested in the little pocket of the community that I'm a part of,

so the blind community, and that's sort of where I'm starting to examine things, and then I'm interested in sort of looking at how they generalize across other disability identities and communities. So I guess back to the question, I find that there are higher prevalences of acute and chronic health conditions, including diabetes, cardiovascular disease, migraine headaches, osteo rheumatoid arthritis, Encephalitis, meningitis, multiple sclerosis, Alzheimer's and these are just the things that I've looked at that I've found held disparities in.

So there's a whole host of other chronic and acute conditions that need to be looked at in the disability population so that we can get a sense of what the long term effects are or just kind of the, the long term health disparities that, that this population is experiencing. And yeah, so that's sort of where I'm at right now and down the line, I'm interested in looking at more stress and other things in more causal terms.

So sort of being able to maybe follow people across time and examine like more directly, what are long term effects. But for now, this is sort of what I found. That there are these the long term effects on particularly I guess, the chronic health conditions. But also setting people up to be more vulnerable for acute health conditions.

And I don't have COVID-19 here, but we, my, one of the research teams that I'm involved with has, we're sort of looking at some new data that we've collected on COVID-19 and experiences of people with disabilities here in Texas, and we're starting to find health disparities there as well. A lot of them are driven by access to resources, like information, accesses to tech, access to testing and to vaccination.

And there are health disparities there. And furthermore, there are intersectional effects there too. So people who are. Identify as having a disability and who have a minoritized racial or ethnic identity as well. They seem to be impacted even more. 

Shireen: That is interesting. And when you mentioned about stress in particular, so it seems that in the last couple of years, people's stress levels have been elevated, you know, higher than usual.

COVID has certainly not helped. Right. So what kind of healthy choices would you recommend so that they don't create the habit of stress eating? Any ideas around that?

Heydarian: Sure. So I, I I guess, like for, for starters, I don't really have much research experience. I've seen a little bit here and there, but this, I haven't really looked at it myself directly, but with that caveat, I guess one of the first thoughts I have was making healthier versions of comforting foods.

So I guess I'm a little guilty of this as well. There's definitely like some comfort in. In food and in times of stress, it's nice to have that there in moderation. And just to sort of substitute out some what you have available, I guess for when you're reaching for something, when you are feeling stressed that can be really helpful just to sort of sub out for healthier versions where you can and.

Also complicated because different people have different access to to things and have other resources that can help them like have access to healthy foods. So this is, yeah, it's a, it's an interesting question. And I, I feel like I yeah, it's, it's an interesting question. And one that could be there probably health disparities in my community as well.

Shireen: When you, when you mentioned earlier about communities of color and then that intersection of people with, with disabilities and seeing more disproportionate sort of acute and chronic disease there, what have you found in some of your research? Can you tell us a little bit about that? Some of the biggest obstacles that you have seen, in these communities? 

Heydarian:  Sure. So I think back to the social determinants of health, so these communities tend to get the short end of the stick, so to speak when it comes to social behaviors, social determinants of health. So, less access to quality education, less access to quality healthcare. And this could be due to logistical reasons, but also due to social cognitive factors like prejudice and stereotyping less economic stability for access to safe and secure neighborhoods and community and social contexts, actually, that can be.  And when, I guess when you're plugged in with a community and that could be a minoritized community as well, that has buffering factors that, that has like beneficial factors. So that might be one thing that it, it could be detrimental if you're sort of out of touch with your, your minoritized identities community, but it can also be an asset, and have protective factors against your health. So yeah, that and, and just fewer access. So, and I'm, I do research with Latino families with children with intellectual developmental disabilities, and we study the health behaviors of the primary female caregiver.

So a lot of the time. The mother of the child and the child that has the intellectual developmental disability. And in that particular intersection of minoritized ethnicity and disability, there's also a lot of lack of access to disability related resources that can impact the mother's health as well, as well as the child's health, but the mother's health in that it's just, fewer access to resources that could help them to sort of like raise a child with a disability that they would, without these resources they're taking on a lot of this themselves. And that causes, it just, it's an extra burden that causes stress. And so there's, there's also sort of a lack of those specific resources.

And I guess you can cycle back to issues like economic stability, access to quality healthcare, access to quality education. So that's sort of what those social determinants look like in that particular segment of the population, I guess, that, that I'm currently doing research with.

Shireen: Anything interesting that you found there that you think our, our audience may want to hear about in that, in that particular research that you mentioned.

Heydarian: Ooh, that's a good question. I'm gonna take a moment and pause and think about this one. Cause that's a good question. I guess one of the most striking things is the, the, the differences in the access to the disability specific services. So Latino families tend to get a diagnosis later and they are less plugged into to services like yeah, like therapeutic services for autism, for example. So that, I guess those are, that's kind of the most surprising. I wish I had something more useful for the, the listeners, but like, I guess that's kind of like one of the most striking and important, because it's a, we're identifying this disparity that needs to be addressed.

And a lot of the, like, I guess the ways I'm gonna answer questions is kind of, and it's kind of indicative of where the field is. It's like, well, we're kind of learning what the problems are right now.  Before we can sort of solve them, so it's gonna be a bit of a bummer sometimes, Shireen. It's gonna be like, well, here's what the problem is.

I don't know how to fix it yet, but it's an interesting problem. And we, we kind of need to, I guess, learn more about it. And then we can go about addressing health disparities.

Shireen: No,  (It's)  understood and that, and that's just it, right? Because a lot of this research is, is happening now. Be it, you know, in, in a lot of these underserved groups, you've got people with disabilities across ethnic groups, like you were talking about at that intersection.

So a lot of the research is still catching up, so you're, you're absolutely right. And, perfectly perfectly good answer. You mentioned a little bit ago about stereotyping. I do wanna, I, I wanna switch gears quickly to the health specialist side of things. So how have you found in your research that health specialists are stereotyping patients and then what can be done so that there is better relationship between the health professional and their patients?

Heydarian: Let's see here. So the content of the stereotypes I'd say has a lot to do with competence. So with people with disabilities, the stereotype content is usually about low competence and this could look like the healthcare professional talking to a non-disabled person that they assume to be there with the person, with the disability and to be their caregiver.

And this could be problematic because a lot of the times this, this could be a perfect stranger that just happens to be standing behind you in the line. Healthcare professionals in my research, I've found that sometimes they can talk to a stranger that they assume to be a caregiver about the patient's confidential health information.

I've heard stories of healthcare professionals just handing over sensitive medical documents to a perfect stranger that's just sitting next to you. Because of an assumption that, oh, this disabled patient must have a caregiver and the caregiver must be the person sort of standing or sitting closest to them.

So I'm going to work through this person to, to sort of work with the patient and that those are just some more extreme examples of what that can look like. Sometimes. Healthcare professionals are just uncomfortable talking to people with disabilities. They do things like talk loudly in particular to blind and vision people who might not have hearing related disabilities assumptions about caregiving.

So they'll assume that the patient has a caregiver at home and maybe not explain a course of treatment in depth enough. So that the patient is able to then go and manage their own health condition. Assumptions about the caregiver role of the patient, so this person assumptions that this person is probably not a caregiver to somebody else, like a child or an elderly parent, or maybe a spouse who needs care at the time.

And this could lead to healthcare professionals either directly or indirectly by setting into motion other I guess, services available like social services that interfere with the patient's primary caregiver role for other people. And these are just a few ways also assumptions about how much time it'll take to work with a patient.

So healthcare provider. Assume that there's gonna be a greater burden of time spent with disabled patients and these all, they're all sort of, if we think about microaggressions, I guess that's more of a prevalent topic in discourse these, these days, which is awesome. More people are talking about it and sort of understanding what these are.

So a lot of these are kind of microaggressions that don't sound like they would have a very serious impact on health. In some situations, some situations they do have a very serious impact on health. But in most it, doesn't sound like it, but it really adds up and it can erode important things like trust in a healthcare professional, and it can lead people to sort of disengage with their own healthcare and also to avoid interactions with healthcare professionals.

And as far as what to do about it, I think that there needs to be greater education on disabilities and alternative models to the medical model of disability that healthcare professionals get some sort of training in. So the medical model of disability is basically saying that the origins of the disability and any sort of problems arising from the disability.

Like maybe disparities in health, for example, or lack of access to any of those social determinants of health that we talked about. Those are due to the disability within the individual, or specifically the whatever's going wrong with the individual, basically that makes them different.  And it's the individual's responsibility to overcome their disability or to cure their disability or just, you know, like seek out a cure.

They maybe not cure themselves, but it's their responsibility to seek out appropriate medical intervention to cure themselves. And the, the onus is really on the individual to sort of deal with their disability and fit in to a broader society that's not designed for disabled people. So that's an either implicitly or explicitly, we all get that message.

Here in the United States and that includes healthcare professionals and there are alternative models or alternative models to thinking about disability. So for example, the social model is it's often the sort of painted as the opposite to the medical model. So we're all a bit familiar with the medical model of disability from just, 

everything that society feeds us here in the United States and healthcare professionals are not immune to that so they get a lot of these messages as well, and they don't get any sort of counter messaging in, in their medical training. So another model of an alternative model to the medical model and there are, I should say multiple models of disability, disability studies as a whole.

Broad and very fascinating field. But a lot of the time, the, the sort of first model that you think of that's the opposite to the medical model is the social model of disability. And the social model of disability basically states the origin of any sort of issues that people with disabilities face are due to sort of external factors like a society that's not built.

For and I mean, built like socially as well as like physically, structurally like a building. It's not built to accommodate people with disabilities. It's built with people without disabilities in mind, and it's not really meant to fit people with disabilities in it. And I should point out that I, I kind of use person first versus identity first language interchangeably.

And a lot of people feel really passionate about one way or the other, but I. Kind of find that I'm comfortable using both. So person first language is basically when the word person or people comes before the identity. So in this case it would be person with a disability or people with disabilities or person with autism.

If we're gonna talk about a specific type of disability, for example And that arose in the 1980s to center the person and the humanness of people with disabilities. And since that people also are comfortable talking or using identity first language. So like disabled person or blind person, for example, where the identity word comes first and then followed by the word person or people.

And I think that arose in like maybe the nineties early two thousands, where. People were thinking, well, Hey, wait a minute. We, this is a legitimate aspect of my identity. Why am I sort of relegating it to you know, the end of the phrase, I guess like this is something that can be a legitimate part of your identity that you can embrace and be proud of.

And I find that the, the, it it's useful, the both types of language are useful in different contexts. So if you wanna emphasize like the common humanness, you might be wanting to use person first language. If you want to maybe highlight your group membership then you might want to use identity first language. And,

it would be helpful for healthcare professionals to understand these things, as well as just other things about access and accessibility and disability etiquette. So things like, it's not okay to grab a wheelchair like a, a. That a person is sitting in and just wheel them to where you think they're trying to go.

It's not okay to just like grab a, a blind person by their shoulder and try to guide them across the street. When you think that they're trying to get across the street. So things like that, like you ask, if somebody, you would like your help, for example and just having things available in. And alternate formats, for example braille, large print.

So having forms and, and documents available in those, those media having electronic documents ready to go that are prepared in accessible formats. So the more technical things about disability and I just call it all disability etiquette. So this includes accessibility issues. But it also includes like.

How to, what to do and what not to do when interacting with a person.

Shireen: Mm-hmm  and that's, and that's the kind of training that we're hoping health professionals are getting or, or, or seek to, to receive so that they're using appropriate language and it, it blows my mind that in, in what you mentioned, and I can almost envision it to where they're handing medical records, right,

Private information to a perfect stranger. So it it's, it's interesting how, and, and a lot of work to be done still ahead. Mm-hmm  with, with that, we are towards the end of the episode, how can our listeners connect with you and just learn more about your work?

Heydarian: So Twitter, I guess, is the best place. So this is where I will I guess tweet, post about the research that I'm publishing. So that is a good place. And I, my Twitter handle is below, but it's also at NAZ, N-A-Z Heydarian, H E Y D A R I A N. All one word without any fanciness in between. And yeah, that, I guess that's the main thing.

I'm like, I'm not the best when it comes to social media, but Twitter is a good place because the journals have Twitter and they will like post about articles that they have, have published. And then I can just sort of post the, the ones that are relevant to me. And then also the ones that are publications of what I've done.

Can I take a minute and plug one of my research studies?

Shireen: Please! Absolutely.

Heydarian: Okay. Yay. Thank you. And that's I guess one way, like we can connect and you can sort of learn more about the research process. And a lot of the times, like if you participate in research, you can sign up to hear about the results of that particular research study.

So I'm doing a couple research studies right now, and one that I'm actively recruiting for is the PODER study. So basically this is the, this is the study of Latinx families with children with intellectual and developmental disabilities that we're doing right now. So we are examining a lot of the health behaviors like nutrition and

exercise and social cognitive aspects of health in greater depth to sort of characterize what that looks like in the subpopulation. So Latinx families with children with intellectual and developmental disabilities, because it hasn't really been done before. And we need to understand these things so that we can move forward to creating interventions to promote the health.

Particular population. So right now we're actively recruiting primary female caregivers of children with intellectual and developmental disabilities, who are between the ages, the children are between the ages of six and 17 years old. And we have a study that's for Latino families, but also for non-Latino families.

So if you're interested and you identify either of those. And basically it's three interviews. And you just talk about your basically nutrition and exercise and your family. And it, it can be really interesting and it's not an intervention yet, but we also can provide you with important and interesting feedback about your own health information.

So we provide like a summary of your nutrition profile and your exercise profile that we gather from the, from the study. There's a small incentive. So I believe it's $25 for each of the three interviews. And then your child gets to choose to to fun items like toys or books. 

Shireen: Oh, and I was gonna say if there's a link for it what, if you can share that with us?

We're happy to throw that link in the show notes as well.

Heydarian: Awesome. Thank you.

Shireen: Awesome. So with that, thank you so very, very much for your time, Dr. Heydarian, It has been an absolute pleasure having you on.

Heydarian: Thank you, Shireen. The pleasure's been all mine. It's been, it's been fun to talk about these things.

Shireen:  Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn. For tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspectives. You can also visit our website Yumlish.com for more recipes advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first. Stay well.

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