Date August 18, 2021
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Parisa Afsharian: Translating research into actionable health advice

As a Hassenfeld Summer Scholar, Afsharian is researching the connection between language and health outcomes – and using her multilingualism to improve the health of families.

PROVIDENCE, R.I. [Brown University] — On the first floor of the Weight Control and Diabetes Research Center, Parisa Afsharian, a rising junior at Brown, greets families in a mix of Spanish and English. The families have signed up to participate in an arm of a CDC-funded study, called JOIN for ME, that focuses on ways to adapt, test and package effective programs to reduce obesity among children from lower-income families.

After collecting information from parents in Spanish, Afsharian often chats with the kids in English about going to the beach or pool with friends, or about what they’re looking forward to doing in school. One child asked Afsharian, “Do you speak two languages like me?” She seemed delighted when Afsharian replied that she had also grown up multilingual. For Afsharian, whose family is from Iran, Farsi as well as English were spoken at home. She studied Spanish as an elective in middle and high school.

But unlike the participants in the JOIN for ME study, Afsharian’s family members didn’t always receive health information in a language they could understand. Her grandparents aren’t fluent in English – especially when they’re on the receiving end of a doctor’s rapid-fire medical lingo.

Afsharian recalled their frequent encounters with health providers. “My grandfather would come home from an appointment and my mother would ask him how it went, and he’d say that he couldn’t keep up with the pace of the doctor’s questions and recommendations,” Afsharian said. “He will often just nod along as a sign of respect to the physicians.”

Fortunately for her grandparents, Afsharian’s parents are pharmacists who were able to take an active role in her grandparents’ medical care, following up on medications and translating instructions. But Afsharian said that she can see how a person whose first language isn’t English could be intimated in a medical setting and might not want to admit their lack of comprehension.

Because she wants to use what she’s learned from her own family's experiences to “be a helpful interpreter for someone else’s grandparents,” Afsharian volunteers as a medical interpreter for Spanish-speaking patients at the Rhode Island Free Clinic. There, she’s witnessed how a patient’s lack of English proficiency can have serious health consequences. She described meeting a patient with pre-diabetes who said they didn’t understand their physician’s recommendations for diet and physical activity changes and therefore wasn’t able to follow them, causing their condition to escalate to full-blown diabetes.

“It wasn't until this patient came to the clinic and had an interpreter available to speak to them in a language they could understand that their health situation was adequately explained to them,” she said. “The lack of interpreters available in regular primary care settings means that there’s a very high potential for miscommunication.”

Afsharian was selected to participate in the 2021 Hassenfeld Summer Scholars program, a competitive internship with the Hassenfeld Child Health Innovation Institute that provides an intensive, hands-on research experience for Brown students interested in pediatric health. As part of her internship, she’s involved in multiple research projects that allow her to build from her own experiences and explore larger trends in how cultural and language differences contribute to health outcomes. She’s also using her language skills as well as her knowledge about healthy behaviors to have an impact on families’ well-being.

Afsharian has been pursuing an independent research project that explores the relationship between limited English proficiency in parents and overweight and obesity rates in children. She analyzed the data from 2017 and 2018 cohorts of children from low-income communities who were enrolled in Hassenfeld-organized studies, and looked at their primary language and BMI. The results, which she presented in early August, showed that children with Spanish-speaking parents had a BMI percentile of 13.9 percentage points higher, on average, than children with English-speaking parents — even when the study controlled for factors like race and ethnicity, income level, maternal education and diet.

“This was one of the first studies I’ve seen that explicitly looked at how language – not race or ethnicity — was impacting the child’s risk for overweight or obesity,” Afsharian said. She worked on this study with Dr. Whitney Evans, Brown assistant professor of psychiatry and human behavior (research). Her next step, she said, is to delve deeper into the data to explore how energy density, calorie intake and physical activity impact the association between a parent’s limited English proficiency and childhood obesity.

When you show children and their families how to establish healthy habits when the kids are really young, they're more likely to be able to carry those life skills into their future — and hopefully even pass them on to future generations

Parisa Afsharian Class of 2023
Portrait of Parisa Afsharian with laptop computer

At Brown, Afsharian is pursuing a concentration in health and human biology with a focus on the social context of disease. In the spring of her first year, she took the course Health Care in the United States, and was so intrigued by what she learned that she started to shift her focus away from neuroscience and towards public health. When she heard about the Hassenfeld Summer Scholars program, she knew it was the right fit for her – especially if she could help with a project in the Health Weight, Nutrition and Fitness Initiative. 

“I’ve read a lot of studies about how diet can be used to manage chronic disease, especially in kids, and I’m also very interested in how this initiative is examining the relationship between race and ethnicity and overweight and obesity in children,” Afsharian said. “Basically, every study that came out of that Hassenfeld initiative was something that I actually wanted to read, something that I’d go tell my friends about at dinner that night. So I feel like this program combined everything I wanted to do and learn about.”

The JOIN for ME study is led by Elissa Jelalian, Brown professor of psychiatry and human behavior and professor of pediatrics, and co-lead of the Healthy Weight Nutrition and Fitness Initiative. The program is designed to meet the needs of the participants, many of whom speak Spanish as their first language, so there are bilingual staff members who can deliver the information in Spanish as well as English.

Afsharian was attracted to this project because it aligns with her goals of improving children’s health. “I’m particularly interested in how nutrition and physical activity can be used as a means of preventative care,” said Afsharian, who plans to become a pediatrician. “When you show children and their families how to establish healthy habits when the kids are really young, they're more likely to be able to carry those life skills into their future – and hopefully even pass them on to future generations.”

In addition to greeting study participants, Afsharian helps with recruitment, screening, data collection and analysis, and more — whenever possible in participants’ native and preferred language. “When I’m interacting with the families, I speak more Spanish than English,” she said. “I just spent this morning translating end-of-session surveys into Spanish.”

Afsharian says she didn’t realize how well the hands-on aspect of her Hassenfeld internship would complement her independent research project. After identifying the impact, in her own study, of parent-limited English proficiency on children’s weight, it felt exceptionally meaningful to work a different study that was carefully designed to be culturally competent, with materials offered in the participant’s language, featuring culturally-relevant images and delivered by Spanish-speaking staff members.

“It was really nice to be able to look at the health consequences of language barriers and then to see a real-life example of a thoughtful and culturally competent research intervention to address that very problem,” she said.

This summer experience has helped Afsharian hone her focus on her coursework and her future career.

“Being a part of this program has solidified my plans to become a pediatrician who integrates public health into my work,” Afsharian said. “So much of what occurs inside a pediatrician’s office, with the health of the child, starts with everything that occurs outside the door. In pediatrics you have an amazing opportunity to become a part of the patient’s family and make changes that can impact their long-term health, and the fact that kids have the ability to keep their joy even under struggle is an inspiration in and of itself.”