Research Faculty Spotlight: April Wilhelm, MD, MPH

April Wilhelm, MD, MPH, is a faculty physician and clinician-researcher at the University of Minnesota St. John's Hospital Family Medicine Residency and the Program for Health Disparities Research. Prior to joining the faculty, she completed an interdisciplinary fellowship in child and adolescent primary care research at the University of Minnesota. Her research program centers on promoting healthy behaviors among adolescents in refugee and immigrant communities and child and adolescent tobacco prevention and control.

Why did you decide to focus on primary care as your career?

For me, primary care is always about the relationships that you get to build with your patients and better understanding patient context. I wanted to be the kind of doctor who knows my patients well and who is able to be their advocate and to help them walk through whatever life throws their way.

I feel like primary care is just such a beautiful opportunity to do that over the course of a physician's career. The doctors that I have met and admired as great role models always had that strong foundation of relationship with their patients, and I wanted something similar.

The other thing I love about primary care is the opportunity to help people become the best version of themselves and to help support healthy behavior changes. There's not a “one size fits all” approach to that; it's about working on that individual-level solution. That's the other compelling thing for me in primary care: that opportunity to personalize the care within the context of delivering it to the patient.

You started out as clinical faculty. What led to your decision to transition from clinical to research faculty? And what was that process like?

I have been engaged in academic research since I started doing biochemistry experiments as an undergraduate and have done a lot of different types of research in my career. I love the idea of using research as a platform for advocacy and system change and how we can help make the systems within healthcare work better for our patients.

There are a lot of inequities in healthcare today that I find frustrating as a clinician when I'm trying to help my patients make healthy choices for themselves and better their lives. Research is that place where I can put my hope in making this all work better. As I started my clinical faculty position, I felt myself being pulled in many directions—wanting to focus on continuing to have those strong foundational relationships with my patients, but also making the system better for people down the road.

This new research faculty position weds both of those focuses for me. I get to have my ongoing panel, see the patients I've grown to care so much about, and also have an opportunity to try something new and push boundaries to work toward making the system better and addressing some of those inequities. That's what really excites me.

I think for me that it will actually be a strength to have that foundational experience in practice and knowing what's realistic to pursue with system change while also thinking ahead at what we need to do differently in the research realm to better engage clinicians, staff, and patients in our approaches.

Are there any current research projects you'd like to share?

I have two projects that are at an exciting phase. The first one is actually just kicking off. It's a National Institute of Drug Abuse K23 Career Development Award to conduct a five-year study to address tobacco use among Somali parents. We are trying to better understand how we can use the primary care pediatric visits to identify household tobacco use in Somali families and then adapt an evidence-based intervention to connect parents who smoke with the resources to quit during their child’s visit.

That study just started in January, so it's an exciting time for getting it off the ground and moving that work forward. In the first year, we will be conducting focus groups with Somali parents to better understand challenges they've had with discussing tobacco use with their child's doctor and accessing tobacco treatment. Then we need to work on changing an existing evidence-based intervention to better meet their needs.

My other active project takes a slightly different approach to address this issue of household smoke exposure. This study, funded through the Masonic Cancer Center, is a partnership with WellShare International and my community partner there, Abdillahi Kahin. We’re in year two of this study, which aims to better understand Somali parents' perceptions of secondhand smoke from shisha use (or waterpipe use), and how that affects the health of their children. Then we can develop a community health worker-delivered intervention to educate parents on the risks of these products and their use in the home to reduce secondhand smoke exposure in Somali families.

We've done a lot of the ground work over the past year to describe parent perceptions of shisha smoke exposure risks and strategies that they take to mitigate these risks, and now we're in the exciting phase of building an intervention that community health workers will deliver to spread the word about this issue. It's an under-researched, highly important need in the community locally.

Looking toward the future, what do you plan to focus on for your research?

My long-term career vision is focusing on addressing inequities in tobacco prevention and control in immigrant communities. I've done a lot of work in the Somali community, and I see a lot more work to be done in other local immigrant groups in the tobacco space. We really don't have a lot of evidence-based research on tobacco product use in these cultural communities, how these products are used, and what the downstream effects of that use are on family health.

There's also not a lot of regulation on tobacco products like shisha use. I’m excited to help define what the policy needs are for issues like this so we can pursue multi-level solutions as opposed to only focusing on individual behavior change.

Finally, I'm currently starting a collaboration with the 10,000 Families research team to better understand tobacco use in immigrant groups in Minnesota, including co-use of tobacco products with other products like khat in the East African community and betel or areca nut in South Asian groups.

The intent of these projects is to better characterize some of the tobacco and other recreational products that many members of our immigrant communities are using so we can have better messaging and interventions to address the downstream health effects of their use. I can see that going in many directions, but that's what I hope to spend the next decade or so on.

Is there anything else you'd like to share about your career or your research or plans for the future?

It is a very interesting time to be working in this space given some of the changes in federal funding and the related uncertainty. But for me, being brave and standing up for what we think is important as researchers and not bowing to external pressures to dictate this science is really important. Even if that means in the short term facing some of the consequences of that.

I'm grappling with wanting to be an advocate and wanting to get important health equity science done in a world where it's harder and harder to do that science without interruption. But it's even more important now, so I'm excited by that challenge all the same.