Over a decade ago, Dr. Nicola Hawley, PhD, connected with a colleague in American Samoa to learn more about prenatal care delivery and how pregnancy might provide an opportunity to impact chronic disease prevention interventions.
Obesity and overweight are highly prevalent among pregnant Samoan women, and a previous study conducted by Dr. Hawley and her colleagues found those conditions to be associated with adverse maternal and infant health outcomes. They also discovered a lack of data about gestational diabetes mellitus (GDM) in the U.S. territory, but they estimate that about 40% of women in American Samoa will develop GDM during pregnancy. At the time, screening rates for gestational diabetes were low, largely due to a lack of awareness about the condition and issues with supply-side service provision.
Dr. Hawley is an associate professor of epidemiology (chronic diseases) at the Yale School of Public Health and of anthropology at Yale. She is also a faculty affiliate of the Yale Institute for Global Health (YIGH). Her career research has focused on how maternal exposures during pregnancy can shape the trajectory of a child’s disease risk– a journey that has been supported by YIGH.
In 2017, Dr. Hawley received her first Hecht Global Health Faculty Network Award, which provided her with funding to evaluate a gestational diabetes intervention where she and her colleagues created an educational video in a Samoan drama style, then assessed its impact on knowledge and uptake of GDM screening. She credits the award with helping her build partnerships with colleagues and health facilities in American Samoa, including Dr. Bethel Muasau-Howard, the former head of obstetrics and gynecology at the Lyndon B. Johnson Tropical Medical Center, who helped to establish the pregnancy-focused research program in American Samoa and who continues to be a driving force for health systems level change in her community.
For Dr. Hawley, working alongside communities is key. “I think that one of the most critical pieces of the way that we should be engaging in global health is to both build relationships that are continuous and long standing,” said Dr. Hawley. “If you're going to enter into a community that you are consistently present in and commit to moving their priorities forward, you must be able to build capacity and sit side-by-side with local investigators and involve them in absolutely every aspect of study design and conduct.”
Dr. Hawley’s earlier work using the 2017 Hecht Award informed subsequent studies. In September 2024, Dr. Hawley, Dr. Angela Bengtson (Emory University), and Dr. Erin Kershaw (University of Pittsburgh) were awarded a five-year R01 grant from the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK), with $1 million in funding support in the first year. Other members of the team include Dr. Muasau-Howard, Dr. Clare Flannery (Yale), Drs. Jenna Carlson and Lacey Heinsberg (University of Pittsburgh), Dr. Stephen McGarvey (Brown University) and Kima Faasalele-Savusa – a Samoan midwife who has served as Dr. Hawley’s program manager for the past seven years.
The grant will be used to conduct a study on genetic and behavioral determinants of gestational diabetes in American Samoa and its connection to development of type 2 diabetes postpartum. The team will track glucose levels, genetic profiles, and other factors to examine their associations with maternal and child health outcomes.
“YIGH is extremely grateful for the Hecht Global Health Faculty Network Awards, which have proven to be an important catalyst for innovative research carried out by Yale faculty. Dr. Hawley’s project will contribute to our understanding of chronic diseases in vulnerable populations, while at the same time advancing equitable partnerships with research collaborators. YIGH is proud to support her work and confident in her future success,” said Dr. Michael Cappello, MD, interim director of YIGH, department chair and professor of epidemiology (microbial diseases), and professor of pediatrics (infectious disease) and microbial pathogenesis.
Dr. Hawley and her team have also expanded their research to include a project related to mental health and suicide prevention in American Samoa. While researching diabetes and obesity, they realized that these conditions were affected by a foundation of good mental health awareness. Hawley and Dr. Sarah Lowe, PhD, associate professor of public health (social behavioral sciences) at YSPH and of psychiatry, and an associate clinical professor of nursing, were recently awarded the 2024 Hecht Award. The team, including students from YSPH and American Samoa Community College, will pilot a family skills intervention to improve mental health outcomes and assess whether it is feasible and impactful in the context of American Samoa.
Dr. Hawley also credits YIGH with supporting her through faculty networks, including the Yale Network for Global NCDs (NGN), which Dr. Hawley helped to establish. NGN is a collaborative effort including faculty across Yale’s campus who are conducting research and doing advocacy work related to the burden of non-communicable diseases (NCDs) on a global scale.
“NGN has served as such an important intellectual home for me in terms of being able to draw on shared experiences, figure out best practices around engagement of populations outside the mainland US, good approaches to equity, and doing global health in a community-partnered way,” said Dr. Hawley.
As for those who are passionate about a research topic or looking to get involved in a project, Dr. Hawley encourages young researchers to embark on projects that lead to sustained engagement with the communities they hope to serve. She believes that skills such as empathy, humility, and the ability to listen are essential for high quality, impactful research and needed now, more than ever.