Darrell Dixon’s father was just 25 when he had a major heart attack in the rural Mississippi Delta. By his early 40s, a series of additional attacks had left his heart muscle too weak to pump enough blood to his body. He died in 2013 at the age of 49.
“It was a big jolt for our family,” Dixon, 36, recalled. “For myself, personally, it also got me thinking about heredity. I just wondered whether I was next.”
The death spurred Dixon to get involved in an unusual and ambitious new health study.
Public health experts from some of the nation’s leading research institutions have deployed a massive medical trailer to rural parts of the South to test and survey thousands of local residents. The goal: to understand why the rates of heart and lung disease are dramatically higher there than in other parts of the U.S.
“This rural health disadvantage, it doesn’t matter whether you’re white or Black, it hurts you,” said Dr. Vasan Ramachandran, a leader of the project who used to oversee the Framingham Heart Study — the nation's longest-running study of heart disease. “No race is spared, although people of color fare worse.”
The researchers aim to test the heart and lung function of roughly 4,600 residents of 10 counties and parishes in Alabama, Kentucky, Louisiana and Mississippi while collecting information about their environments, health history and lifestyles. They are also giving participants a fitness tracker and plan to survey them repeatedly for years to check for any major medical events.
Ramachandran, now dean of the University of Texas School of Public Health in San Antonio, said rural populations in the U.S. rarely receive such personal, long-term attention from epidemiologists. More than a dozen institutions are helping with the study, including Johns Hopkins University, the University of California, Berkeley, and Duke University.
The 52-foot-long (16-meter-long), 27-ton trailer is outfitted with instruments that examine calcium in the arteries, the structure of the heart, lung capacity and other, more common health indicators such as blood pressure and weight. The initial exam can take more than three hours.
“They’re reaching out and going out into the community in ways that I have not seen before,” said Lynn Spruill, the mayor of Starkville, Mississippi, in Oktibbeha County, where the trailer arrived in 2022 and medical staff tested more than 700 people.
Studies and data from U.S. health officials show rural populations in the U.S. are unhealthier and have lower life expectancy than Americans in urban areas. The health disparity is even greater in the South, where mortality rates from heart disease — the leading cause of death in the U.S. — for people 35 and older are more than twice the national average in some rural communities. Lung conditions such as chronic obstructive pulmonary disease, or COPD, which the study is also examining, are also more prevalent in the South.
Researchers have multiple theories for the disparity. Hospital closures and physician shortages have left many rural residents with limited access to care. Healthy food, fitness opportunities and public transit are often scarcer. Poverty rates are higher, and fewer people receive health coverage through their employers. In the rural South, poverty rates and the share of people without health insurance are even greater.
Smoking cigarettes is a major cause of heart disease, and at least 20% of adults smoked in Alabama, Kentucky, Louisiana and Mississippi, according to 2019 data from the U.S. Centers for Disease Control and Prevention. Obesity is another factor. In 2022, self-reported height and weight put between 38% and 40% of adults in the four states in the obese body mass index category.
By closely examining local residents and their environments, the rural study seeks clearer answers about what's driving the additional health burden in the South. Researchers also want to understand what makes some rural counties there much healthier than others.
“We’re interested in both the risk, but also the resilience piece of it," said Lindsay Pool, an epidemiologist with the National Heart Lung and Blood Institute, which has awarded more than $40 million for the study.
To accomplish that goal, researchers are also visiting rural areas with low risk for heart and lung disease in three of the states — Louisiana, Mississippi and Kentucky — despite similar demographics.
Oktibbeha County, home to Mississippi State University, in the eastern part of Mississippi near the Alabama border, is the low-risk location. The researchers are contrasting it with Panola County in northern Mississippi about 60 miles (97 kilometers) south of Memphis, Tennessee.
Both counties have poverty rates that exceed 20% and a similar and sizeable share of people under 65 without health insurance. But between 2019 and 2021, the death rate from heart disease for those 35 and over was 647 per 100,000 people in Panola County compared to 395 per 100,000 in Oktibbeha County, according to CDC data.
In more urban Rankin County, Mississippi, part of the Jackson metro area, the figure was 331. The U.S. average over the same period was 326.
Dixon, who works in Panola County for a regional development organization and serves as a consultant for the heart and lung study, helped recruit more than 600 Panola County residents for the project. Heart conditions are so prevalent there that it's common to hear people discussing their medications and side effects at local shops and churches, he said.
Dixon’s father, Darrell Dixon Sr., lived in Clarksdale, about 40 miles (64 kilometers) west of Panola County. He long suffered from high blood pressure and had a strong family history of heart disease.
He had an additional major heart attack after an inmate he had grown close to as chaplain of the Mississippi State Penitentiary was executed, Dixon said, and then spent the last years of his life in and out of the hospital with congestive heart failure.
“He really suffered,” Dixon said. He hopes the study will shed light on any unseen environmental factors that may have played a role in his dad's death and raise awareness among local residents about “how to live better.”
The trailer is now in Louisiana's northeastern Franklin Parish, where the death rate from heart disease between 2019 and 2021 was a whopping 859 per 100,000 people for those 35 and over, according to the CDC data. About 200 miles (322 kilometers) south in New Orleans, it was 340.
The National Heart, Lung and Blood Institute plans to extend the study to 2031, and researchers hope to examine all the participants in person again.
“The longer you can follow people, the more you can understand disease development and progression,” Pool, the epidemiologist, said.
A billboard for a new study about why heart and lung disease is so much higher in the rural South is seen in Napoleonville, La., on May 8, 2024. (Sean Coady/National Heart, Lung, and Blood Institute via AP)
A medical trailer, being used to test rural residents' heart and lung function as part of a study to determine why the rates of heart and lung disease are so much higher in the rural South, is seen, May 8, 2024, in Napoleonville, La. (Sean Coady/National Heart, Lung, and Blood Institute via AP)
Darrell Dixon holds a photo of him and his dad, Darrell Dixon Sr., at his home in Hernando, Miss., on August 11, 2024. (Millicent Dixon via AP)
ATLANTA (AP) — After losing the White House and both houses of Congress, Democrats are grappling with how to handle transgender politics and policy following a campaign that featured withering and often misleading GOP attacks on the issue.
There is plenty of second-guessing after President-elect Donald Trump anchored his victory over Vice President Kamala Harris with sweeping promises on the economy and immigration. But Democrats also will not soon forget the punchline in anti-transgender Trump ads that became ubiquitous by Election Day: “Kamala is for they/them; President Trump is for you.”
“Week by week when that ad hit and stuck and we didn’t respond, I think that was the beginning of the end,” former Democratic Pennsylvania Gov. Ed Rendell said of the 30-second spot that was part of $215 million in anti-transgender advertising by Trump and Republicans, according to tracking firm AdImpact.
“They painted her as something I don’t think she is," Rendell said. “They painted her as a far-left liberal.”
The fallout leaves some progressive and moderate Democrats struggling between the party’s modern identity as a champion of civil rights and its electoral fortunes across swaths of America with whom those attacks resonated.
“There are just a number of issues where we’re out of touch,” Rep. Seth Moulton, a moderate Massachusetts Democrat said in an interview, days after he set off recriminations within his party for saying he didn't want his daughters playing in sports against biological males. Critics said Moulton echoed Trump’s talking points about liberals allowing “men to compete in women’s sports.”
“I think that Republicans have a hateful position on trans issues,” Moulton told The Associated Press, but insisted that Democrats still lose voters because of the party’s “attitude.”
“Rather than talk down to you and tell you what to believe,” he argued, Democrats should “listen to hard-working Americans.”
LGBTQ+ advocates, meanwhile, are arguing that the 2024 election turned more on economic issues than Trump’s transgender rhetoric. They're urging political leaders to counter misinformation that they say threatens the health and safety of transgender Americans, who make up less than 1% U.S. population.
“Trans people have been existing and co-existing,” receiving health care and participating in society for years, said Sarah Kate Ellis, CEO of GLAAD, a leading LGBTQ+ advocacy group. “Nothing new happened,” Ellis said, other than Republicans singling them out in a presidential campaign year.
“It didn’t change one vote,” Ellis argued. “But it did make the world way more dangerous for trans people.”
Another Democratic Massachusetts lawmaker, Rep. Ayanna Pressley, didn't name Moulton, but said some reactions to the election “scapegoated and dehumanized” transgender people. “This Congresswoman sees you and loves you,” Pressley wrote on the social media platform X.
Certainly it’s difficult, if not impossible, to pinpoint single issues that can tip a national election, and there are mixed findings on what voters think about transgender rights.
According to AP VoteCast, a survey of more than 120,000 people who cast ballots this fall, more than half of voters said support for transgender rights in government and society has gone too far. About 2 in 10 said support has not gone far enough and another 2 in 10 said it’s about right. But among Trump voters, 85% said transgender support had gone too far.
Still, slightly more than half of all voters oppose banning gender affirming medical treatment such as hormone therapy and puberty blockers, while slightly less than half support such proposals.
About one-quarter of Harris voters said support for transgender rights in government and society has gone too far. About 4 in 10 said it’s been about right and about 4 in 10 said it hasn’t gone far enough.
Trump and Republicans were relentless in trying to capitalize on the issue. They piled on transgender athletes, with Trump falsely labeling two Olympic boxers as transgender women. They used Harris' comments as a presidential candidate in 2019 — before she became vice president — effectively to blame her for laws granting transgender health care to federal prisoners and detainees.
And Trump repeatedly and falsely claimed that “your kid goes to school and comes home a few days later with an operation” changing their sex.
In reality, the Biden administration has held that Title IX bars discrimination based on sexual orientation and gender identity — but Education Department rules do not explicitly address transgender athletes. Federal law that Trump ads cited does require people in U.S. government custody to have access to gender-affirming medical treatments. Those policies were in place throughout Trump’s 2017-21 term; they are not something Biden’s administration instituted specifically.
And it is not legal in any state for a school to determine and carry out surgical treatment for minor students.
“You gotta fight back” with those explanations, Moulton said, adding that the silence compounds the negative effects for transgender people. “What did we show about our willingness to stand up for trans people by just being silent and ignoring the issue and ignoring the attack?”
Still, Moulton said Democratic leaders on Capitol Hill and in statehouses should give individual elected officials and voters the space to take more conservative positions, and he defended his own comments that he doesn't want his daughters competing in athletics against men.
“I don’t want them getting run over on a playing field by a male or formerly male athlete, but as a Democrat I’m supposed to be afraid to say that,” Moulton told The New York Times last week.
Before he resigned his post as Texas Democratic chairman, Gilberto Hinojosa said supporting transgender rights doesn’t necessarily have to include public funding for gender reassignment surgery.
“We can say, ’OK, we respect people’s right to say, we don’t want my taxpayer money to be used for that,'" Hinojosa told Texas Public Radio. Hinojosa later apologized via social media, saying LGBTQ Americans “deserve to feel seen, valued and safe in our state and our party.”
Ellis, the CEO of GLAAD, pointed to Delaware voters choosing to make state Sen. Sarah McBride the first transgender member of Congress as evidence that Americans “don’t hate trans people.”
For her part, McBride, a Democrat from Delaware, noted that she did not run on her identity – though it was not a secret – and instead talked to voters about “affordable health care, housing and child care” for everyone.
“The party that was focused on culture wars, the party that was focused on trans people was the Republican Party,” McBride told reporters on Capitol Hill after her victory. “It was Donald Trump,” she added, who “was trying to divide and distract from the fact that he has absolutely no policy solutions for the issues that are actually keeping voters up at night.”
Levy reported from Harrisburg, Pennsylvania. Associated Press writer Farnoush Amiri in Washington contributed to this report.
Sarah McBride, Democratic candidate for Delaware's at-large congressional district, speaks during an election night watch party Tuesday, Nov. 5, 2024, in Wilmington, Del. (AP Photo/Pamela Smith)
Republican presidential nominee former President Donald Trump stands on stage with former first lady Melania Trump, as Lara Trump watches, at an election night watch party at the Palm Beach Convention Center, Wednesday, Nov. 6, 2024, in West Palm Beach, Fla. (AP Photo/Evan Vucci)
FILE - Protesters advocating for transgender rights and healthcare stand outside of the Ohio Statehouse, Jan. 24, 2024, in Columbus, Ohio. (AP Photo/Patrick Orsagost, File)
