Featured Investigator: Billy A. Caceres, PhD, RN, FAHA

September 2020: Billy A. Caceres, PhD, RN, FAHA
Assistant Professor, Program for the Study of LGBT Health, Columbia University School of Nursing

Dr. Billy A. Caceres is an Assistant Professor in the Program for the Study of LGBT Health at the Columbia University School of Nursing. Dr. Caceres’ research uses biobehavioral approaches to understand and reduce cardiovascular health disparities in stigmatized populations with a focus on sexual and gender minority (SGM) adults. He was the 2017 recipient of the American Heart Association’s Martha N. Hill New Investigator Award for his dissertation research on stress and cardiovascular disease risk in sexual minority women. Dr. Caceres recently served as the writing chair of the American Heart Association’s first scientific statement on the cardiovascular health of SGM adults. In 2019, Dr. Caceres began a Mentored Research Scientist Development Award from the National Heart, Lung, and Blood Institute. He is conducting an innovative study that uses a sibling design to examine the influence of adverse life experiences on physiological risk factors for cardiovascular disease in sexual minority women and their heterosexual sisters. His work on SGM cardiovascular health has been published in high-impact interdisciplinary journals. Dr. Caceres is a fellow of the American Heart Association and the New York Academy of Medicine. He received PhD from New York University and completed a postdoctoral fellowship in Comparative and Cost Effectiveness Research at Columbia University. Prior to completing his PhD he worked as a cardiothoracic and vascular surgery nurse at New York University Langone Health.

Dr. Caceres was a recipient of a 2020 NIH SGM Early-Stage Investigator Award. He presented his research at the NIH SGM Research Symposium. To see his talk on "Advancing Cardiovascular Science in Sexual and Gender Minority Populations," click here!

Q: What are your current research interests?
My research focuses on identifying social determinants of cardiovascular health in SGM adults. In particular, I have a focus on sexual minority women and people of color. I am working on several studies examining predictors of cardiovascular health in SGM adults. My main project is an NHLBI-funded Career Development Award (K01HL146965) which began in 2019. The Cardiovascular Health and Life Experiences of Sisters Study is using a sibling design to examine the influence of adverse life experiences on cardiovascular disease risk in sexual minority women and their heterosexual sisters. This is an ancillary of the Chicago Health and Life Experiences of Women (R01AA13328), a longitudinal study of sexual minority women’s alcohol use, health, and wellbeing, which my primary mentor Dr. Tonda Hughes has led since 1999. As part of this study, we are also testing the feasibility of remote collection of dried blood spots to assess metabolic and inflammatory markers of cardiovascular risk in women. Findings from this research will provide pilot data to conduct a longitudinal study examining the cardiovascular health of sexual minority women and their heterosexual sisters. In addition, I am collaborating with Dr. Walter Bocking and other investigators at the School of Nursing and the Center for Behavioral Cardiovascular Health at Columbia University to examine determinants of cardiovascular and sleep health among gender minority adults. We are analyzing data from Project AFFIRM (R01HD079603), a multi-site longitudinal study that examines identity development and health among gender minority adults, to identify predictors of poor cardiovascular health among gender minority adults. In addition, we are conducting research on sleep duration and sleep quality in this population. I have become increasingly interested in sleep as a risk factor for cardiovascular disease and other chronic conditions that have been understudied among SGM adults. I also get to work on projects with pre- and post-doctoral fellows in the Program for the Study of LGBT Health at Columbia University including April Ancheta, Joseph Belloire, and Sarah Zollweg, that focus on a variety of topics within SGM health research.

Q: Tell us about your career path – how did you end up where you are now?
I didn’t initially set out to pursue a career as a cardiovascular nurse scientist partially because I didn’t know that was an option. I was a first-generation college student from a low-income background with very few role models to provide guidance on career paths. I was fortunate enough to receive a scholarship to New York University (NYU). I completed my Bachelor’s degree in political science with a focus on political disenfranchisement among marginalized populations. Throughout my undergraduate years, I worked as an alcohol and sexual violence peer educator on campus. I started realizing that I really enjoyed learning about health topics. In 2008, I completed a summer internship with Dr. Susan Hassmiller at the Robert Wood Johnson Foundation where I primarily worked on projects focused on increasing diversity in the healthcare professions. During that internship, I learned a lot about factors that contribute to health disparities among racial and ethnic minorities. Dr. Hassmiller taught me a lot about the importance of policy and conducting strong policy-oriented research that influences population health. I felt that becoming a scientist was a good way for me to study some of the sociopolitical factors that contribute to inequities and how these influence health among marginalized people. But I wanted to have a clinical foundation to support my research program so I decided to enroll in the accelerated Bachelor’s in Nursing at the NYU Rory Meyers College of Nursing. During that time, I worked as a Research Assistant for Dr. Terry Fulmer on an NIA-funded grant (R21AG030664) focused on estimating the prevalence of elder mistreatment in primary care and dental clinics. I primarily recruited Spanish-speaking participants that were being seen at a safety net hospital in New York City. It was such a pleasure to work with Dr. Terry Fulmer who really was my first research mentor and taught me the importance of conducting research that had real-world implications. After completing my nursing program, I worked as a vascular and cardiothoracic surgery nurse at NYU Langone Health and completed graduate education as an Adult-Gerontology Nurse Practitioner at NYU. My clinical experiences provided me with my first exposure to SGM health disparities and really solidified my interest in this research area. Unfortunately, when I attended nursing school there was little attention in the curricula to in SGM minority health with the exception of HIV/AIDS, so I wasn’t exposed to other health disparities in the community.  In 2013, I enrolled in the PhD program in Nursing at the NYU Rory Meyers College of Nursing where I was an interdisciplinary pre-doctoral fellow at the NYU Langone Health Clinical and Translational Science Institute (TL1TR001447). About a year before completing my PhD I met Dr. Patricia Stone from Columbia University at an AcademyHealth meeting who offered me a post-doctoral position on an NINR-funded T32 focused on Comparative and Cost-Effectiveness Research at Columbia University (T32NR014205). After my post-doctoral fellowship, I accepted a position at the Columbia University School of Nursing where I work with investigators in the Program for the Study of LGBT Health, Precision in Symptom Self-Management Center, and the Center for Behavioral Cardiovascular Health to conduct research on the cardiovascular health of SGM minorities.

Q: What organizational challenges have you faced?
I have been lucky that I have had supportive mentors and colleagues at NYU and Columbia University who really championed my research and supported me as an early career investigator. I think the largest issue that still comes up today that isn’t necessarily organizational but is influenced by organizational/institutional norms is there are still some non-SGM health researchers who don’t recognize the value and importance of this work. That’s why I think it’s so important for SGM researchers to conduct rigorous research that has a measurable impact on population health and clinical practice.

Q: What advice do you have for trainees and researchers who want to work in this area or are interested in applying for NIH funding? 
Writing NIH grants is difficult and takes time, but it’s doable. Trainees should start writing grants early and create a plan with writing goals for completing each section of a grant. Although anxiety-provoking, it’s really important to get feedback from scientists within and outside of your area of expertise. This can help identify major flaws in your proposal and helps you think more critically about your work. It’s also important to familiarize yourself with the way NIH works, how grant reviews are conducted, and the acceptable scope of work for the grant mechanism that you are targeting.

Q: Do you have any specific advice for working with and involving SGM populations in research?
It’s important to build relationships with research colleagues and community partners at SGM organizations because your work will only be better for it. You will need a network of colleagues not only for professional collaborations but for support and encouragement as you do this work. If you are a researcher who does not identify as SGM or you are studying a group that you are not a member of, it’s even more important to ensure the representation of people from those groups. SGM research, like research with other marginalized groups, should reflect the values that are important to the population.

Q: Who inspires you?
A: I am inspired by senior SGM researchers who have been conducting SGM research for decades even during times when it was really difficult to get this work funded. I am also really inspired by all the clinicians who have shown such courage during the COVID-19 pandemic. I have always been proud to be a nurse, but this pandemic has put such a spotlight on the importance of nurses and other clinicians that I feel even more honored to be part of the profession.

Q: Any final words of wisdom?
My biggest advice is if you believe your research is important for promoting the health of SGM populations then continue doing it. Toward the end of my PhD program, I had a senior investigator outside of my institution tell me that my work on SGM cardiovascular health was never going to get funded by NIH. It was a particularly upsetting experience that caused me to doubt myself and the sacrifices I made to pursue this career. Less than three years later I was an NHLBI-funded investigator. I truly believe I have been successful in my career so far because I am an SGM health researcher not in spite of it. There are many times in your career where you’ll feel discouraged and doubt yourself, but you have to go back to the value of the work to motivate yourself to move forward. SGM health research is important and we need even more talented people doing this work to achieve health equity for SGM people.