Commentary on “#HeART: Adolescent Reflections on Cardiovascular Health”

As physicians, we strive to promote heart healthy behaviors in our patients. We know that atherosclerosis begins early in life and that maintaining cardiovascular health throughout adulthood dramatically lowers the risk of cardiovascular disease.^1,2 We also know that, unfortunately, adolescents are typically unaware that heart disease is the leading cause of death in the United States.³ Inspired by The Bigger Picture and other health campaigns that leverage art to tackle public health issues, we partnered with students at the Oak Park and River Forest High School (OPRFHS, Oak Park, Illinois) to create #HeART, a collection of adolescent artistic reflections on cardiovascular health.⁴ By engaging with youth directly through #HeART, we gained valuable insights into the issues confronting young patients.

We presented the epidemiology, risk factors and pathophysiology of cardiovascular disease to OPRFHS students and invited students to use visual art or poetry to reflect on the presentation. We had two main objectives: (1) to raise awareness about cardiovascular health and (2) to identify opportunities to effectively communicate cardiovascular risk to adolescents. The three poems, “boiler,” “Stress Fruit,” and “Fairy Dust” were among the winners selected by the initiative designers.

In boiler, Henry Wolff likens the heart to a machine: dependable and seemingly indestructible. He states, “I chose to portray the body as a sort of steam-powered vessel – the imagery flipflops between robot and submarine – with the heart as its boiler. It wasn’t much of a jump from there to describe an air bubble or other fault in the heart like it was a bomb or other act of industrial sabotage.”

In Stress Fruit, Nicholas Berry envisions the body as a piece of fruit that begins to bruise under the pressure of looming adulthood. He writes, “This poem was inspired mostly by my current circumstances as a senior in high school, and the new kinds of stress that come with that…Stress is one of many factors that contribute to heart disease, and one of the factors that I feel is not addressed nearly enough.” Nicholas further explains, “In this poem I illustrate how ‘useful’ stress may seem when it comes to being productive, but once that productivity ceases that stress can have a huge impact on the body. I really just wanted to give vision to the idea that even ‘useful’ things, can also be detrimental to a person.”

In Fairy Dust, Adele Henning depicts cigarette ash with an almost childlike wonder. A sprinkling of “fairy dust” magically brings about peer acceptance and stress relief. She explains, “I chose this topic because young adults prefer not to think about the fragility of their bodies… People smoke to bond with one another, to fit in, or even simply as a coping mechanism.” The author acknowledges that decisions made in the naivety of youth have serious consequences. Adele writes, “Young adults tend to ignore the potential long term effects of their actions…But to get hooked on a habit that started when we were young is so hard to break later on, and I wanted to capture the beginner smoker’s mindset in this poem.”

Finally, in Heart Attack, Halley Bergen has illustrated the myocardium in sickness and in health.⁵

The themes elicited from the students and conveyed in their art—the feeling of invincibility, the ubiquitous stress in adolescents’ lives, peer influence, and short versus long-term risks—all contribute to physicians’ understanding of the barriers and opportunities for discussing cardiovascular risk with youth. These poems and other works produced through the #HeART project may serve to remind all of us, medical educators and learners, that art and poetry are powerful ways of giving voice to and motivating change in youth.