Dr. Susana Ramírez on Using Communication Strategies to Improve Diet, Help Prevent Breast Cancer Among Latinas

September 27, 2023, by CRCHD Staff

What inspired your interest in cancer research and, specifically, cancer disparities research?

I came to cancer disparities organically. I went to graduate school in communication with a goal of understanding how the power of the media could be harnessed for social good. When I started graduate school, my life — like that of most twentysomethings — had been relatively untouched by cancer. But my doctoral advisor had one of the first NCI-funded Centers of Excellence in Cancer Communication Research, with an aim to advance understanding of how the public information environment shaped decision-making about cancer prevention and screening behaviors. Through the network of these Centers — there were several Centers around the country, and we had the opportunity to meet once a year — I became part of a cohort of junior scholars focused on cancer and communication.

My interest in disparities specifically emerged from that early exposure to cancer epidemiology and behavioral factors, at the same time that I found myself asking questions about representation of Latinos in cancer research and in media studies. Geography and personal history were important here: I was born in Mexico and brought to the U.S. as a young child and raised in the West. I moved to Philadelphia for graduate school, and the demographic makeup of Philadelphia — and of the University of Pennsylvania specifically — represented major cultural differences. Racial and ethnic disparities in health outcomes were frequent topics of conversation, but the limited scholarship centering Latinos focused almost exclusively on Spanish-speaking, immigrant populations. From my own experiences, I identified an important gap in the literature and sought, from my dissertation on, to address it myself.

Following my doctoral training, I was awarded a Cancer Prevention Fellowship from NCI. Under the auspices of that program, I studied public health at Harvard with leaders in social epidemiology and health disparities. Once at NCI, I connected with a number of mentors who continued to support my interest in understanding and addressing disparities.

Can you describe the research supported by your NCI CRCHD Continuing Umbrella of Research Experiences (CURE) K01 grant?

My K01 research sought to advance understanding of how communication with English-speaking Mexican American women about how to improve diet quality could be used as a primary breast cancer prevention strategy. The particular target group was selected because they are both at elevated risk of diet-related disease and, as I showed through my doctoral and postdoctoral research, typically left out of health promotion campaigns.

The overarching aim of my K01 was to improve understanding of the mobile technologies that could be used to disseminate a culturally tailored intervention to improve diet quality among Mexican American women. We sought to first identify key barriers and facilitators to healthy diet adoption among bicultural and bilingual Latinas. Findings revealed the importance of structural and environmental forces in shaping the dietary quality and diet-related cancer risk for this population. That is, racialized marketing for junk foods, so-called “food swamps” (where many Latinas live), low income, and lack of cooking skills are powerful determinants of unhealthy diets. Moreover, the corruption of traditional Mexican foods in the American food and cultural landscape devalues the traditional produce-rich, low-fat Mexican diet and creates perceptions among young Mexican women that their food heritage is unhealthy. In addition, my K01 research debunked a popular trope attributing cultural beliefs as the cause of Latinas’ poor diets; rather, I found that the overwhelming amount of diet- and nutrition-related information available produced information overload that, together with disparities in access to information and the ability to make sense of that information (i.e., educational attainment), compounds disparities.

In addition, my K01 research debunked a popular trope attributing cultural beliefs as the cause of Latinas’ poor diets; rather, I found that the overwhelming amount of diet- and nutrition-related information available produced information overload that, together with disparities in access to information and the ability to make sense of that information (i.e., educational attainment), compounds disparities.

Message strategies to overcome these barriers to healthy diets must include appeals to empower audiences for social change. Thus, we sought to test a unique set of messages as exemplars of distinct message features. The messages were short (three to five minutes), professionally produced spoken-word poems set to still and moving images. They conveyed the role of social and environmental factors, including racialized marketing. The poems were written and performed by ethnic minority (Black and Latinx) young adults who had participated in a public arts and diabetes education program.

How do you hope your CURE K01 research has improved breast cancer prevention among Mexican American women who speak English?

I am proud that my work has moved understanding of communicating with Latinos beyond the linguistic challenges to considerations associated with acculturation processes and broader changes in culture, and I am proud that my work has had real-world impacts. I hope that my research provides guidance to practitioners who wish to develop messaging that more effectively reaches and persuades Mexican American women to adhere to healthy lifestyles and cancer screening guidelines. And I hope that policymakers and administrators recognize the multiple levels of influence on these individual-level behaviors that disproportionately affect Mexican American women.

My driving motivation has always been to use communication to improve the human condition. In the first phase of my career, I developed expertise in understanding and applying communication to influence individual- and organizational-level change, centering an interrogation of “culture” and acculturation processes in message effectiveness studies. CRCHD supported much of this work through my K01.

What is the focus of your research now and moving forward?

In my current work, I focus on advancing understanding of policy discourse pertaining to population health. Building on a theoretical framework for racialized marketing, I examine the advocacy strategies employed by both public health scientists and multinational food and beverage corporations in their quest to influence policy.

Please share your thoughts on the importance of culturally and linguistically competent health care services, information, and resources and how they can improve health outcomes in racial and ethnic minority communities.

My driving motivation has always been to use communication to improve the human condition. In the first phase of my career, I developed expertise in understanding and applying communication to influence individual- and organizational-level change, centering an interrogation of “culture” and acculturation processes in message effectiveness studies. CRCHD supported much of this work through my K01.