The goal of this K01 proposal is to develop a culturally tailored nutrition communication intervention for primary prevention of breast cancer among bicultural Latinas. The overarching goal of the study is to advance understanding of how communication and acculturation processes influence cancer risk behaviors in order to design effective culturally tailored interventions to reduce cancer risk behaviors. This approach is particularly relevant when considering research on the health of the population of CA's San Joaquin Valley (SJV). A vast, largely rural region that produces over half of the nation's fruit, nuts, and vegetables, SJV is 50% Latino, mostly of Mexican origin6. The SJV has a very diverse Latino population: 25% are foreign-born, and their primary language may be an indigenous Mexican language rather than Spanish, while 75% are native-born U.S. citizens, who possess varied fluency in English abilities and whose families may include both legal and undocumented immigrants. The linguistic and acculturative diversity of this population poses new challenges for understanding how to design effective behavior change interventions. Most community-based interventions with Latinos have focused on those who speak Spanish exclusively, limiting our understanding of how acculturation and linguistic diversity impact communication intervention design and effectiveness. mHealth strategies offer a way of delivering interventions that are not only culturally appropriate for Latinos across the acculturation spectrum, but also appropriate for primary cancer prevention among young adults who are eager adopters of technology. This study aims to fill the knowledge gaps through a research plan designed around three sequential aims employing mixed methods for message testing and community intervention research.
In Aim 1, we will conduct semi-structured interviews with SJV Latinas (N=25) to explore factors that influence diet and food preparation behaviors as well as barriers and facilitators to the adoption of healthier diets. Results will inform the content categories for message tailoring, the structure of the messages, and the means of dissemination.
In Aim 2, we will use the findings from Aim 1 to build and test a library of messages that are culturally appropriate for bicultural Latinas using focus groups and cognitive interviews.
Aim 3 is the design, pilot test, and evaluation of an intervention to improve diet behaviors. The intervention consists of a series of culturally appropriate messages, developed in Aim 2, tailored to each participant's needs and preferences, to be disseminated via mobile phone over a 4-week period. We will evaluate preliminary outcomes (e.g., usage and feedback about the intervention and changes in knowledge, attitudes, and behavioral intentions) at four different times. We will determine preliminary estimates of effect size for behavioral outcomes (consumption of dietary fat, fruits and vegetables), based on two post-intervention data collections. We will additionally evaluate the feasibility, acceptability, and sustainability in order to refine the intervention for a future larger randomized controlled trial, to be proposed in an R01 application before the end of this award.

Public Health Relevance

The demographic and risk factor profiles for Latinos suggest a looming cancer epidemic: Latinos are younger, poorer, and less likely to have access to cancer screening than the general population. The 'Acculturation Paradox' further suggests that acculturation is a risk factor for diet-related breast cancer risk. This project aims to improve eating behaviors as a primary cancer prevention strategy, and the emphasis on young adult, bicultural Latinas focuses on those at high preventable cancer risk. The overall goals of this career development grant are to improve understanding of (a) factors that influence Latinas' cancer-related behaviors that may be modifiable through communication-based strategies, and (b) factors that influence Latinas' communication preferences and intervention effectiveness, in order to inform a culturally appropriate mHealth intervention.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Scientist Development Award - Research & Training (K01)
Project #
Application #
Study Section
Subcommittee I - Transistion to Independence (NCI)
Program Officer
Tilahun, Mulualem Enyew
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California Merced
Other Basic Sciences
Earth Sciences/Resources
United States
Zip Code
Ramírez, A Susana; Arellano Carmona, Kimberly (2018) Beyond fatalism: Information overload as a mechanism to understand health disparities. Soc Sci Med 219:11-18
Ramírez, A Susana; Golash-Boza, Tanya; Unger, Jennifer B et al. (2018) Questioning the Dietary Acculturation Paradox: A Mixed-Methods Study of the Relationship between Food and Ethnic Identity in a Group of Mexican-American Women. J Acad Nutr Diet 118:431-439
Meyer, Oanh L; Liu, Xiaoyan Lucia; Tancredi, Daniel et al. (2018) Acculturation level and caregiver outcomes from a randomized intervention trial to enhance caregivers' health: evidence from REACH II. Aging Ment Health 22:730-737
Cameron, Linda D; Durazo, Arturo; Ramírez, A Susana et al. (2017) Cultural and Linguistic Adaptation of a Healthy Diet Text Message Intervention for Hispanic Adults Living in the United States. J Health Commun 22:262-273
Ramirez, A Susana; Diaz Rios, Lillian K; Valdez, Zulema et al. (2017) Bringing Produce to the People: Implementing a Social Marketing Food Access Intervention in Rural Food Deserts. J Nutr Educ Behav 49:166-174.e1
Ramírez, A Susana; Estrada, Erendira; Ruiz, Ariana (2017) Mapping the Health Information Landscape in a Rural, Culturally Diverse Region: Implications for Interventions to Reduce Information Inequality. J Prim Prev 38:345-362
Ramírez, A Susana; Willis, Gordon; Rutten, Lila Finney (2017) Understanding Spanish-Language Response in a National Health Communication Survey: Implications for Health Communication Research. J Health Commun 22:442-450
Valdez, Zulema; Ramírez, A Susana; Estrada, Erendira et al. (2016) Community Perspectives on Access to and Availability of Healthy Food in Rural, Low-Resource, Latino Communities. Prev Chronic Dis 13:E170