From the air in gyms to the food available on corner store shelves, San Diego State University researchers are tackling the interconnected factors that affect community health.
Routine screening for cervical cancer can lead to earlier diagnosis, improved treatment outcomes and reduced mortality. But when a family’s basic needs are not met, screening can be delayed.
“When you’re worried about where your next paycheck is coming from or whether your kids will be able to eat, you don’t necessarily prioritize cancer screening,” said a public health researcher Corinne McDaniels-Davidsonwhich adds that screening and follow-up rates are lower among marginalized populations.
McDaniels-Davidson is one of many SDSU faculty studying how health disparities disproportionately affect marginalized populations by partnering with communities to better understand and implement interventions that address deep-rooted social and economic inequities.
“When we think about health disparities, we’re really talking about health and health care disparities between groups that stem from these broader inequalities,” said the speech and language professor Sonia Pruitt-Lord.
SDSU is well positioned to take on health care disparities. “We’ve been intertwined with the community for so long that the SDSU name is trusted in the community,” McDaniels-Davidson said. “It makes it possible to do work that others may not be able to do.”
Inequalities in health care
In addition to studying disparities in cancer screening, McDaniels-Davidson and her team partnered with San Diego County early in the COVID-19 pandemic to implement a contact tracing program led by community health workers. She also collaborates with an epidemiologist Susan Keane to implement a community testing program funded by the National Institutes of Health, an effort that involved middle school students in the Sweetwater Union High School District and their family members.
“When you’re able to partner with communities to address any health issue that’s important to them, you start to build these very close relationships,” McDaniels-Davidson said.
SBLRC studies reveal high rates of undiagnosed diabetes in the Latino community, as well as an association between neighborhood environment and increased risk of hypertension and diabetes.
The SBLRC also showed that an integrated care intervention targeting the behavioral and physical health needs of people with diabetes improved both diabetes management and psychological well-being.
The San Ysidro port of entry connecting Mexico to the US is one of the busiest border crossings in the world. But few of the people living in the neighboring community benefit economically from the trade that passes through. Instead, San Ysidro residents—mostly low-income and more than 90 percent Latino—inhale pollutants from idling vehicles waiting to cross the border and from trucks passing through their community.
She recently received funding from Caltrans, California’s transportation agency, to monitor air quality related to emissions from heavy-duty trucks along the border and share that information with the community. The project will serve as a basis for evaluating the effect of ongoing improvements on truck traffic and emissions in the border region.
She believes air quality data will help shape policy, such as increasing staffing at border crossings to reduce wait times and building particulate-free gyms where children can safely exercise.
“When you start measuring it and publishing the data, it really brings a lot more attention and political will to the problem,” Quintana said.
Nutrition Assistant Amanda McClain has seen the choices families face when struggling to access nutritious, culturally appropriate food.
“Food insecurity is not just about money, but all the things that come along with living in or near poverty in the United States,” she said. “One month you pay bills and don’t buy enough food, and the next month you buy enough food and don’t buy the medicine you need or pay the bills.”
Her research finds links between the stress of marginalization — food insecurity, poverty, identifying as a racial or ethnic minority — and the risk of developing obesity and cardiovascular disease. Recently, her team found that San Diego agencies are comprehensively addressing food insecurity. In addition to connecting families with food and nutrition assistance, interagency partnerships enable agencies to help families find affordable housing, pay bills and access mental health services. “All these things are connected,” she said.
“BrightSide’s main goal is to ensure that everyone has access to fresh produce at an affordable price,” she said.
Castro said it is run as a nonprofit organization and student interns take on responsibilities related to their interests and majors.
National City, a community in San Diego’s South Bay, has neighborhoods that are considered food deserts because they are more than a mile from a supermarket.
“Because of BrightSide’s presence in 13 stores in National City, all residents now have access to produce within a half mile of their homes,” Castro said.
Family and community interventions
Family and community connections can be a powerful way to address health disparities.
Through a partnership with the YMCA, a psychology researcher Arredondo River and her team recently tested a pilot project that promotes physical activity and well-being among Hispanic mothers and their preadolescent daughters. At this age, girls tend to become less active and are bombarded with messages on social media about body image.
“We engage their mothers because mothers still have an influential role at this stage,” Arredondo said. “They can be an example of physical activity being associated with a lower risk of depression, with healthier eating, with family engagement and relationships. So it’s a very holistic intervention and approach.”
Arredondo also studies how community-engaged interventions can be successful in the long term.
“SDSU works with all of these programs,” she said. “We’re constantly thinking about how to translate them into practice, adapt them to different communities and sustain them.”