Promoting Health and Wellness in Latino Communities
When she was completing her B.S. in health sciences in 2009, Cynthia Lebron, PhD, MPH fell in love with her research methods class. After graduating, she taught high school and middle school science and geometry for a couple of years – but as it turned out, that class had ignited a curiosity that would soon take her on a very different journey.
In 2011 Lebron began a master’s in public health (MPH) program at the University of Miami (UM), and in 2012, a new job as a community health worker on a study to help prevent cardiovascular disease in older Latinos with diabetes. She provided health coaching to participants in their homes, gaining personal insight into their lives and the multisystemic challenges they faced.
It was her introduction to health disparities research.
Cynthia Lebron, PhD, MPH
“I learned a lot about social determinants of health, because they wanted to talk about housing, unemployment, immigration – diabetes was not their priority,” said Lebron, now an assistant professor at the University of Miami’s School of Nursing and Health Studies (UM-SONHS). “But they became motivated to prioritize their health when I helped them to get appointments, medications and diabetes supplies, and to navigate the healthcare system.”
The experience profoundly impacted her research interests.
“It hit a nerve, because my grandfather had recently passed away from diabetes,” she recalled. “I got on this track of health and obesity, talking to them about diet and physical activity. I began to see how obesity and its comorbidities could be prevented.”
“I want to do this for the rest of my life.”
It was clear Lebron was feeling called to a career in public health and health disparities research. She began working on a “Familias Unidas” (United Families) study under the mentorship of principal investigator Guillermo (Willy) Prado, Ph.D., who is currently professor at the UM-SONHS and serves as UM vice provost for Faculty Affairs and dean of the Graduate School.
“Willy was my first professor in the M.P.H. program,” she said, “and when I heard him talk about his research, I said ‘I want to do this for the rest of my life.’”
When Lebron was accepted into UM’s Ph.D. in Prevention Science and Community Health program, she worked with Prado and professor Sarah Messiah, Ph.D., M.P.H. on a study targeting Latino adolescents and their parents.
“The team adapted Familias Unidas to focus on health and wellness through obesity prevention,” she explained. “We looked at risk and protective factors impacting Latino adolescents who had overweight or obesity.”
The intervention led to increased family communication, peer monitoring and parental involvement.
“While we didn’t see the obesogenic variables change in the adolescents, we did see it in the parents, including increased intake of vegetables and lower BMI,” said Lebron. “But it’s very promising that the parents were making the changes first. If we can get the parents to maintain those changes, eventually the kids will benefit.”
The team also found that mealtime communication was an important protective factor for the Latino families.
“Mealtime matters because it impacts both risk and protective factors,” Lebron explained. “Kids who eat with their families do better in school and have better relationships with their parents. But mealtime’s strength as a protective factor varies depending on what else is happening. Just sitting together during the meal isn’t enough – if the TV is on, eating together isn’t protective.”
Creating syndemic profiles
Lebron earned her PhD in 2020 and was immediately recruited into her current faculty position at the UM-SONHS. That was when professor and associate dean for research Victoria Behar-Zusman, Ph.D., who serves as principal investigator for the NIH-funded Center for Latino Health Research Opportunities (CLaRO), encouraged her to apply for a diversity supplement through the NIH’s National Institute on Minority Health and Health Disparities (NIMHD).
“We know that substance abuse, risky sex and obesity all share risk factors such as depression and anxiety, and protective factors such as family functioning and communication,” said Lebron. “This study asks how these three conditions interact and exacerbate one another, and whether we can create a risk profile that reflects this.”
Funded in 2021, the one-year study is drawing on the data set from the Familias Unidas health and wellness trial to identify multiple syndemic risk profiles of Latino adolescents and to understand how these profiles might change over time.
“We talk about a syndemic when certain behaviors or conditions in a population occur together and are interconnected in ways that create greater risk of negative health outcomes,” she explained. “So I wanted to explore syndemic risk profiles of Latino kids with overweight or obesity.”
Ultimately, Lebron hopes to identify how to make Familias Unidas and other interventions more adaptive for these Latino adolescents.
“If we can identify and understand the risk profiles, we can adapt the intervention to make it work better,” she said. “Maybe they need certain add-ons to the intervention. We’re asking, what more do you need, and how can we give you that? This is where everything comes together.”
Looking to the future
Lebron is excited about her future research plans. “I want to do obesity prevention interventions with Latinos,” she said. “To improve the Familias Unidas intervention by understanding who it can serve, and how we can create better opportunities to serve them.”
Lebron also sees herself working with women during their pregnancies and in the early months of their children’s lives. Her dissertation looked at how in utero and perinatal risk factors, such as an obesity-complicated pregnancy or gestational diabetes, can lead to early childhood obesity by age two.
“I’d like to work with Latina mothers to prevent obesity in their babies in the first six months of life,” she said, “It matters, because once you’re obese as a child, you’re more likely to be obese as an adult.”
The intervention she’s developing will include grandmothers, because in her earlier work she found that young Latina moms sought advice from their own mothers. But it’s clear that wherever her research takes her, it will always be about strengthening families.
“The family is central to Latino culture,” she said. “If we can make families stronger, understand what parents need, everything else will come from it. That is a beautiful idea.”
CLaRO launches young investigators into new professional realms
Lebron’s diversity supplement provides protected time for training and learning, including conferences, courses, and mentoring with Behar-Zusman and Prado, as well as with UM-SONHS associate professor and associate dean for Health Studies Arsham Alamian, Ph.D., M.Sc., F.A.C.E., who is providing expertise in latent class analysis and latent profile analysis.
“I’m learning so much from these health disparities researchers,” said Lebron. “How interventions are created and adapted, how to make them culturally appropriate, and how you really need to understand your population for the intervention to work for them. It has fueled me and given me a road map for how to move forward in my career.”
CLaRO has also provided Lebron with professional visibility and national leadership opportunities.
“I attribute so much to CLaRO,” said Lebron. “I’m the new president of the Latino Caucus for Public Health in the APHA [American Public Health Association]. We’ve created webinars and a podcast called Sana, Sana, Latinos in Public Health.”
The podcast’s name is drawn from the traditional rhyme that generations of Latino parents have said to their children when they get hurt. The start of each episode features the soothing voice of Lebron’s grandmother reciting the mischievous, well-loved words: Sana, sana, culito de rana, si no te sanas hoy, te sanas mañana (Heal, heal, frog’s little fanny, if you don’t heal today, you’ll heal tomorrow).
“As a kid, when your mami or abuela said those magic, healing words, you just knew everything was going to be okay,” she recalled.
Lebron has also participated in CLaRO’s research training institute, where she presented on how to write an F31 proposal – the funding that supported her dissertation.
“The institute is such a huge asset – you meet great people and generate new ideas,” she said. “It’s also led to opportunities for professional collaborations and mentoring.”
Behar-Zusman sees great promise in Lebron as an emerging investigator and leader.
“Cynthia is an exciting young Latina scholar,” she said. “Only a couple of years out from earning her PhD, she’s already well on her way to a successful research career, is an outstanding teacher and mentor, and is an emerging leader in her discipline. I feel very fortunate to have her on the CLaRO team as a diversity scholar.”
For her part, Lebron is deeply grateful for Behar-Zusman’s mentorship, especially during a challenging time.
“There’s no amount of appreciation I can offer for the understanding, support and grace Vicky extended when I was pregnant and on maternity leave – she doesn’t discount the fact that I’m a mom, she sees it as an asset,” Lebron said. “And I always feel I’m being guided in the right direction.”