November 2007

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Physician-Scientist Touts Bottom-up Community Education

By Eddy Ball
November 2007

Working to improve environmental health for residents along the Texas-Mexico border and in the metropolitan area of Louisville, Kentucky, Irma Ramos, M.D., has learned firsthand the difference that bottom-up community involvement can make in the success or failure of outreach and health education efforts. On October 10, as part of Hispanic Heritage Month, the University of Louisville School of Public Health professor shared her insights with an audience in Rodbell Auditorium. Her lecture, titled “Improving Hispanic Health: A Culturally Sensitive Approach,” was hosted by Postdoctoral Fellow Rose Ramos, Ph.D., and sponsored by the NIEHS Hispanic Heritage Month Committee.

Irma Ramos said approximately 1,800 “colonias,” or neighborhoods, exist along 1,248-miles of border between the United States and Mexico border with an estimated population of more than 500,000 people, 98 percent of them Hispanic. Of these, 65 percent — and about 85 percent of residents under 18— were born in the United States. Ramos said these residents live in poverty and unsanitary conditions with very little community support.

Ramos’ work focused on the communities of Progresso, San Carlos, Las Milpas and Cameron Park in South Texas. As she explained, the objective of the project was “to translate major research findings in the environmental health sciences into practical concepts that can be easily adopted by rural communities in Texas.”

As part of the project, Ramos and her team accessed an important resource within the colonias — the network of “promotoras” or lay educators and community health workers who are widely known and trusted members of the community. In South Texas colonias, promotoras are certified members of a professional association and paid just above minimum wage for their services as part-time community liaisons.

“This bottom-up model of education,” Ramos observed, “ensures that the community will support the program and that the program will continue in the community even after the research project is finished.”

Outcomes analysis of data from Texas is still ongoing, but Ramos said that results so far are encouraging. Comparing pre- and post-intervention results, she found increases in environmental health literacy among promotoras and subjects, and data collected at the beginning of the project pinpointed health needs that should be addressed in future efforts and documented suspected environmental health risks. The study is being published in an upcoming issue of the Journal of Immigrant and Minority Health.

After moving to Kentucky, Ramos encountered several region-specific challenges to using the same model in the Louisville metropolitan area of Jefferson and Shelby counties. There, the Hispanic population has grown rapidly, increasing 173 percent between 1990 and 2000. The population is far less cohesive than the population in South Texas, as well as more diverse, representing 20 Spanish-speaking countries. The region has a weaker social support network, and little is known about the population’s needs, concerns and environmental risks.

Because of the fragmentation and transience of the Hispanic population in Kentucky, the project is being forced to build a promotoras infrastructure virtually from scratch. Along with language barriers related to dialects and indigenous languages, the population includes more undocumented individuals than the Texas population, making the promotoras approach even more critical to success of the project.

Ramos is a pediatrician and public health specialist with research interests in the fetal basis of environmental disease, cancer and occupational health. She served as the director of Community Outreach and Education in the National Institute of Environmental Health Sciences Center for Environmental and Rural Health at Texas A & M University. In October 2003, Ramos accepted her current academic appointment and later assumed the position of director of Community Outreach and Education with the Environmental Health Sciences Core Center at the University of Louisville.

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