Conversation with Dr. Guadalupe X. Ayala, San Diego State University

Exploring new and adapted interventions to reduce Latino health disparities in obesity, diabetes, and asthma

Meet Dr. Guadalupe X. Ayala, professor of public health in the Division of Health Promotion and Behavioral Science at San Diego State University (SDSU), director of the SDSU HealthLINK Endowment, and co-director at the SDSU HealthLINK Center for Transdisciplinary Health Disparities Research.

The SDSU HealthLINK Endowment and Center are funded by the National Institute on Minority Health and Health Disparities (NIMHD). Both are helping to build research infrastructure to support population health and health disparities research at SDSU and its partner organizations. The Center is a new member of the RCMI national network. Dr. Ayala is also a director at the Institute for Behavioral and Community Health (IBACH) and previously served as senior core investigator.

Dr. Ayala identifies as a Latina because it reflects her Mexican and Argentine heritage. Her upbringing started at the rural border community of Calexico, California, which influenced a bicultural experience encouraged by her parents.

Growing up in this community, Dr. Ayala developed a passion for addressing the unhealthy conditions visibly present in the California-Mexico border region. She was further influenced to pursue a career in minority health and health disparities when she assumed her first faculty position at the University of North Carolina at Chapel Hill, Department of Health Behavior, Health Education.

She recalls, “In North Carolina, I was exposed to living and working in new immigrant-receiving communities. Community organizers reminded me of the importance of retaining a connection to one’s heritage to combat the negative effects of migration into less established immigrant communities. These experiences transformed my thinking about how to approach a research career in minority health and health disparities research.”

Dr. Ayala’s research focuses on developing new and adapted interventions to reduce Latino health disparities in obesity, diabetes, and asthma. This has included developing evidence-based individual, family, health care, and community interventions to improve diet, physical activity, and other behavioral, social, and environmental determinants of obesity, diabetes, and asthma.

Over the past several years, she has worked with colleagues at IBACH to develop several conceptual models for promoting health among Latino persons. The most recent example of this effort is her leadership on the Hispanic Community Health Study/Study of Latino Youth (HCHS/SOL Youth) which recruited 1600 youth and their families from four different sites in the U.S. to better understand Latino subgroup differences in risk factors for cardiovascular disease.

Dr. Ayala has received numerous honors and awards for her exemplary impact on students and research achievements. These include the Presidential Leadership Fund Faculty and Staff Excellence Award from SDSU in 2014, the 2018 Henry Montes Presidential Award from the American Public Health Association Latino Caucus, and Wang Family Excellence Award – Outstanding Faculty Research from California State University in 2019.

Q & A with Dr. Guadalupe Ayala

What is the center’s research goal, purpose and aim?
The SDSU HealthLINK Center was funded by NIMHD in September 2018. Early during our first two years of funding, we developed our vision and mission. Our vision is to inspire transformational and collaborative research that promotes health equity and well-being for all people and communities. Our mission is to foster meaningful, high-quality, transdisciplinary research that advances health equity.

We accomplish these by building the capacity of individual investigators and their institutions (at SDSU, SDSU Research Foundation, and our partners) to support research collaborations involving innovative investigations and solutions. Disciplines include public health, psychology, physical therapy, computational and engineering sciences (electrical, mechanical), information sciences, biology and biochemistry, geography, sociology, and math/statistics.

The SDSU HealthLINK Center goals include generating, using, and disseminating findings derived from basic biomedical, behavioral, clinical, and population-based research to inform additional innovations in research, practices, and policies to reduce health disparities.

How is the center advancing the health of populations experiencing health disparities? Which populations? Are you seeing specific changes in particular communities or groups?
We seek to continue advancing health equity and health disparities research that can impact the lives of Latino/Hispanic persons, the LGBTQ community, residents of rural areas, and people experiencing poverty. Our Center activities span San Diego and Imperial counties along the U.S (California)-Mexico border.

We are advancing health disparities research by supporting two research projects: one a basic research study examining obesity and cancer, and a randomized controlled clinical trial testing a cognitive-behavioral physical therapy (CBPT) intervention delivered through telehealth to address chronic spine pain.

The Center also funded 17 pilot projects that span the continuum of science from basic biomedical research on autism, to clinical research testing methods for promoting advanced care planning among older Latino/Hispanic people, and population-based research on cancer among Latino/Hispanic persons.

We measure change in many ways, including whether Latino/Hispanic chronic spine patients experience less pain after participating in the CBPT intervention. Although it is too early to report on these findings, we observe changes in how people think about how to approach their research questions, including whom they involve in the research conceptualization phase.

From the research you’re doing, what has surprised you about the discoveries from your center and its impact?
We are not yet at the research discovery stage. Nevertheless, based on the research we are fostering at the Center, I have learned three things:

1. Transdisciplinary research is the future but disciplinary differences introduce challenges. Therefore, our Center sought to foster more engineering-type NIH research in health disparities given potential innovations in technology for health. But finding the right fit between the stage of a junior investigator’s research program and future NIH fundability required additional considerations.
2. Community engagement is critical but challenging. Community-engaged research maximizes the relevance of the science to the communities it seeks to serve, but it takes its toll on non-academic partners and the community. Structures such as the Community Engagement Core, requirements for a Community Advisory Committee, and administrative supplements open to partner organizations are clear ways of fostering their involvement and development.
3. Center support is essential for developing research infrastructure at predominantly teaching institutions. Programs like the RCMI program are essential for institutions like SDSU, to allow us to have a sustainable infrastructure for implementing innovative research methods across extramurally funded projects.

What inspired you to become a researcher in minority health and health disparities?
I was first inspired to do something about the conditions affecting the health and well-being of underserved communities while growing up in Calexico, California. Despite strong social ties and social capital that crossed the U.S.-Mexico border, this vibrant community suffered both health-related and socioeconomic problems (e.g., high unemployment and poverty rates).

Later, during an undergraduate research methods course, a professor of psychology inspired me to become a researcher. The systematic approaches to identifying possible cause-and-effect mechanisms strongly influenced my pursuit of training and experience in health psychology/behavioral medicine. I sought to become the best researcher possible so as not to exacerbate health disparities by building evidence poorly. This led me to train in experimental and clinical (health) psychology and public health.

Today, I remain inspired by community health workers and other community and organizational leaders. They inspire me to make this work relevant to the communities we serve.

How do we encourage the next generation of scientists?
Provide universal pre-K education to all children. Ensure that all families have access to quality food, opportunities and space to be active, safe and affordable housing, education (including higher education), and health care. My point is that the process of encouragement begins early and needs to consider the context for the development of great scientists.

In the classroom, we can encourage the next generation of scientists by fostering critical thinking and applying skills to real-world projects. As we have discovered, this is common in many fields, including public health and electrical engineering. Thus, it also provides a common base upon which to build transdisciplinary efforts across diverse university disciplines in university classrooms.

We should strive for authentic partnerships outside the classroom and serve as the best role models possible to junior investigators. Authentic partnerships have at their core a desire for a mutual understanding of individual and institutional needs in a research partnership.

What do you envision as the future of minority health and health disparities research?
Innovative models for funding collaborative research. I am hopeful that we will identify funding models that best serve the needs of community-engaged academic researchers and their partners. There is an infrastructure requiring support at all involved institutions, including academic ones, but what those look like, how best to build them, or foster their development and maintenance, is not entirely clear. This is partly because our measures of center impact may not adequately represent the perspective of these stakeholders.

Innovative collaborations across disciplines. I am hopeful that we can identify the best models to support junior investigators and their mentors working collaboratively to address health disparities in our region. There are challenges to simultaneously addressing the needs of junior investigators from diverse disciplines, such as social work and mechanical engineering. Their physical, human resources, and partnership needs may differ significantly, as does their approach to science and its potential fundability by NIH.

Page updated October 8, 2021