Hutch News

Bridging the cultural gaps

Epidemiologist Gloria Coronado works to bring effective science and health screening to Latinos and other immigrant communities

Dec. 16, 2004
Dr. Gloria Coronado

Images in Dr. Gloria Coronado's office of migrant farm workers are constant reminders of the health-care disparities in some Latino communities.

Photo by Todd McNaught

Stark photographs line the walls of Dr. Gloria Coronado's office. In one of the black-and-white images, a Latina child poses shyly in front of the assemblage of sticks and plastic tarps she calls home. In another, a woman sits in light and shadow, her face weathered by years of sunrise-to-sundown farm labor.

Between the often-distant worlds of migrant farm workers and health care stands Coronado, who works for the Cancer Prevention Program and joined the Public Health Sciences Division faculty in August. As a Mexican-American, Coronado aspires to create a connection between her Eastern Washington roots and her epidemiological work.

"I'm definitely interested in the Latino community because my dad is from Mexico," she said. "I have a desire to bring science to that community and to bridge the gap."

Coronado's work, largely focused on the Mexican migrant settlements in Washington's Lower Yakima Valley, looks at cancer and screening rates and interventions to improve both. In addition, her work is branching out to include public-health research in Asian-immigrant communities.

"Gloria is a unique and valued addition to our program, PHS and the center as a whole," said Dr. Polly Newcomb, head of the Cancer Prevention Program. "Her research in health disparities in the Latino communities — both in the United States and internationally — will contribute to more effective health-care delivery and the promotion of health behaviors. Her work has already improved the quality of life for many."

Coronado, who received her doctoral degree in epidemiology from the University of Washington School of Public Health and Community Medicine, first came to the center in 1995 as a graduate student. She worked with Dr. Beti Thompson, a PHS investigator, on a study which found that farm workers in the Yakima Valley track significant amounts of pesticides into their homes, thus exposing their children to potentially harmful chemicals.

Bicultural understanding

The researchers worked through health clinics, churches and schools to educate parents in how to minimize pesticide exposure in their children. They also created a curriculum for the local Head Start programs to teach preschoolers about lowering their risk by washing their hands and produce, as well as obeying "keep out of field" signs.

Thompson appreciates Coronado's bicultural understanding, as well as her strong investigative skills. "She's very well-trained, an excellent colleague. I've always been impressed by her ability to understand and tackle new research problems," Thompson said.

In 2001, Coronado took a short-term leave from the center to work as a consultant for the Pan American Health Organization, an international public-health agency and part of the World Health Organization.

"My goal was to develop an information system to organize data about cervical-cancer screening participation and follow-up care among women in El Salvador so that the country could better allocate its resources for prevention," she said.

Coronado found women in their 20s were being overscreened for cervical cancer, while females over 30, who are at higher risk, weren't getting screened as often.

When Coronado returned to Fred Hutchinson in 2002, she joined PHS as a staff scientist. "The Hutch is very well-organized, and the faculty and staff are highly accomplished. That gives me a sense of confidence in dealing with situations that arise in research or in communities," she said.

Establishing relationships with a network of community leaders and programs in the Yakima Valley has led to other cancer-prevention studies. Latinos are at greater risk for cervical, stomach and esophageal cancers, types of cancers caused by viruses or other infectious agents.

Coronado has identified differences in cervical-cancer screening rates between Hispanic and non-Hispanic whites, work that provided a basis for the development of culturally sensitive programs aimed at boosting cancer-screening practices among Hispanic women.

Lack of HPV screening

"With an expected HPV (human papillomavirus) vaccine in 2006 and additional screening modalities being developed, it's an exciting time to be studying cervical cancer," she said. "Although it's a cancer with fairly low incidence in the United States among non-Hispanics, it has a higher incidence among immigrants and in other countries because of lack of screening." HPV is a common sexually transmitted disease. Long-term HPV infection increases the risk of cervical cancer. Coronado has studied the use of colposcopy (visual examination of the cervix to determine the cause of an abnormal Pap test) among Hispanics and overcoming barriers to its use among women with abnormal Pap test results.

Coronado and fellow researchers are also examining impediments to colonoscopy screening among Latino patients with positive fecal-occult blood test results.

Follow-up care, especially in communities with a large percentage of undocumented workers, is difficult. Some of these workers fear deportation if they seek medical care. Concern over deportation is especially high in colonias — rural communities located along the Mexican border that often lack infrastructure and basic services. Center scientists are collaborating with researchers at New Mexico State University to improve screening rates for colorectal cancer in these remote areas.

The 2000 census identified more than 35 million Latinos living in the United States. That number represented a 142 percent increase over the 1980 census, and means that this fast-growing demographic group now makes up nearly 13 percent of the U.S. population, according to the Pew Hispanic Center/Kaiser Family Foundation 2002 National Survey of Latinos. In some Eastern Washington communities, Latinos comprise more than 80 percent of the population.

Asian communities

In addition to her work in Latino communities, Coronado is also interested in research projects focusing on Asian immigrant and refugee communities. Along with Dr. Vicky Taylor in the PHS Division, she is developing and testing an English as a second language curriculum to promote hepatitis B testing in Chinese-Americans.

"The immigrant story is really everybody's story," Coronado said. "The compassion you might have for one community can transfer to other communities. I think the basic seed is honoring humankind."

An especially rewarding aspect of Coronado's work is supervising summer internships of minority high-school students from the Yakima Valley and New Mexico State University undergraduate students through the Building Minority Research Capacity project. The high-school students carry out small research projects in their communities, culminating in presentations before scientists at the center and at home in front of their families and community members.

"The students are saying, 'This is the work I did, and this is why it's meaningful,'" Coronado said. "It allows the parents to understand the research that their child carried out and why it is good for the community. It gives the parents a vision of research so they can understand how it is relevant to their lives."

From her personal experience, Coronado knows many minority students face resistance from their parents in going to college. "Their parents may want them to stay home and continue to be with family and to contribute to the family," she said. "For students to do science among people like themselves, can be very powerful."

Coronado, Thompson Honored

Drs. Gloria Coronado and Beti Thompson will be recognized for their contributions to underserved communities at the annual Women of Color Luncheon on Jan. 28, sponsored by the Northwest Asian Weekly Foundation.

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