Scholar Story: Uriyoán Colón-Ramos, ScD, MPA

“As a researcher, I aspire to design studies to inform policy to level the field for more vulnerable populations…and have a more lasting impact.”

Uriyoán Colón-Ramos acknowledges that conducting research in under-resourced communities requires a grasp on the limitations placed upon that community. As a child growing up in a rural mountainous area of Puerto Rico, Uriyoán realized that many of her choices, particularly about the food she and her family ate, were dictated to her by the limitations of what was available to eat.

“Growing up in the Caribbean where 95 percent of the foods are imported gave me an intuitive understanding about the limitations that people face in the context of an environment that does not enable certain food or beverage choices,” Uriyoán says. “I’ve brought that perspective with me in studying nutrition and asking to what extent those environments can influence diet behaviors.”

As an undergraduate student at Cornell University, she created her own major, Sociological Perspectives of Nutrition in Developing Countries, to acquire a society- and systems-based understanding of nutrition behaviors. Her research now focuses on underserved communities in the U.S., Latin America, and the Caribbean. Continuing on that interdisciplinary path, she received a Master’s degree from Cornell in public administration and a ScD in public health nutrition from Harvard University.

“For me, addressing nutrition from a clinical and individual perspective was not as interesting as food system questions that takes society into consideration, because that was my reality growing up,” Uriyoán explains. “People would receive individual nutrition and health counsel that would get ‘messy’ when they put it in practice in their living context. For example, when I was little, when we were told to eat a variety of fruits, for whatever reason that meant either apples and pears, or fruit cocktails. Since apples and pears were imported, expensive, and tasted like cardboard, we would be served canned fruit cocktail in heavy syrup. Then eventually the family would develop recipes using these foods and those dishes would become part of traditions and served repeatedly.”

Uriyoán’s research, therefore, asks, “How can policies that promote locally-produced fruits, or that discourage high-sugar canned fruit purchase, for example, be coupled with educational programs to help shape individual diet choices? I want to understand to what extent society, systems, and policies can have an influence.”

Looking at behaviors from that perspective is crucial. By focusing only on the individual, researchers often neglect to understand that people are subject to larger, societal and systemic factors that prevent them from engaging in beneficial health behaviors. For example, her current research tries to understand if sugary drinks can be replaced with drinking water in a low-resource Latino community. However, many people in under-resourced communities lack access to safe water and cannot afford to buy bottled water—this coupled with the widespread availability and affordability of sugary drinks leads to higher sugary drink consumption. Uriyoán’s work, therefore, focuses on understanding which elements within systems can be leveraged to facilitate healthy behaviors, so that the burden of changing health behaviors does not fall entirely on the individual.

“Through focusing on food systems, we can level the field and ensure that healthy options are there and easy to do,” Uriyoán says. “As a researcher, I aspire to design studies that can inform policy and level the field for more vulnerable populations—those impacted by obesity, chronic diseases, poverty, racial discrimination, stress. Ultimately, I want to take my current research on water and have an impact on policy or a system design, an infrastructural design.”

For the last few years, Uriyoán and a team of researchers at George Washington University have worked on a community participatory research project around water security and sugary drinks in a Central American immigrant population in the Washington D.C. metro area.

The research team, which collaborates with community partners, local NGOs, and local parents in the formulation, implementation, and interpretation of the research, began four years ago by asking kids to take pictures of things they wanted to change in their community. Many took pictures of fast food restaurants, noting that they learned about nutrition in school, but couldn’t apply it because of the limitations of their environment.

Community members further refined the research question to look at sugary drink consumption, and the team began by promoting water consumption in schools, businesses, restaurants, and homes. Then, news broke about the water crisis in Flint, MI, which led the team to think about whether replacing sugary drinks with tap water was a viable solution for their population.

“People didn’t have the perception that tap water was safe. If they drank water, it was bottled. They were spending so much on bottled water, making it hard to replace sugary drinks with water,” Uriyoán explains.

Other research offers context for the avoidance of tap water in some communities. White people consume more tap water and are more likely to believe it is safe. While communities of color think the opposite, and will not give tap water to their kids, which has been associated with increased sugary drink consumption, Uriyoán notes that there is further difference in the consumption of tap water in different communities. While her team is working on interventions with Central Americans, the exact same intervention may not work with an African American community because of different experiences.

Uriyoán and her team are now testing their tap water intervention, which provides a home tap filter, information about the cost of bottled water and juices, information about the amount of sugar in juice, and information about the health impacts of sugary drinks. The community is hoping to find out whether this information and the presence of a tap filter is enough to sustainably replace sugary drinks in the long term.

Uriyoán credits the New Connections network with helping her gain some of the funding for this project. She brought a funding proposal to a recent coaching clinic and was able to receive strong critiques, preparing the proposal for successful submission.

“Usually you have colleagues who provide this feedback, but New Connections was that on steroids,” Uriyoán remarks. “I was able to give them my proposal and get thorough feedback, making my proposal stronger. I ultimately secured federal funding through that proposal.”

As a former grantee, Uriyoán says she appreciated the unique nature of New Connections. “It’s hard to know how to work with RWJF or NIH and get funding. It’s extremely competitive, so New Connections was a way to break into that godfathering mechanism when that godfather doesn’t exist for you. This was a really special group.”