Ana Paula Cupertino, PhD Director
I am an Associate Professor in the Department of Preventive Medicine at Kansas University Medical Center and Director of Juntos. My academic career has focused on the development and implementation of research projects incorporating cultural factors and principles of community-based participatory research. As a social behavioral scientist, my tobacco control research has focused on smoking cessation and access to cessation treatments among underserved and understudied populations focused primarily on Latinos.
On several projects, I have combined my experience in multidisciplinary tobacco research involving community-based studies with survey development, research design and methodology in ethnic minority populations, participant recruitment and human subjects’ protection, data management, research staff training and supervision.
In addition, I have the great opportunity to be out in the community and participate in health events focused on Latinos in partnership with health care providers, academic organizations, coalitions, health departments and community-based organizations serving Latinos in the state of Kansas.
I am originally from Juiz de Fora, Minas Gerais, Brazil. I grew up in different states across Brazil, but during my teenager years I lived in the Barrio Belgrano, Buenos Aires, Argentina. My experiences growing up exposed me to different cultures and contributed to my fluency in English and Spanish.
I attended catholic school for elementary, middle and high school. I earned my undergraduate and masters degrees in social psychology from the Federal University of Brazil. Based on my master’s degree performance, I was awarded a fellowship by the Brazilian Ministry of Education to pursue doctoral studies at the University of California-Davis. In California, I married a Mexican-American and became heavily involved in community organizations working to promote health among Latino immigrants.
In my early doctorate research, I joined Dr. Mary Haan’s research team to work on the Sacramento Area Latino Study on Aging (SALSA). This longitudinal study was designed to assess changes among older Latinos in cognitive performance and explore risk factors for cognitive decline. Participants were recruited in census tracts, door-to-door, and were interviewed in their homes. Besides improving my theoretical background on psychosocial risk factors and health in minorities groups, I learned how to plan community studies and maintain a registry database with screening, recruiting and interviewing data.
I also strengthened my skills in implementing a community-based study, including training recruiters and interviewers. I learned methods to identify participants, and gained an understanding of the nuances among different Latino cultures and generations of immigrants. For my dissertation, I conducted a secondary data analysis of the impact of socioeconomic disparities on cardiovascular morbidity and mortality in the Normative Aging Study, a cohort study within the Boston Veterans Affairs.
Upon returning to Brazil, I was the Principal Investigator of the first community-based study on health psychology and aging. Our research team identified and interviewed 956 older adults in census tracts with high concentrations of older adults. The main goal of the study was to validate the psychometric properties of Portuguese translations of a variety of different research scales.
Our most recent manuscripts include: 1) an assessment of internal construct validity for the Center of Epidemiological Studies–Depression Scale in elderly people; 2) a qualitative assessment of successful aging among older adults in Brazil to guide the development of a scale13; and 3) an analysis of the relationship between psychosocial variables in childhood and aging14.
As part of this study, I also examined the relationship between smoking and depression among older adults. This work received a methodological award at the Latin American Congress on Nicotine Dependence and Addiction. The completion of this three-year study provided me with invaluable experience in leading a research team. In 2005, I reunited with my family in the U.S. and accepted a post-doctoral fellowship in the Department of Preventive Medicine and Public Health at KUMC.
Our Research Program
For the past six years, I have been actively engaged with the Latino community, implementing a community-based participatory research approach to understand their perceptions of their health needs and identify ways that further research could help address these needs.
Community members are essential partners in the process of understanding and improving community health. They know what issues are important and understand the context and situations that foster Latino health disparities. Research conducted in collaboration with community members is more likely to be sustained over long periods, thereby increasing the likelihood of improving health outcomes.
In November 2008, I became an Assistant Professor in the Department of Preventive Medicine and Public Health at KUMC. As a faculty member, my goal has been to initiate a new line of health disparities research in the Latino community in Kansas. As a social behavioral scientist, my tobacco control research has focused on smoking cessation and access to cessation treatments among underserved and understudied populations with a primary focus on Latinos.
I also have experience in the development and implementation of research projects incorporating cultural factors and principles of community-based participatory research. Besides writing several grants in partnership with community-based organizations, I have focused my efforts on submitting NIH- NCI grants directly related to my research purposes.
Over the years I have began to collaborate with entities outside of the Department of Preventive Medicine, engaging other departments and centers within KUMC. I have enlisted new Latino and non-Latino investigators’ interest in supporting a research program to address health priorities within the Latino community, including those from other institutions in the region, such as Children’s Mercy Hospital.
With additional research funding, I currently supervise 7 research staff members working on our Latino health program (Mercedes, Natalia, Susan, Ana Vargas, Marina, Randy and Aura). In sum, the University of Kansas Medical Center, and in particular, the Department of Preventive Medicine, now has a solid area of research and network of Latino health organizations to support its future research initiative.
My current NCI K-01 career development research program continues to support my salary for the following two years and allows me to implement my smoking cessation clinical trial with Latino smokers. In 2010, I decided to accelerate my K-01 training award to increase diversity in Cancer Research and was awarded funding from August 2009 to July 2013.
By accelerating the career-development-funded research program, I have been able to take on additional research responsibilities. Our community-based research infrastructure has significantly grown since I became OPI in two subcontracts with KU Lawrence Workgroup – Community Development and Center Disease Control – MAPP assessment in the Wyandotte County.
I have also received funding for several projects submitted in 2009 including: R03 Fogarty – CO-PI; U54 – PI of the pilot project; RC4 – Co-investigator), 1 training grant (OCED – Co-director of community core). I have also submitted an NIH-NCI research grant to assess smoking cessation treatment for Latino light smokers (21% percentile). Lastly, in the past year, I have become a consultant to a Fogarty-R01 community- based tobacco control in Brazil (Dr. Isabel Scarinci, PI).
Community Organizations and Volunteer/mentorship Programs
As our JUNTOS name reflects, I am a strong believer that, “a dream is more likely to become real when it is dreamed together.” Focusing on my work in Kansas, over the past six years I have actively worked with the Kansas Department of health and Environment Center for health Disparities, Missouri health Department Tobacco Control Committee, Coalition of Hispanic Women Against Cancer, El Centro, Inc. and Riverview Health Center.
Within Juntos, I have had the honor of working with the Internship Community Advisory Board, Smoking Cessation Community Advisory Board and JUNTOS Community Advisory Board. One of the highlights of my community involvement is the collaborative work we have done within the Celebrating Healthy Families annual health focus event over the past seven years.
Teaching and Mentoring
Throughout my career I have been fortunate to have had strong mentorship from inspiring individuals (to name a few: Drs. Gunther, Aldwin, Haan, Ellerbeck and Richter), in my life that help guide my professional career development maintaining a commitment to healthier communities. I can only hope to share what I have learned from my mentors with others through mentorship and teaching.
My teaching goals are focused on health disparities, development of culturally tailored and linguistically appropriate health interventions and community-based programs that enhance health equity among Latino immigrants in the U.S. As a result, I have developed a core of educational activities on health disparities among Latinos for graduate students, medical students, community-based organizations, public health leaders, graduate fellows and health care professionals.
At the center of my philosophy is the practice of service learning, in which students and professionals enhance their effectiveness as researchers and clinicians by engaging in structured opportunities to engage in community efforts to improve health. By doing so, they learn first-hand the impact of minority status on health risks, access to health care and health outcomes.
In the Master of Public Health (MPH) program, my course offerings focus on independent studies, supervision and individualized teaching of graduate students, as well as advising students and other learners. I have offered independent studies on Latino Health to a total of 16 students. I have developed curricula for two new elective courses in response to a demand from students. The first, which focuses on Health Disparities, is ready for pilot testing with a small set of students and the second, entitled Migration and Health, has already received approval by the Graduate Council (PRVM822).
In partnership with Dr. Lisa Sanderson Cox, I led the implementation of a four-hour lecture series each semester called, “Enhancing Health Initiatives in the Latino Community.” Over the past five years, approximately 450 faculty, professionals and students have attended this event.
For the School of Medicine I lead highly rated small group discussions (CORE850; CORE800) and a course in Advanced Medical Spanish (PMED912). I have also served as project mentor for five Health of the Public (PMED960) clerkship projects with fourth-year Medical Students. I have also been highly engaged in enhancing understanding in international health issues. I mentored 14 fourth-year medical students in the International Health rotation (PMED 950) on projects in South and Central America. Moreover, I took a leadership role in the development, implementation and evaluation of a new medical education partnership between the School of Medicine of the University Autonoma de Morelos, Mexico, and our School of Medicine. As a result of this partnership, a fourth-year medical student spent eight weeks at University Autonoma de Morelos as part of the international rotation.
On behalf of the Medical Center, over the past three years I developed and implemented the Latino Summer Internship in Health Disparities Research program that has engaged 23 high school and college-aged youth from under-represented communities in the Kansas City area. In the summer of 2010, I developed and pilot tested a curriculum focused on health disparities research empowering high school and undergraduate students interested in health careers.
This curriculum has led to National Institute of Health R25 educational research grants pending council review (impact score 29). This curriculum incorporated research mentorship from research faculty, structured training classes focused on key dimensions of health disparities and meetings with Latino medical students and graduate students.
In accordance with a mutual desire to promote further cooperation between the United States and Mexico, KUMC has signed two bilateral agreements.
A letter of intent for cultural and scientific cooperation signed on December 18th, 2009 between KUMC and the Ministry of Health of Mexico aims to develop a coordinated bilateral effort to conduct research, teaching and information exchange in the field of migrants and health to promote access to the health services for Mexican migrants and their families.
Secondly, an agreement between KUMC and the Universidad Autónoma del Estado de Morelos in Mexico was signed on April 27th, 2010 to promote cooperation in all fields of academic endeavor including joint research, educational activities and exchange of faculty, research personnel and graduate students.
Following a community-based participatory research methodology, since 2006 the Department of Preventive Medicine and Public Health at the University of Kansas Medical Center has supported health focus events during Binational Health Week (BHW).
The BHW is an annual series of health promotion and health education activities held in October. It started in California in 2001 and is considered one of the largest mobilization efforts of volunteers, community-based organizations, government agencies, and Latin American consulates to improve the health and well-being of the underserved Latino population living in the United States.
In 2010, the Tenth BHW took place in 40 states in the United States, including Kansas. In 2012, we have formalized our partnership with Mexico by signing an agreement to be the reference site for Ventanilla de Salud in Kansas.
Beyond community activities during BHW week, the Department of Preventive Medicine & Public Health at the University of Kansas Medical Center hosted two Binational Health Week Summits (2009 and 2010). The goal of these summits is to create a platform where researchers, community members, key stakeholders, and healthcare providers can discuss issues that impact the health of Latinos.
In 2010, local, national, and international speakers were invited to present on topics related to the implications of the U.S. health care reform on Latinos, data and policy issues in immigration and immigrants in our region, Mexico initiatives on immigrant health and challenges in providing health care to the local Latino population. The 2010 event was organized in partnership with Children’s Mercy Hospitals and Clinics, Alianzas (a program of University of Missouri Extension and the University of Missouri-Kansas City Institute for Human Development), and the Consulate of Mexico in Kansas City.
Tobacco Control and Smoking Cessation in Brazil
Brazil has the fifth largest population and one of the largest income gaps between the rich and poor in the world. Its primary care system is specifically structured to overcome access barriers and health disparities.4In 1988 Brazil decentralized primary care services and relocated UBS facilities into the communities they served.
These community-based primary care facilities are called Unidades Basicas da Saúde—UBS’s. UBS’s are assigned to oversee primary care for every citizen. All Brazilian households are grouped into microareas—neighborhood groups consisting of about 250 households. Two to six microareas are assigned to each UBS. UBS’s are staffed by health care teams, consisting of family medicine physicians, nurses, social workers, community agents, and in some cases, dentists and physical therapists. UBS’s are also staffed with community agents—paid community health workers who live within their microarea and usually have no specialized health care training.
Multiple community agents are assigned to each microarea to identify and address health issues via home visits and other health promotion activities. As of 2004, there were 20,000 health care teams, and 200,000 community agents operating in the 64,000 UBS’s in Brazil. UBS’s provide virtually all primary care for low-income Brazilians, although some middle- and many upper-income Brazilians supplement UBS care with private health care plans. In this context, we have established two line of research in partnership with Brazil.
Optimizing Treatment for Brazilian Smokers through Community-based Primary Care (R03).
Although Brazil provides universal coverage for evidence-based tobacco treatments, it continues to have disparities in tobacco prevalence and access to treatment. The twofold purpose of this project is to 1) conduct a research project to understand and enhance access to tobacco treatment for Brazilian smokers, and 2) build a research collaboration between the U.S. and Brazil.
The research project involves collaborating with community-based primary care clinics in Juiz de Fora, Brazil to achieve the following specific aims: 1) create a representative registry of smokers to determine tobacco prevalence and attitudes toward treatment; 2) describe health care provider perspectives on how best to reach low-income smokers; 3) develop and pilot test a community agent intervention to enhance access to tobacco treatment services.
The project will be conducted in collaboration with Brazilian P.I. Dr. Oscarina da Silva Ezequiel and her staff at the Universidade Federal de Juiz de Fora (UFJF). Research capacity building activities include formal course offerings, mentored research projects, and community lectures designed to build knowledge and skills for conducting applied clinical research.
Aldwin CM, Spiro A III, Levenson MR, Cupertino AP. Longitudinal findings from the Normative Aging Study: III. Personality, individual health trajectories, and mortality. Psychology and Aging. 2001 Sep;16(3): 450-65.
Oliveira BH, Cupertino AP. Gender and age differences in life stressors in a random sample of older adults. Textos sobre Envelhecimento, 2005;8(2).
Cupertino AP, Aldwin CM, Oliveira BH. Moderadores dos efeitos do estresse na saúde auto-percebida de cuidadores. Moderators of caregiving stressors in health among older adults. Informação em Psicologia. 2006;10(10):9-18.
Cupertino AP, Oliveira BH, Coelho ER, Guedes DV, Milano RS, Rubac JS, Sarkis SH. Stress and social support in childhood and adolescence related with depression symptoms in the elderly. Revista Reflexão e Crítica, Porto Alegre-BR. 2006;19(3):371-378.
Cupertino AP, Heringer F, Riberito P. Definição de envelhecimento saudável na perspectiva de indivíduos idosos. Successful aging definition in a sample of older adults. Revista Reflexão e Crítica, Porto Alegre-BR. 2007;20(1): 81-86.
Batistoni SS, Neri AL, Cupertino AP. Validity of the Center for Epidemiological Studies Depression Scale among Brazilian elderly. Rev Saude Publica. 2007 Aug;41(4):598-605. Portuguese
Cupertino AP, Mahnken JD, Richter K, Cox LS, Casey G, Resnicow K, Ellerbeck, EF. Long-term engagement in smoking cessation counseling among rural smokers. J Health Care Poor Underserved. 2007 Nov;18(4 Suppl):39-51.
Fortes AG, Neri AL, Cupertino AP. Eventos estressantes, estratgias de enfrentamento, auto-eficcia e sintomas depressivos entr idosos residents na comunidade. Stressors, coping strategies, self-efficacy and depressive symptoms among older adults. Revista Psicologia e Reflexão. 2008;21:(1).
Cupertino AP, Richter KP, Cox LS,Nazir N, Greiner KA, Ahluwalia JS, Ellerbeck EF. Smoking cessation pharmacotherapy preferences in rural primary care. Nicotine Tob Res. 2008 Feb;10(2):301-07. PMCID: PMC2821185
Cox LS, Cupertino AP, Mussulman LM, Nazir N, Greiner KA, Mahnken JD, Ahluwalia JS, Ellerbeck EF. Design and baseline characteristics from the KAN-QUIT disease management intervention for rural smokers in primary care. Prev Med. 2008 Aug;47(2):200-5. Epub 2008 May 3. PMCID: PMC2577567
Ribeiro PCC., Domingos B.H., Neri, A.L., Cupertino, A.P., Yassuda, M.S. Desempenho de idosos na bateria cognitiva CERAD: relações com variáveis sociodemográficas e saúde percebida. Performance of the elderly in the CERAD cognitive battery: relations with socio-demographic variables and perceived health. Revista Psicologia Reflexão e Crítica. (2009) Vol. 23(1):102-109.
Fortes-Burgos A, Neri A, Cupertino AP. Stressful life events in Brazilian community-dwelling elderly. Estudos de Psicologia (Natal). (2009) 14(1):69-75.
Motta ME, Banhato EC, Silva KC, Cupertino AP. Triagem cognitive: comparação entr o mini-mental (MEEM) e o teste de trilhas. Cognitive screening: comparisons between the mini-mental and the trail-making test. Estudos de Psicologia. (2009) 25(3):353-359.
Ellerbeck EF, Mahnken JD, Cupertino AP, Cox LS, Greiner KA, Mussulman LM, Nazir N, Shireman TI, Resnicow K, Ahluwalia JS. Impact of varying levels of disease management on smoking cessation: a randomized trial. Ann Intern Med. 2009; Apr 7;150(7):437-46. PMCID: PMC2825176
Ribeiro PCC, Neri AL, Cupertino AP, Yassuda MS. Variabilidade no envelhecimento ativo segundo gênero, idade e saúde. Variability in active aging as a function of gender, age and health. Psicologia em Estudo. (2009) July/Sept. 14(3): 501-509.
Cupertino AP, Wick JA, Richter KP, Mussulman L, Nazir N, Ellerbeck EF. The impact of repeated cycles of pharmacotherapy on smoking cessation: a longitudinal cohort study. Arch Intern Med. 2009 Nov 9;169(20)1928-30. PMCID: PMC2826277
Oliveira BH, Yassuda MS, Cupertino AP, Neri AL. Relações entre padrão do sono, saúde percebida e variáveis sócio-econômicas em uma amostra de idosos residentes na comunidade – Estudo PENSA. Relations between sleep patterns, perceived health and socioeconomic variables in a sample of community resident elders: PENSA Study. Ciência & Saúde Coletiva. 2010 May;15(3):851-60. Portuguese.
Cupertino AP, Richter K, Cox LS, Garrett S, Mujica F, Ramirez R, Ellerbeck EF. Feasibility of a Spanish/English computerized decision aid to facilitate smoking cessation efforts in underserved communities. Journal of Healthcare for the Poor and Underserved. 2010 May;21(2):504-517.
Cupertino AP, Cox LS, Garrett S, Suarez N, Sandt H, Mendoza I, Ellerbeck EF. Tobacco use and interest in smoking cessation among Latinos attending community health fairs. J Immigr Minor Health. 2010 Oct 9. (Epub ahead of print) PMCID: PMC Journal.
Batistoni SS, Neri AL, Cupertino AP. Prospective measures of depressive symptoms in community-dwelling elderly individuals. Rev Saude Publica. 2010 Dec;44(6):1137-1143. English, Portuguese.
Engelman KK, Cupertino AP, Daley CM, Long T, Cully A, Mayo MS, Ellerbeck EF, Geana MV, Greiner A. Engaging diverse underserved communities to bridge the mammography divide. BMC: Public Health. 2011 Jan 21; 11:47. PMCID: PMC3036625
Cox LS, Wick JA, Nazir N, Cupertino AP, Mussulman LM, Ahluwalia JS, Ellerbeck EF. Predictors of early versus late smoking abstinence within a 24-month disease management program. Nicotine & Tobacco Research 2011 Mar;13(3):215-20. Epub 2011 Jan 13. PMCID: PMC3045464
Watts J, Cowden JD, Cupertino AP, Dowd MD, Kennedy C. 911 (Nueve Once): Spanish-speaking parents’ perspectives on prehospital emergency care for children. J Immigr Minor Health. 2011 June; 13(3):526-32. PMCID: PMC Journal – In Process
Cox LS, Cupertino AP, Tercyak K. (in press). Interest in Participating in Smoking Cessation Programs among Latino Primary Care Patients. Journal of Clinical Psychology in Medical Settings.
Cupertino AP, Berg C, Gajewski B, Hui SA, Richter K, Catley D, Ellerbeck E. (2011). Change in Self-efficacy, Autonomous and Controlled Motivation Predicting Smoking. Journal of Health Psychology.
Suarez N, Cox LS, Richter K, Mendoza I, Fernández C, Garrett S, Scarinci I, Ellerbeck EF, Cupertino AP. (2012) Success of “Promotores de Salud” in identifying immigrant Latino smokers and developing quit plans. Int Public Health J 2012;4(3):00-00.
Hunt JJ, Cupertino AP, Garrett S, Friedmann PD, Richter KP. How is tobacco treatment provided during drug treatment? Journal of Substance Abuse Treatment. 2012 Jan;42(1):4-15. Epub 2011 Aug 9.
Cupertino AP, Suarez N, Cox LS, Fernández C, Jaramillo ML, Morgan A, Garrett S, MendozaI,
Ellerbeck E. (2012). Empowering Promotores de Salud to engage in Community-Based Participatory Research. Journal of Immigrant and Refugee Studies.
Richter K, Hunt J, Cupertino AP, Garrett S, Friedman P. (2012). Understanding the drug treatment community’s ambivalence toward tobacco use and treatment. International journal of Drug Policy, 2012.