The UMass Worcester Prevention Research Center (PRC) is committed to working toward optimal health of communities, families and individuals. Founded in 2009 as part of the CDC's Prevention Research Center Network, our mission is to promote health and prevent disease and disability through: real-world community engaged research, evidence-based practice, and education. We accomplish our work through partnerships with public health, community and clinical organizations. This site is a repository of posters and presentations produced by UMass Worcester Prevention Research Center faculty, staff, students and community partners.


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Recently Published

  • Association between food insecurity and CVD risk factors is moderated by intake of fruits and vegetables in Latinos

    Lopez-Cepero, Andrea; Lemon, Stephenie C.; Rosal, Milagros C. (2018-04-13)
    Background: Food insecurity has been consistently associated with CVD risk factors (i.e., obesity, type 2 diabetes, hypertension and hypercholesterolemia). Consumption of fruits and vegetables may reduce CVD risk factors among food insecure Latinos. Objective: To examine the potential moderating effect of fruit and vegetable intake in the association between food insecurity and CVD risk factors in a sample of Latino men and women in the northeast U.S. Methods: A representative community sample of Latino individuals was recruited from a community health center in Lawrence, MA. Food insecurity was measured with the 6-item USDA Household Food Security Scale. Fruit and vegetable intake, was measured with Block’s Fruit and Vegetable Screener. CVD risk factors examined included: obesity assessed by body mass index (BMI), and diagnoses of type 2 diabetes, hypertension and hyperlipidemia abstracted from electronic health records. Covariates considered included: age, gender, education and BMI (except in the obesity model). Statistical analyses included multivariable logistic regression testing for interaction between food insecurity and diet. Results: Overall, 51% of the sample were women and most self-identified as Dominicans (73%). Thirty-one percent of the sample experienced food insecurity and 79% consumed less than 5 servings of fruits and vegetables per day. Twenty percent of food secure participants and 23% of food insecure individuals consumed 5 servings or more of fruits and vegetables per day (p=0.439). In adjusted models, food insecurity was positively associated with type 2 diabetes in individuals consuming less than 5 servings of fruits and vegetables per day (OR=1.79; 95% CI=1.11–2.89) but not in individuals consuming 5 servings or more of fruits and vegetables per day. Interaction analyses showed that these estimates were significantly different from each other (p=0.04). Conclusion: Among those who were food insecure, low consumption of fruits and vegetables, was associated with type 2 diabetes in this Latino sample. Studies are needed to confirm our findings. Further, longitudinal studies are needed to understand a potential causal relationship. Interventions to increase availability of fruits and vegetables among food insecure Latinos may help alleviate diabetes disparities in this vulnerable group.
  • Exploring Perceptions of Sugar Sweetened Beverages Among Early Adolescents in Worcester, MA: a Qualitative Study

    Haughton, Christina F.; Sreedhara, Meera; Pbert, Lori; Waring, Molly E.; Rosal, Milagros C.; Lemon, Stephenie C. (2018-03-09)
    Background: Among adolescents, sugar-sweetened beverages (SSBs) are the primary source of added dietary sugar and constitute 10-15% of their total caloric intake. A range of factors influence adolescent dietary behaviors and food choices. This study aimed to explore adolescents' attitudes and knowledge about SSBs, how they receive messages about SSBs, and motivations for SSB consumption. Methods: We conducted 5 focus groups with youth aged 12-14 years that attend one of the eight Youth Connect programs in Worcester, MA in 2016-2017. Groups were sex-specific because of changes during adolescence and experiences with body image and health behaviors between the groups. A semi-structured guide was used to facilitate a discussion with adolescents' around SSBs. The audio recorded data were transcribed and all transcripts were double coded. The data were analyzed using thematic analysis. Results: Discussions included 16 boys in three focus groups and 17 girls in two groups. Participants were 12-14 years old, 27% identified as Hispanic, 24% black and 33% white. One third speaks more than one language at home and the majority consume SSBs daily. Qualitative analysis led to the identification and classification of various subdimensions under the following analytic categories: Attitudes, Motivations, Knowledge, and SSB Messaging. Common themes that emerge under each category will be reported. Analyses are in progress. Conclusions: This research will present a deeper understanding of factors that influence Worcester adolescents' beverage choices from their own perspective. The information can be used in public health messaging in Worcester around obesogenic behaviors such as excess caloric intake from SSBs.
  • Inclusion of evidence-based healthy eating policies in Community Health Improvement Plans: Findings from a national probability survey of US local health departments

    Sreedhara, Meera; Goins, Karin V.; Rosal, Milagros C.; Lemon, Stephenie C. (2018-03-09)
    Introduction: Evidence-based healthy eating (HE) policies can increase opportunities to engage in a healthy diet. The adoption of evidence-based policies into practice is limited and no study reports the status of HE policies nationally. Community Health Improvement Plans (CHIPs) strategically address health priorities, steer evidence-based strategy selection and implementation, and require collaboration. Local health departments (LHDs) are often key stakeholders. We aimed to determine the proportion of LHDs with a CHIP having evidence-based HE policies. Methods:A national probability survey of US LHDs serving populations of Results: 44.1% (95%CI: 34.7-54.0%) of US LHDs with a CHIP reported at least one evidence-based HE policy. The proportion of specific HE policies ranged from 28.9% for school district nutrition/procurement/vending policies to 1.3% for sugar-sweetened beverage tax. Conclusions: Increased implementation of evidence-based HE policy approaches are needed within communities.
  • Do U.S. adults living in food insecure households experience poorer cardiovascular health?

    Sreedhara, Meera; Lopez-Cepero, Andrea; Rosal, Milagros C.; Lemon, Stephenie C. (2017-11-06)
    Background Twelve percent of U.S. adults live in food insecure households, putting them at risk for adverse health outcomes. Relationships between food insecurity and cardiovascular disease (CVD) risk factors range from well-established to inconsistent and understudied. Food insecurity has been positively associated with poor glycemic control, tobacco use, and poor diet. The link with unhealthy body mass index (BMI) is only observed among women. Inconsistent evidence of relationships with hypertension and dyslipidemia has been found and literature examining physical activity is sparse. The relationships between food insecurity and overall cardiovascular health metrics have not been studied in a nationally representative sample of U.S. adults. Objective To quantify the extent to which food insecurity in U.S. adults is associated with poorer cardiovascular health, as measured by the Life Simple 7 metrics, and to assess gender differences in these associations. Methods This was a cross-sectional analysis of 1,446 National Health and Nutrition Examination Survey participants (2011-2012) aged >20 years. The United States Department of Agriculture Adult Food Security Module 10-item questionnaire assessed food insecurity status. Affirmative responses were summed and dichotomized as food secure (responses) or food insecure (>3). An ideal cardiovascular health score was generated from the sum of American Heart Association’s (AHA) Life’s Simple 7 metrics components achieved. The metrics included three health factors (blood glucose, cholesterol, and blood pressure) and four health behaviors (non-smoking, physical activity, healthy BMI, and healthy diet) as measured by laboratory values, anthropometric measures, self-reported questionnaires, and dietary recalls. Multiple linear and logistic regressions determined the associations between food insecurity and overall ideal cardiovascular health, defined as meeting all of the AHA Life Simple 7 metrics, and individual cardiovascular health components, respectively. The interaction between food insecurity and gender and ideal cardiovascular health was tested. Results No U.S. adults met all ideal cardiovascular health components. The 15.8% of adults living in food insecure households achieved a lower ideal cardiovascular health score (adjusted β coefficient: -0.27; 95% Confidence Interval (CI): [-0.50 to -0.04]) than adults living in food secure households. Tests for gender interaction were non-significant. In analyses assessing individual cardiovascular health components, only smoking was significant; adults living in food insecure households were half as likely to be non-smokers or recent quitters relative to their food secure counterparts (adjusted Odds Ratio 0.51; 95% CI: [0.31-0.81]). Conclusion Adults living in food insecure households achieved a lower ideal cardiovascular health score, which was driven by its association with smoking status. In addition to primary and secondary prevention, primordial prevention and cardiovascular health promotion approaches are necessary to reduce CVD burden. Effective policies and health behavior interventions are prudent, specifically to improve diet quality among all U.S. adults and tobacco cessation within food insecure populations.
  • Healthy Kids & Families: Overcoming Social, Environmental and Family Barriers to Childhood Obesity

    Borg, Amy; Haughton, Christina; Kane, Kevin J.; Lemon, Stephenie C.; Pbert, Lori; Li, Wenjun; Rosal, Milagros C. (2017-11-03)
    Healthy Kids & Families, the applied research project of the UMass Worcester Prevention Research Center, is testing the impact of a community health worker (CHW)-delivered intervention aimed at helping families overcome barriers to childhood obesity prevention. The intervention addresses social, environmental, and family issues that may pose as barriers to healthy choices. The intervention is compared to a comparison condition consisting of a CHW-delivered intervention aimed at helping families improve positive parenting skills. The intervention and comparison condition are identical in format, Both use multiple delivery modalities to maintain novelty and prevent attrition/burden. These include home visits, telephone contacts, print (literacy sensitive newsletters), social media (Facebook), and community events. Parents and children will complete scheduled assessments at baseline, 6-, 12-, 18- and 24-month follow-up. Study participants are 240 parent-child dyads recruited from nine elementary schools. Inclusion criteria include: adult and their K-6th grade children attending a participating school, have access to a telephone, speak English or Spanish, and plan to live in the neighborhood for at least two years. Exclusion criteria include medical condition or advice from a doctor that precludes the child from walking or eating fruits and vegetables. Healthy Kids & Families is being implemented in racial/ethnically diverse underserved communities in Worcester, Massachusetts. Funded by the US Centers for Disease Control and Prevention, it involves a partnership between UMass Worcester Prevention Research Center of UMass Medical School, the Worcester Public Schools, and Oak Hill Community Development Corporation.
  • Racial/Ethnic Representation in Lifestyle Weight Loss Intervention Studies in the United States: A Systematic Review (poster)

    Haughton, Christina; Silfee, Valerie J.; Wang, Monica L.; Estabrook, David P.; Lopez-Cepero, Andrea; Frisard, Christine F.; Rosal, Milagros C.; Pagoto, Sherry L.; Lemon, Stephenie C. (2017-03-30)
    Objective: Despite efforts to enhance inclusion, underrepresentation of minorities in research has been documented. The primary aim of this review was to evaluate representation of racial/ethnic sub-group members in behavioral weight loss interventions conducted among adults in the United States. The secondary aims were to assess recruitment and study design approaches to include racial/ethnic groups and the extent of racial/ethnic sub-group analyses conducted in these studies. Methods: PubMed, PsycInfo, and Medline were searched for behavioral weight loss intervention trials conducted in 2009-2015 using keywords: weight, loss, overweight, obese, intervention and trial. Results: The majority of the 87 studies reviewed included a majority White sample. Across the included studies, 61% of participants were White, 18% were Black/African American, 9% were Latino/Hispanic, 2% were Asian and 1% were American Indians. An additional 7.8% were categorized as “other”. Nine of the 87 studies enrolled exclusively minority samples. More than half (59.8%) of the studies did not report an intention, approach or specific site/location to recruit a sample that was racially or ethnically diverse. Of the 54 studies that included more than one racial/ethnic group, 8 included sub-group analyses of weight loss outcomes by race/ethnicity. Conclusions: Lack of adequate representation of racial and ethnic minority populations in behavioral trials limits the generalizability and potential public health impact of these interventions. Given persistent racial/ethnic disparities in obesity in the U.S., the high morbidity, mortality, and economic costs associated with obesity and obesity-related conditions among racial/ethnic minority groups, findings from this review emphasize the need to maximize representation of some underrepresented racial/ethnic groups in behavioral lifestyle weight loss trials.
  • Trajectories of Weight for Length Growth for Infants During the First Year of Life

    Lopez-Cepero, Andrea; Nobel, Lisa; Moore Simas, Tiffany A.; Rosal, Milagros C. (2017-03-29)
    Background: Childhood obesity is a major public health problem. Studies of patterns of child growth contributing to the development of obesity are scarce, particularly in infancy. Group based trajectory analyses among infants are a novel procedure that may help characterize subgroups of infants with similar longitudinal growth profiles. Objective: To identify trajectories of weight for length growth during the first year of life. Methods: Subjects were singleton infants and their mothers (N=90 mother-infant pairs) who participated in the Pregnancy and Postpartum Observational Dietary Study. Women completed assessments throughout their infant's first year of life and included sociodemographic characteristics and feeding behaviors. Infant weight for length measures from birth to 12 months were abstracted from pediatric office records. Weight for length percentiles were calculated according to the World Health Organization guidelines for infants. Group-based trajectory analysis was done to identify subgroups of infants with similar growth profiles. Results: Infants were from mother’s with average of 28 years (SD=5.2), 70.0% White, 60.0% high-school educated and 63.2% had two or more children. Over half of mothers introduced solid foods to their infants by 6 months of age (63.2%) and about one third self-reported breast feeding at 12 months post-partum (31.9%). Three growth trajectories were identified: a low and stable growth group (38.3%), a rapid growth group (35.0%) and a moderate growth group (26.7%). Maternal and feeding variables were all similar across the three infant growth trajectory groups (p>0.05). Conclusion: Trajectory models suggested three patterns of infant growth. If replicated, future studies can help identify and subsequently target modifiable risk factors associated with rapid infant growth trajectories.
  • Association of dysfunctional eating with metabolic risk factors for cardiovascular disease in Latinos

    Lopez-Cepero, Andrea; Frisard, Christine F.; Lemon, Stephenie C.; Rosal, Milagros C. (2016-04-02)
    Background: Latinos bear high burden of nutrition related cardiovascular disease (CVD) risk factors. Dysfunctional eating behaviors (emotional eating, uncontrolled eating and cognitive restraint of eating) may influence metabolic CVD risk factors but little is known about this relationship in Latinos. Objective: To examine associations between dysfunctional eating behaviors and metabolic risk factors for CVD in Latinos. Methods: Latino individuals were recruited from a community health center. Participants completed standardized interviews (i.e., demographics, Three Factor Eating Questionnaire-TFEQ-R18V2, Perceived Stress Scale-10) and anthropometric measurements. Data on diagnosis of type 2 diabetes, hypertension and hyperlipidemia were abstracted from medical records. Statistical analysis included multivariable logistic and Poisson regression models. Results: A total of 578 participants (51% female, 67% Dominican), ages 21-84, were included in this analysis. Controlling for age, sex, education and perceived stress high emotional eating (hEE) was associated with greater odds of obesity (OR=2.25 (1.47, 3.24)) and diabetes (OR=1.80 (1.07, 3.01)). High uncontrolled eating (hUE) was associated with obesity (OR=2.16 (1.34, 3.47)) and high cognitive restraint (hCR) was associated with greater odds of obesity (OR=2.55 (1.64, 3.98)), diabetes (OR=2.39 (1.40, 4.04) and hyperlipidemia (OR=1.92 (1.17, 3.14)). Lastly, hEE, hUE and hCR were significantly associated increased odds of having a greater number of the metabolic CVD risk factors (IRR=1.39 (1.20, 1.59), IRR=1.21 (1.04, 1.42), IRR=1.45 (1.24, 1.69); respectively). Conclusion: Interventions that target eating behaviors may facilitate reduction of metabolic CVD risk factors and health disparities in CVD among Latinos.