The Prevention Research Center at UMass Chan Medical School (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 prevent disease, promote health and advance health equity through the integration of community engaged research, practice, policy and education. With a focus on integrating our work into the Greater Worcester’s collaborative public health system, we also seek to be a research partner that addresses real-world challenges across Massachusetts, and a national model for research that connects academia, public health, community and health care systems. This site is a repository of posters and presentations produced by PRC faculty, staff, students and community partners.


Contact escholarship@umassmed.edu with your questions.

Recently Published

  • Barriers and Facilitators to the Implementation of Adolescent Cancer Prevention Interventions in Rural Primary Care Settings: A Scoping Review

    Ryan, Grace W; Whitmire, Paula; Batten, Annabelle J.; Goulding, Melissa; Baltich Nelson, Becky; Lemon, Stephenie C.; Pbert, Lori (2023-03-13)
    Purpose: We conducted a scoping review of studies to examine the implementation of interventions to promote adolescent cancer prevention in rural, primary care settings and identify barriers and facilitators. Methods: We followed the JBI scoping review protocol and used a systematic extraction and coding process. Our search of MEDLINE, PsycInfo, Cochrane, CINAHL, and Scopus identified articles related to implementation of interventions in the following areas: obesity, human papillomavirus (HPV) vaccination, tobacco use, and sun exposure. We used the Consolidated Framework for Implementation Research (CFIR), an implementation framework consisting of 5 domains (outer setting, inner setting, intervention characteristics, individual characteristics, process), each with a sub-set of constructs, to classify barriers and facilitators reported. Results: We identified 3046 references, excluded 2969 during initial screening, assessed 74 for full-text eligibility, and abstracted 24. Of these, 17 addressed obesity, 6 addressed HPV vaccination, 1 addressed skin cancer, and 1 addressed multiple behaviors. 10 studies were either non-randomized experimental designs (n=8) or randomized controlled trials (n=2). The remaining were observational or descriptive research. Barriers in the outer setting (e.g., lack of external funding sources, patients' beliefs) and inner setting (e.g., time available for implementation efforts and clinic infrastructure) were most common, compared to the other CFIR domains. Similarly, facilitators in the outer setting (e.g., partnerships with other organizations and parents' trust in health care providers) and inner setting (e.g., efficiency in practice protocols) were commonly reported. Conclusions: Adolescence is a critical growth window to establish healthy behaviors to prevent future cancers. Rural areas have higher rates of cancer morbidity and mortality than urban ones, putting rural adolescents at heightened risk for cancers. Yet, we found a dearth of studies addressing the implementation of adolescent cancer prevention in rural primary care settings. Further research is needed to understand the implementation challenges and potential strategies to improve implementation efforts to promote cancer prevention among rural adolescents.
  • Extent and Equity of the Implementation of Clinical Practice Guidelines for Pediatric Blood Pressure Screening in a Massachusetts Safety-net Health Care System

    Goulding, Melissa; Frisard, Christine F.; Person, Sharina D.; Goldberg, Robert J.; Garg, Arvin; Lemon, Stephenie C. (2022-12-13)
    Background: The American Academy of Pediatrics 2017 clinical practice guidelines (CPG) call for regular blood pressure (BP) screening in children ≥3 years. However, it is unknown to what extent the BP screening CPG has been implemented or if such implementation has been equitable. Methods: Cross-sectional data from January 1-December 31, 2018 were extracted from electronic health records from the largest health care system in Central Massachusetts. Outpatient visits for children aged 3-to-17-years without a prior hypertension diagnosis were included. Adherence was defined by the BP screening CPG recommending ≥1 BP screening per year for children of a healthy body mass index ((BMI) <85%) and at every encounter for children who are overweight (BMI ≥85%). Independent variables included social determinant of health indicators at the child-level (insurance, language, child opportunity index) and clinic-level (urban/rural, Medicaid population). Covariates included child’s age, gender, race/ethnicity, and BMI, as well as clinic’s specialty (pediatrics/family medicine), patient panel size, and number of providers. We used direct estimation to calculate prevalence estimates and multivariable mixed effects logistic regression to determine the odds of undergoing CPG adherent BP screening. Findings: We identified 44,947 visits for 19,787 children (median age 11 years) across 7 pediatric and 20 family medicine clinics in 2018. The prevalence of CPG adherent BP screening was 83%. In the multivariable adjusted model, children with private insurance (adjusted odds ratio (aOR) 1.22, 95% CI 1.09-1.35) and those seen in clinics with a lower Medicaid population (aOR 1.02, 95% CI 1.0-1.05 per 1% decrease) were more likely to undergo CPG adherent screening. CPG adherent screening was also more likely among older children, those with BMI <85%, those in family medicine clinics, and those in clinics with more providers. Implications for D&I Research: Despite overall high adherence to pediatric BP CPG indicating relatively successful implementation, our findings suggest that this implementation is not equitable. Adherence was lower for children who are more likely to be impoverished, have higher social needs, and benefit from preventive screenings (BMI ≥85%, publicly insured, and treated in Medicaid predominant clinics). Future implementation efforts should address structural factors, especially those related to insurance and pediatric practice to achieve more equitable implementation.
  • Electronic Health Record-Assisted Community Health Worker Coaching for Medication Adherence: Adaptation of an Evidence-Based Intervention

    Rosal, Milagros C.; Borg, Amy; Bertrand, Sarah; Plasencia, Nelly; Le, Thuha; Negron Cruz, Leopoldo; Frisard, Christine F.; Azaroff, Lenore; Ortiz, Evelyn; Blumhofer, Rebecca; et al. (2022-12-12)
    Background: Community health workers (CHWs) are often employed in healthcare settings to link patients with services and providers to improve the quality and cultural competence of healthcare service delivery, particularly among populations experiencing health inequities. However, limited data exist on strategies to best integrate CHWs into the patient’s clinical team to deliver evidence-based care. Electronic health records (EHRs) may facilitate this integration and support care delivery. The BP Control project uses the EHR to facilitate the delivery of an evidence-based antihypertensive medication adherence coaching intervention by CHWs while integrating CHWs into the clinical team. The methods and process used to adapt the coaching intervention for EHR-assisted delivery by CHWs are described. Methods: A team from two community health centers, each represented by a medical champion, operations champion, CHW, CHW supervisor and information technology staff, and a university-based practice facilitator, used a co-production methodology to adapt the EHR-assisted CHW-delivered coaching intervention. The practice facilitator led bi-monthly 90-minute meetings to discuss and identify strategies to leverage the EHR. The team identified key skills for the CHW to deliver the intervention and contributed to developing the CHW training curriculum. A smaller team of the CHWs, CHW supervisors and practice facilitator conducted Beta testing and made recommendations for improving functionality. EHR technical adaptations were implemented by an Information Technology consultant. Findings: Strategies for EHR-assisted CHW-delivered coaching and CHW clinical team integration included: 1) EHR prompts to deliver each step of the evidence-based coaching algorithm, 2) EHR fields to document session information and generate fidelity reports, 3) EHR algorithms to track patient progress/follow up, and 4) EHR prompts to facilitate referrals to CHWs and CHW-initiated messaging to referring providers. The CHW training curriculum included basic medical knowledge (hypertension, medications, adherence) and behavioral counseling (5As, motivational interviewing) skills and addressed comfort utilizing technology and logistical matters of implementing the intervention in a larger care system. This curriculum was implemented via didactic sessions, videos, and role-plays to build skills. Implications for D&I Research: Our co-production adaptation methodology leveraged EHR potential to improve the delivery of evidence-based interventions by CHWs to improve quality of patient care and address disparities in hypertension control.
  • The Impact of COVID-19 on the Behavioral Health of Massachusetts Tribal Communities

    Aronowitz, Teri; Woods, Cedric; Kim, BoRam; Frisard, Christine F.; Beatriz, Elizabeth; Cardoso, Lauren; Lin, Ta-Wei; Stack, Caroline; Lemon, Stephenie C. (2022-11-07)
    Background: American Indian/Alaskan Native (AI/AN) individuals were 3.5 times more likely to be hospitalized from the virus compared to other race/ethic groups (CDC, 2021). Despite being disproportionately impacted by COVID-19, the experiences of the AI/AN population during the pandemic have not been documented. There are approximately 93,123 individuals in Massachusetts (MA) that identify as AI/AN (U.S. Census, 2020). This study examined the impact of COVID-19 on the behavioral health of the MA AI/AN population. Methods: A web-based survey was completed by 452 AI/ANs. A focus group with members of the AN/AI/AN (n=10) community was conducted to provide insights into the survey results. Individuals were recruited through the Institute of New England Native American Studies research team’s Community Advisory Board. Results: Forty-two percent of sample were between 45-64 years of age, female (77.2%), and identified as AN/AN in combination with another race (85%). Almost half of AI/AN participants had 15 or more days of poor mental health in the past month with rates highest among younger individuals. Forty-four percent reported that their substance use was a lot or somewhat more than pre-pandemic. Focus group findings indicated that the pandemic exacerbated (1) behavioral health challenges; (2) isolation from others and from AI/AN organizations; (3) telehealth was helpful to some; but (4) 30% had limited broadband access. Conclusion & Implications: The AI/AN community in MA has experienced devastating behavioral health outcomes during the pandemic. Urgent action is needed to address with crisis. Funding for risk-reducing programs and culturally specific treatment interventions are needed.
  • Youth Empowerment Modeling in building COVID-19 Vaccine Confidence in Local Communities

    Minkah, Princilla; Borg, Amy; Ryan, Grace W; Goulding, Melissa; Perrone, Domenica; Castiel, Matilde; Rosal, Milagros C.; Lemon, Stephenie C. (2022-11-07)
    Background: Rates of COVID-19 vaccinations among youth remain sub-optimal, particularly among racial and ethnic minority populations. The Centers for Disease Control and Prevention-funded UMass Worcester Prevention Research Center partnered with the vaccination equity initiative of Worcester, Massachusetts and youth-serving organizations to develop, implement, and evaluate a youth led public health campaign to promote COVID-19 vaccine confidence and uptake. Methods: Guided by the youth empowerment model to promote behavior change by helping youth reflect, identify, and take action on what is meaningful to them, we created a youth vaccine ambassador public health campaign to promote COVID-19 vaccination. Ambassadors were guided through self-reflection of questions, answers and motivations for COVID-19 vaccination. Youth motivations and narratives became the campaign messaging. Youth collaborated to create and disseminate social media, video, and print content to display in local neighborhoods, using social norming approaches to foster youth and family vaccine confidence and vaccination. Results: We trained nine youth (aged 18- 22 years) as vaccine ambassadors. English/Spanish vaccine messages developed by youth ambassadors were disseminated through social media platforms (n=3), radio (n=2), local TV (n=2), flyers (n=2,086), posters (n=362), billboards (n=7), and local bus ads (n=18). Qualitative youth feedback indicated participation in the campaign was a positive and empowering experience which reinforces the importance of engaging youth in public health messaging. Discussion: Amplifying youth voices by engaging them to develop and share their personal vaccine stories and motivations facilitated youths’ role as public health messengers. Youth empowerment through storytelling and personal narratives holds promise for future public health campaigns.
  • Association between Optimism and Emotional Eating in US Latino adults

    López-Cepero, Andrea A; Frisard, Christine; Spruill, Tanya M.; Suglia, Shakira F; Lewis, Tené T; Lemon, Stephenie C.; Rosal, Milagros C. (2022-04-07)
    Background: Emotional eating (EE), a dysfunctional eating behavior characterized by eating due to negative emotions or adversity, is prevalent among Latinos in the United States (US) and has been shown to be associated with risk factors for cardiovascular disease in this population. Optimism has been consistently linked with favorable cardiovascular health and health behaviors, likely due to more adaptive coping to negative emotions and adversity. However, the association between optimism and EE has remained largely understudied, especially among US Latinos. Objective: To examine the association between optimism and EE in a sample of US Latinos. Methods: This cross-sectional analysis used data from the Latino Health and Well-being Study, a cohort of Latino men and women aged 21-84 years residing in the northeast US (analytic sample: n=587). Optimism was measured with the Life Orientation Test – Revised version (categorized in tertiles: low, moderate, and high). EE was measured with the Three-Factor Eating Questionnaire R18-V2 (categorized as no EE, low EE, and high EE). Adjusted Poisson models with robust error variance estimated prevalence ratios (PR) and 95% confidence intervals (CI). Results: Overall, 50.3% of the sample were female, 73.3% self-identified as Dominicans, and mean (SD) age was 46.6 ± 15.5 yr. In the total sample, high EE was reported by 34.2%, low EE in 26.9%, and no EE in 38.8%. The proportion of individuals reporting high EE was greater in the low (39.0%) and moderate (36.8%) optimism groups than that in the high optimism group (24.8%; p=0.011). In adjusted models, individuals with high optimism (vs. low) were 32% less likely to report high EE over no EE (PR=0.68; 95% CI=0.53-0.88). Moderate optimism was not significantly associated with high EE. Optimism was not associated with low EE. Conclusion: High levels of optimism were negatively associated with high EE in a sample of US Latinos. Longitudinal studies are needed to confirm our findings. Interventions and clinical programs promoting optimism may hold promise for preventing EE in US Latinos.
  • Association between food insecurity and CVD risk factors is moderated by intake of fruits and vegetables in Latinos

    López-Cepero, Andrea A; 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.
  • 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.
  • 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.
  • Do U.S. adults living in food insecure households experience poorer cardiovascular health?

    Sreedhara, Meera; López-Cepero, Andrea A; 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.; López-Cepero, Andrea A; 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

    López-Cepero, Andrea A; 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

    López-Cepero, Andrea A; 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.