Honors & Awards


  • NIH Research Supplement to Promote Diversity in Health-Related Research, National Institute of Environmental Health Sciences (2020-2022)

Boards, Advisory Committees, Professional Organizations


  • Member, American Society for Nutrition (2018 - Present)
  • Member, Society for Epidemiologic Research (2020 - Present)
  • Postdoctoral member, Society for the Advancement of Chicanos/Hispanics and Native Americans in Science (2021 - Present)

Professional Education


  • Doctor of Philosophy, University of Michigan Ann Arbor (2022)
  • Master of Public Health, University of California Berkeley (2018)
  • Bachelor of Science, University of California Davis (2014)

Stanford Advisors


All Publications


  • Trimester two gestational exposure to bisphenol A and adherence to Mediterranean diet are associated with adolescent offspring oxidative stress and metabolic syndrome risk in a sex-specific manner FRONTIERS IN NUTRITION Zamora, A. N., Marchlewich, E., Téllez-Rojo, M. M., Burant, C. F., Cantoral, A., Song, P. X., Mercado, A., Dolinoy, D. C., Peterson, K. E. 2022: 961082

    Abstract

    Exposure to prenatal bisphenol A (BPA) and Mediterranean Diet Score (MDS) has been linked to metabolic risk in child offspring. It remains unclear if independent and interactive effects persist in adolescence.We examined prenatal BPA and MDS on adolescent offspring metabolic syndrome risk score (MRS) and 8-isoprostane (8-iso), a biomarker of oxidative stress. Data from maternal-adolescent dyads from a Mexico City cohort were utilized, including trimester-specific prenatal BPA from spot urine and MDS from food frequency questionnaires. Offspring socio-demographic data and biomarkers to estimate MRS and 8-iso were obtained during peri-adolescence.Adjusted linear regression models examined associations between trimester-specific BPA, MDS, and BPA*MDS on outcomes. Sex-stratified analyses revealed a significant association between MDS with increased 8-iso (β = 0.064, p < 0.05), and a marginal association between trimester two BPA with increased 8-iso (β = 0.237), while MDS modified the marginal association between BPA and 8-iso in females (β = 0.046). A negative, marginal association was observed between trimester two BPA and MRS (β = - 0.728), while BPA * MDS was marginally, positively associated with MRS (β = 0.152) in males.Study findings indicate that trimester two prenatal BPA and maternal adherence to a Mediterranean diet may have sexually dimorphic effects on adolescent offspring oxidative stress and metabolic syndrome risk.

    View details for DOI 10.3389/fnut.2022.961082

    View details for PubMedCentralID PMC9579372

  • Third-Trimester Maternal Dietary Patterns Are Associated with Sleep Health among Adolescent Offspring in a Mexico City Cohort JOURNAL OF NUTRITION Zamora, A. N., Peterson, K. E., Tellez-Rojo, M. M., Cantoral, A., Song, P. K., Mercado-Garcia, A., Solano-Gonzalez, M., Fossee, E., Jansen, E. C. 2022; 152 (6): 1487-1495

    Abstract

    Maternal diet during gestation has been linked to infant sleep; whether associations persist through adolescence is unknown.We explored associations between trimester-specific maternal diet patterns and measures of sleep health among adolescent offspring in a Mexico City birth cohort.Data from 310 mother-adolescent dyads were analyzed. Maternal diet patterns were identified by principal component analysis derived from FFQs collected during each trimester of pregnancy. Sleep duration, midpoint, and fragmentation were obtained from 7-d actigraphy data when adolescents were between 12 and 20 y old. Unstratified and sex-stratified association analyses were conducted using linear regression models, adjusted for potential confounders.Mean ± SD age of offspring was 15.1 ± 1.9 y, and 52.3% of the sample was female. Three diet patterns were identified during each trimester of pregnancy: the Prudent Diet (PD), high in lean proteins and vegetables; the Transitioning Mexican Diet (TMD), high in westernized foods; and the High Meat & Fat Diet (HMFD), high in meats and fat products. Mean ± SD sleep duration was 8.5 ± 1.5 h/night. Most associations were found in the third trimester. Specifically, PD maternal adherence was associated with shorter sleep duration among offspring (-0.57 h; 95% CI: -0.98, -0.16 h, in the highest tertile compared with the lowest) and earlier sleep midpoint among females (-0.77 h; 95% CI: -1.3, -0.26 h). Adherence to the HMFD and TMD was nonlinearly associated with less fragmented sleep, with the latter only evident among females.Findings indicate that maternal dietary patterns, especially during the third trimester of pregnancy, may have long-term impacts on offspring sleep.

    View details for DOI 10.1093/jn/nxac045

    View details for Web of Science ID 000773266500001

    View details for PubMedID 35218195

    View details for PubMedCentralID PMC9178955

  • Association between pesticide exposure and sleep health among a representative sample of US adults: evidence from NHANES 2009-2014 BMC PUBLIC HEALTH Zamora, A. N., Watkins, D. J., Peterson, K. E., Jansen, E. C. 2021; 21 (1): 2199

    Abstract

    Data suggest that pesticides interact with the melatonin receptor, which may influence sleep. However, the link between pesticides and sleep remains unexplored among the general adult population. This study evaluated unstratified and sex-stratified associations between urinary pesticide exposure (N = 4,478) and self-reported acute household pesticide exposure (N = 14,956), with sleep health outcomes within a nationally representative sample of US adults.Data from the National Health and Nutrition Examination Surveys (NHANES) 2009-2014 were combined for analysis of aim 1 and aim 2. Urinary pesticide metabolite concentrations served as biomarkers of pesticide exposure. Acute household pesticide exposure (if any chemical products were used in the home in the past seven days to control pests) was self-reported (yes/no). Insufficient sleep duration (< 7 h/night) and trouble sleeping (yes/no) were self-reported. Log-binomial regression models that accounted for complex survey weights and adjusted for confounders were used to compute prevalence ratios and 95% CI.Log urinary 3-phenoxybenzoic acid (3-PBA) was related to a higher probability of insufficient sleep [1.09 (95% CI: 1.00, 1.20), p = 0.04] and trouble sleeping [1.14 (95% CI: 1.02, 1.27), p = 0.02] among males. Self-reported acute household pesticide exposure was associated with a higher probability of insufficient sleep duration [1.16 (95% CI: 1.02, 1.32), p = 0.03] and trouble sleeping [1.20 (95% CI: 1.01, 1.44), p = 0.04] in the unstratified sample. Sex-stratified findings showed that associations between acute household pesticide exposure and trouble sleeping only persisted  among males [1.69 (95% CI: 1.27, 2.24), p < .001].In summary, acute pesticide exposure may be detrimental to adult sleep health, particularly among US males.

    View details for DOI 10.1186/s12889-021-12014-x

    View details for Web of Science ID 000724759500002

    View details for PubMedID 34852798

    View details for PubMedCentralID PMC8638511

  • Prenatal maternal pesticide exposure in relation to sleep health of offspring during adolescence ENVIRONMENTAL RESEARCH Zamora, A. N., Watkins, D. J., Peterson, K. E., Tellez-Rojo, M. M., Hu, H., Meeker, J. D., Cantoral, A., Mercado-Garcia, A., Jansen, E. C. 2022; 204: 111977

    Abstract

    The neurobiological processes involved in establishing sleep regulation are vulnerable to environmental exposures as early as seven weeks of gestation. Studies have linked in utero pesticide exposure to childhood sleep-disordered breathing. However, the impact of in utero pesticide exposure on the sleep health of adolescents remains unexplored.Data from 137 mother-adolescent pairs from a Mexico City cohort were analyzed. We used maternal urinary 3-phenoxybenzoic acid (3-PBA, pyrethroid metabolite) and 3, 5, 6-trichloro-2-pyridinol (TCPy, chlorpyrifos metabolite) from trimester three to estimate in utero pesticide exposure. Among adolescents, we obtained repeated measures of objectively assessed sleep duration, midpoint, and fragmentation using wrist-actigraphy devices for 7 consecutive days in 2015 and 2017. Unstratified and sex-stratified associations between maternal urinary 3-PBA and TCPy and adolescent sleep measures were examined using generalized linear mixed models (GLMMs). We also examined the interactive effects of maternal pesticide exposure and offspring sex on sleep outcomes.3-PBA and TCPy were detected in 44.4% and 93% of urine samples, respectively. Adjusted findings demonstrated that higher exposure to maternal TCPy was associated with longer sleep duration and later sleep timing. Findings from interaction tests between maternal pesticide exposure and offspring sex were not statistically significant, although adjusted sex-stratified findings showed that the association between TCPy with duration and midpoint was evident only among female offspring. To illustrate, those in the highest tertile of exposure had a 59 minute (95% CI: 12.2, 104.8) (p, trend = 0.004) longer sleep duration and a 0.6 hour (95% CI: 0.01, 1.3) (p, trend = 0.01) later sleep midpoint. We found no significant associations between 3-PBA and sleep outcomes.Within a cohort of mother-adolescent pairs, we found associations between maternal prenatal pesticide exposure and longer sleep duration and later sleep timing among adolescent offspring. Further, this association may be female-specific.

    View details for DOI 10.1016/j.envres.2021.111977

    View details for Web of Science ID 000704696700006

    View details for PubMedID 34469742

    View details for PubMedCentralID PMC8639673

  • Sleep Difficulties among Mexican Adolescents: Subjective and Objective Assessments of Sleep BEHAVIORAL SLEEP MEDICINE Zamora, A. N., Arboleda-Merino, L., Tellez-Rojo, M., O'Brien, L. M., Torres-Olascoaga, L. A., Peterson, K. E., Banker, M., Fossee, E., Song, P. X., Taylor, K., Cantoral, A., Roberts, E. S., Jansen, E. C. 2022; 20 (2): 269-289

    Abstract

    Self-reported sleep difficulties, such as insomnia symptoms, have been reported among adolescents. Yet, studies of their prevalence and correlates are scarce among Latin Americans. This study sought (1) to describe associations between sociodemographic and lifestyle factors with self-reported sleep difficulties and (2) to examine associations between self-reported sleep difficulties and actigraphy-based sleep.Participants included 477 Mexican adolescents from the ELEMENT cohort.Over 7 days, self-reported sleep measures (hard time falling asleep, overall sleep difficulties, and specific types of sleep difficulties) were obtained from daily sleep diaries. Actigraphy-based sleep measures (duration, i.e. sleep onset to morning wake, midpoint, and fragmentation) were concurrently assessed using a wrist actigraph.Mean (SD) age was 15.9 (2.2) years, and 53.5% were females. Mean (SD) sleep duration was 8.5 (1.2) h/night. Half reported a hard time falling asleep at least 3 days, and 25% had sleep difficulties at least 3 days over 7 days. The 3 types of sleep difficulties commonly reported among the entire cohort were insomnia/restlessness (29%), environmental (27%), and mental/emotional difficulties (19%). Female sex, smoking behavior, and socioeconomic indicators were among the most consistent factors associated with sleep difficulties. Subjective sleep difficulties were associated with shorter sleep duration (β = -20.8 [-35.3, -6.2] min), while subjective hard time falling asleep was associated with longer sleep duration (β = 11.3 [4.6, 27.2] min).A high proportion of Mexican adolescents in the sample reported sleep difficulties. Findings demonstrate the importance of obtaining subjective and objective sleep measures for a more comprehensive assessment of adolescent sleep.

    View details for DOI 10.1080/15402002.2021.1916497

    View details for Web of Science ID 000650548800001

    View details for PubMedID 33983860

    View details for PubMedCentralID PMC8589870

  • Exposure to Phenols, Phthalates, and Parabens and Development of Metabolic Syndrome Among Mexican Women in Midlife FRONTIERS IN PUBLIC HEALTH Zamora, A. N., Jansen, E. C., Tamayo-Ortiz, M., Goodrich, J. M., Sanchez, B. N., Watkins, D. J., Tamayo-Orozco, J., Tellez-Rojo, M. M., Mercado-Garcia, A., Baylin, A., Meeker, J. D., Peterson, K. E. 2021; 9: 620769

    Abstract

    Background: Evidence suggests exposure to endocrine-disrupting chemicals (EDCs) can influence Metabolic Syndrome (MetS) risk in adults, but it is unclear if EDCs impact women during midlife. We examined if EDCs measured in adult women were predictive of MetS and its components 9 years later. Methods: We measured urinary phthalate metabolites, phenols, and parabens collected in 2008 among 73 females from the ELEMENT study. MetS and its components (Abdominal Obesity, Hypertriglyceridemia, Cholesterolemia, Hypertension, and Hyperglycemia) were assessed in 2017. We regressed log-transformed EDC concentrations on MetS and MetS components using logistic regression, adjusting for age and physical activity. Results: At follow-up, the mean (SD) age was 46.6 (6.3) years; the prevalence of MetS was 34.3%. Sum of dibutyl phthalate metabolites (ΣDBP), monobenzyl phthalate (MBzP), and monoethyl phthalate (MEP) were associated with an increased odds of hypertriglyceridemia. 2,5-dichlorophenol (2,5 DCP) and 2,4-dichlorophenol (2,4 DCP) were associated with increased odds of hypertriglyceridemia. The odds of hypertension were 4.18 (95% CI: 0.98, 17.7, p < 0.10) and 3.77 (95% CI: 0.76, 18.62, p < 0.10) times higher for every IQR increase in MCOP and propyl paraben, respectively. The odds of hyperglycemia were 0.46 (95% CI: 0.18, 1.17 p < 0.10) times lower for every IQR increase in the sum of di-2-ethylhexyl phthalate metabolites (ΣDEHP), and the odds of abdominal obesity were 0.70 (95% CI: 0.40, 1.21, p < 0.10) lower for every IQR increase in the concentration of triclosan. Conclusion: We found EDCs measured in 2008 were marginally predictive of hypertriglyceridemia and hypertension 9 years later. Results suggest that lower exposure to certain toxicants was related to lower markers of metabolic risk among midlife women.

    View details for DOI 10.3389/fpubh.2021.620769

    View details for Web of Science ID 000627761900001

    View details for PubMedID 33718320

    View details for PubMedCentralID PMC7952420

  • Parental Hopes and Understandings of the Value of Prenatal Diagnostic Genomic Sequencing: A Qualitative Analysis FRONTIERS IN GENETICS Outram, S. M., Brown, J. H., Zamora, A. N., Sahin-Hodoglugil, N., Ackerman, S. L. 2022; 13: 883225

    Abstract

    Objective: To provide qualitative empirical data on parental expectations of diagnostic prenatal genomic sequencing and the value of the results to families. Methods: We interviewed 15 families-mothers and/or fathers-who had had prenatal genomic sequencing about their expectations and their respective evaluations of the benefits of genomic sequencing. Results: Families' hopes for genetic sequencing clustered around three themes: hoping to identify the cause of the fetal anomaly in a terminated pregnancy; hopes for guidance as to the likely outcome of current pregnancy; and hopes for information to support future family planning. In addition, hopes were discussed in terms of the potential for results to be beneficial in acquiring greater knowledge, while at the same time recognizing that new knowledge may raise more questions. Assessment of the value of sequencing largely mirrored these expectations when positive results seen. Negative results can also be seen as valuable in ruling out a genetic cause and in providing certainty that families had done everything that they could to know about the cause of fetal demise. Conclusion: It would appear that with guidance from genetic counsellors, families were largely able to navigate the many uncertainties of prenatal genomic sequencing and thus see themselves as benefitting from sequencing. However, support structures are essential to guide them through their expectations and interpretations of results to minimize possible harms. Engaging in the process of genomic sequencing was seen as beneficial in of itself to families who would otherwise be left without any options to seek diagnostic answers.

    View details for DOI 10.3389/fgene.2022.883225

    View details for Web of Science ID 000835215200001

    View details for PubMedID 35923691

    View details for PubMedCentralID PMC9339950

  • Perspectives and preferences regarding genomic secondary findings in underrepresented prenatal and pediatric populations: A mixed-methods approach GENETICS IN MEDICINE Rego, S., Hoban, H., Outram, S., Zamora, A. N., Chen, F., Sahin-Hodoglugil, N., Anguiano, B., Norstad, M., Yip, T., Lianoglou, B., Sparks, T. N., Norton, M. E., Koenig, B. A., Slavotinek, A. M., Ackerman, S. L. 2022; 24 (6): 1206-1216

    Abstract

    Patients undergoing clinical exome sequencing (ES) are routinely offered the option to receive secondary findings (SF). However, little is known about the views of individuals from underrepresented minority pediatric or prenatal populations regarding SF.We explored the preferences for receiving hypothetical categories of SF (H-SF) and reasons for accepting or declining actual SF through surveying (n = 149) and/or interviewing (n = 47) 190 families undergoing pediatric or prenatal ES.Underrepresented minorities made up 75% of the probands. In total, 150 families (79%) accepted SF as part of their child/fetus's ES. Most families (63%) wanted all categories of H-SF. Those who declined SF as part of ES were less likely to want H-SF across all categories. Interview findings indicate that some families did not recall their SF decision. Preparing for the future was a major motivator for accepting SF, and concerns about privacy, discrimination, and psychological effect drove decliners.A notable subset of families (37%) did not want at least 1 category of H-SF, suggesting more hesitancy about receiving all available results than previously reported. The lack of recollection of SF decisions suggests a need for alternative communication approaches. Results highlight the importance of the inclusion of diverse populations in genomic research.

    View details for DOI 10.1016/j.gim.2022.02.004

    View details for Web of Science ID 000806512700005

    View details for PubMedID 35396980

  • "Let's Just Wait Until She's Born": Temporal Factors That Shape Decision-Making for Prenatal Genomic Sequencing Amongst Families Underrepresented in Genomic Research FRONTIERS IN GENETICS Brown, J. H., Zamora, A. N., Outram, S., Sparks, T. N., Lianoglou, B. R., Norstad, M., Sahin Hodoglugil, N. N., Norton, M. E., Ackerman, S. L. 2022; 13: 882703

    Abstract

    Genomic sequencing has been increasingly utilized for prenatal diagnosis in recent years and this trend is likely to continue. However, decision-making for parents in the prenatal period is particularly fraught, and prenatal sequencing would significantly expand the complexity of managing health risk information, reproductive options, and healthcare access. This qualitative study investigates decision-making processes amongst parents who enrolled or declined to enroll in the prenatal arm of the California-based Program in Prenatal and Pediatric Genome Sequencing (P3EGS), a study in the Clinical Sequencing Evidence-Generating Research (CSER) consortium that offered whole exome sequencing for fetal anomalies with a focus on underrepresented groups in genomic research. Drawing on the views of 18 prenatal families who agreed to be interviewed after enrolling (n = 15) or declining to enroll (n = 3) in P3EGS, we observed that the timing of sequencing, coupled with unique considerations around experiences of time during pregnancy and prenatal testing, intersect with structural supports beyond the clinic to produce preferences for and against prenatal sequencing and to contain the threat of unwelcome, uncertain knowledge. Particularly for those without structural supports, finding out consequential information may be more palatable after the birth, when the first stage of the uncertain future has been revealed. Future research should examine the role of temporality in decision-making around prenatal genomic sequencing across diverse population cohorts, in order to observe more precisely the role that structural barriers play in patient preferences.

    View details for DOI 10.3389/fgene.2022.882703

    View details for Web of Science ID 000806608700001

    View details for PubMedID 35669190

    View details for PubMedCentralID PMC9164104

  • The difficulties of broad data sharing in genomic medicine: Empirical evidence from diverse participants in prenatal and pediatric clinical genomics research GENETICS IN MEDICINE Norstad, M., Outram, S., Brown, J. H., Zamora, A. N., Koenig, B. A., Risch, N., Norton, M. E., Slavotinek, A., Ackerman, S. L. 2022; 24 (2): 410-418

    Abstract

    This study aimed to understand broad data sharing decisions among predominantly underserved families participating in genomic research.Drawing on clinic observations, semistructured interviews, and survey data from prenatal and pediatric families enrolled in a genomic medicine study focused on historically underserved and underrepresented populations, this paper expands empirical evidence regarding genomic data sharing communication and decision-making.One-third of parents declined to share family data, and pediatric participants were significantly more likely to decline than prenatal participants. The pediatric population was significantly more socioeconomically disadvantaged and more likely to require interpreters. Opt-in was tied to altruism and participants' perception that data sharing was inherent to research participation. Opt-out was associated with privacy concerns and influenced by clinical staff's presentation of data handling procedures. The ability of participants to make informed choices during enrollment about data sharing was weakened by suboptimal circumstances, which was revealed by poor understanding of data sharing in follow-up interviews as well as discrepancies between expressed participant desires and official recorded choices.These empirical data suggest that the context within which informed consent process is conducted in clinical genomics may be inadequate for respecting participants' values and preferences and does not support informed decision-making processes.

    View details for DOI 10.1016/j.gim.2021.09.021

    View details for Web of Science ID 000797597400013

    View details for PubMedID 34906477

  • A Call for Competence in the Social Determinants of Health Within Dietetics Education and Training JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS Zamora, A. N., Anderson, O. S. 2022; 122 (2): 279-283

    View details for DOI 10.1016/j.j.2021.10.007

    View details for Web of Science ID 000768857600005

    View details for PubMedID 34628076

  • Impact of Transitioning to Remote Learning on Student Learning Interactions and Sense of Belonging Among Public Health Graduate Students Impact of Transitioning to Remote Learning on Student Learning Interactions and Sense of Belonging Among Public Health Graduate Students Zamora, A. N., August, E., Fossee, E., Anderson, O. S., et al 2022
  • Exploring the beliefs and perceptions of spending time in nature among US youth BMC PUBLIC HEALTH Zamora, A. N., Waselewski, M. E., Frank, A. J., Nawrocki, J. R., Hanson, A. R., Chang, T. 2021; 21 (1): 1586

    Abstract

    The prevalence of poor mental health continues to rise among youth; however, large-scale interventions to improve mental and physical health remain a public health challenge. Time spent in nature is associated with improved health among youth. This study aimed to assess youth experiences with nature and the self-perceived impact on their mental and physical health among a nationwide sample of US youth.In September 2020, five open-ended questions that aimed to assess perceptions regarding nature were posed to 1174 MyVoice youth, aged 14-24 years. Qualitative responses were analyzed using thematic analysis, and data were summarized using descriptive statistics.The mean (SD) age of the 994 respondents (RR = 84.7%) was 18.9 (2.7) years; 47.4% were female, and 57.4% Non-Hispanic White. Among youth, many felt that spending time in nature positively impacted their mental health, with 51.6% mentioning that it made them "feel calm when I am out in nature"; 22.1% said that it relieved stress or "reduces my anxiety," and 17.1% felt that being in nature positively impacted their physical health and "makes me feel more active and in shape." However, 7.0% said it negatively impacted their health, such as "It makes me feel isolated." Most youth (87.8%) want to spend more time in nature, with 22% mentioning barriers (i.e., busy schedules, built environment, and COVID-19) impeding them from doing so.Youth in our sample generally report feeling physically and mentally better when spending time in nature and want to spend more time in nature. Public health policies and practices that eliminate barriers and actively support time spent outside may be a feasible and acceptable practice to promote overall well-being among youth.

    View details for DOI 10.1186/s12889-021-11622-x

    View details for Web of Science ID 000687688900002

    View details for PubMedID 34425797

    View details for PubMedCentralID PMC8381719

  • Exposure to phthalates in relation to sleep duration and social jetlag among adolescent boys and girls in Mexico City International Society for Environmental Epidemiology (ISEE) Zamora, A. N., Peterson, K. E., Téllez Rojo, M. M., Meeker, J. D., Goodrich, J. M., Dolinoy, D. C., Song, P. X., Toress Olascoaga, L., Cantoral, A., Jansen, E. C. 2021

    View details for DOI 10.1093/cdn/nzab046_042

  • A Prospective Study of Prenatal Maternal Dietary Patterns and Offspring Adipokine Levels During Adolescence American Society for Nutrition Fossee, E., Zamora, A. N., Peterson, K. E., Cantoral, A., Perng, W., Téllez-Rojo, M. M., Jansen, E. C. 2021

    View details for DOI 10.1093/cdn/nzab046_04