Lisa Goldman Rosas, PhD MPH is an Assistant Professor in the Department of Epidemiology and Population Health and the Department of Medicine, Division of Primary Care and Population Health at Stanford School of Medicine. An epidemiologist by training, Dr. Goldman Rosas’ research focuses on addressing disparities in chronic diseases such as diabetes, heart disease, depression, and cancer among racial/ethnic minority families. This research features rigorous quantitative and qualitative methodologies, participatory qualitative approaches, and shared leadership with patient and community partners. She is passionate about integrating patients, caregivers, community organizations, and other key stakeholders in the research process in order to affect the greatest improvements in health and well-being. As a reflection of this passion, Dr. Goldman Rosas serves as the Faculty Director for the School of Medicine Office of Community Engagement and the Stanford Cancer Institute Community Outreach and Engagement Program. In these roles, she supports other faculty and patient and community partners to develop sustainable and meaningful partnerships to support transformative research. In addition to research, she teaches at the undergraduate and graduate levels and has a special focus on increasing diversity in biomedical research.

Academic Appointments

Administrative Appointments

  • Associate Director- Community Engagement, Center for Population Health Sciences (2018 - Present)
  • Faculty Director, Community Outreach and Engagement Program, Stanford Cancer Institute (2018 - Present)
  • Faculty Director, Office of Community Engagement, Stanford School of Medicine (2018 - Present)

Professional Education

  • PhD, University of California, Berkeley, Epidemiology (2008)
  • MPH, University of California, Berkeley, Maternal and Child Health (2002)
  • BS, University of Michigan, Environmental Science (1998)

Clinical Trials

  • Research Aimed at Improving Both Mood and Weight Recruiting

    The RAINBOW study is an NIH R01-funded randomized controlled trial to evaluate the clinical and cost effectiveness and implementation potential of a primary care integrated multicondition intervention program to help improve mood and weight for obese adults with clinically significant depressive symptoms. The ENGAGE study is a mechanistic investigation added to the main trial with funding through the NIH common fund for the Science of Behavior Change roadmap initiative. Beginning Jan 11, 2016, at least 100 of newly enrolled trial participants will be consented to undergo additional assays evaluating neurobiological mechanisms of self-regulation.

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  • The RESTING Insomnia Study: Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy Recruiting

    This project aims to compare the effectiveness and implementation potential of two primary care friendly approaches to delivering an effective non-pharmacological intervention - cognitive behavioral therapy - for insomnia to middle aged and older adults.

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  • Community Health Workers and Precision Medicine Not Recruiting

    The purpose of this randomized controlled trial is to evaluate whether a trained community health worker (CHW) who engages with newly diagnosed patients after a diagnosis of cancer can effectively improve knowledge and receipt of evidence-based precision medicine cancer care services among low-income and minority patients.

    Stanford is currently not accepting patients for this trial. For more information, please contact Manali I Patel, MD, MPH, MS, 650-498-6000.

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2020-21 Courses

Stanford Advisees

All Publications

  • Measurement challenges for childhood obesity research within and between Latin America and the United States. Obesity reviews : an official journal of the International Association for the Study of Obesity Berrigan, D., Arteaga, S. S., Colon-Ramos, U., Rosas, L. G., Monge-Rojas, R., O'Connor, T. M., Perez-Escamilla, R., Roberts, E. F., Sanchez, B., Tellez-Rojo, M. M., Vorkoper, S., Cross Borders Working Group 2021: e13242


    Childhood obesity is a major public health challenge across Latin America and the United States. Addressing childhood obesity depends on valid, reliable, and culturally sensitive measurements. Such progress within and between countries of the Americas could be enhanced through better measurement across different age groups, different countries, and in sending and receiving communities. Additionally, better and more comparable measurements could accelerate cross-border collaboration and learning. Here, we present (1) frameworks that influenced our perspectives on childhood obesity and measurement needs across the Americas; (2) a summary of resources and guidance available concerning measurement and adaptation of measures for childhood obesity research; and (3) three major areas that present challenges and opportunities for measurement advances related to childhood obesity, including parental behavior, acculturation, and the potential to incorporate ethnographic methods to identify critical factors related to economics and globalization. Progress to reduce childhood obesity across the Americas could be accelerated by further transnational collaboration aimed at improving measurement for better surveillance, intervention development and evaluation, implementation research, and evaluation of natural experiments. Additionally, there is a need to improve training related to measurement and for improving access to valid and reliable measures in Spanish and other languages common in the Americas.

    View details for DOI 10.1111/obr.13242

    View details for PubMedID 33942975

  • Use of Korean dramas to facilitate precision mental health understanding and discussion for Asian Americans. Health promotion international Ta Park, V. M., Park, C. J., Kim, C., Nguyen, N. C., Tran, A. T., Chiang, A., Rho, S. J., Olaisen, R. H., Vuong, Q., Rosas, L. G., Cho, M. K. 2021


    Precision mental health holds great potential for revolutionizing care and reducing the burden of mental illness. All races and ethnicities such as Asian Americans, the fastest growing racial group in the United States (U.S.), need to be engaged in precision mental health research. Owing to its global popularity, Korean drama ('K-drama') television shows may be an effective educational tool to increase precision mental health knowledge, attitudes and behaviors among Asian Americans. This qualitative study examined the participants' perspectives about and acceptance of using K-dramas to educate and engage Asian Americans about precision mental health. Twelve workshops were conducted in English, Vietnamese and Korean with a convenience sample in the San Francisco Bay Area in the U.S. (n=122). Discussions were coded for themes. Findings revealed that all language groups reported positive reactions to using K-dramas to learn about precision health, genetics and mental health. Overall, participants shared that they learned about topics that are not generally talked about (e.g. precision health; genetic testing; mental health), from other people's perspectives, and the importance of mental health. Participants expressed how much they enjoyed the workshop, how they felt relieved due to the workshop, thought the workshop was interesting, and had an opportunity for self-reflection/healing. This pilot test demonstrated that K-dramas has promise to be used as a health educational tool in a workshop format focused on mental health among a diverse group of Asian Americans. Given the widespread access to K-dramas, they present a scalable opportunity for increasing awareness about specific health topics.

    View details for DOI 10.1093/heapro/daab012

    View details for PubMedID 33582752

  • Weight loss effects in usual primary care: Findings from 5 behavioral weight loss RCTs. Obesity research & clinical practice Ronneberg, C. R., Lv, N., Xiao, L., Rosas, L. G., Shrestha, R., Dosala, S., Eckley, T., Wittels, N., Ma, J. 2021


    Primary care is an important setting for obesity treatment and behavior therapy is considered the first line. However, current practice often does not meet clinical guidelines and, furthermore, effects of usual care (UC) on weight loss are unclear. This makes it difficult to design sufficiently powered weight loss trials in primary care. This study analyzed data from UC control participants across 5 primary care-based randomized clinical trials of behavioral weight loss interventions to assess UC effects for 4 weight outcomes: body mass index (BMI), weight change (kg and %), and percent of participants achieving clinically significant 5% weight loss. Results indicated modest UC effects, suggesting modest weight loss is possible in usual primary care.

    View details for DOI 10.1016/j.orcp.2021.02.001

    View details for PubMedID 33589391

  • Implementation outcomes of Humanwide: integrated precision health in team-based family practice primary care. BMC family practice Brown-Johnson, C. G., Safaeinili, N., Baratta, J., Palaniappan, L., Mahoney, M., Rosas, L. G., Winget, M. 2021; 22 (1): 28


    BACKGROUND: Humanwide was precision health embedded in primary care aiming to leverage high-tech and high-touch medicine to promote wellness, predict and prevent illness, and tailor treatment to individual medical and psychosocial needs.METHODS: We conducted a study assessing implementation outcomes to inform spread and scale, using mixed methods of semi-structured interviews with diverse stakeholders and chart reviews. Humanwide included: 1) health coaching; 2) four digital health tools for blood-pressure, weight, glucose, and activity; 3) pharmacogenomic testing; and 4) genetic screening/testing. We examined implementation science constructs: reach/penetration, acceptability, feasibility, and sustainability. Chart reviews captured preliminary clinical outcomes.RESULTS: Fifty of 69 patients (72%) invited by primary care providers participated in the Humanwide pilot. We performed chart reviews for the 50 participating patients. Participants were diverse overall (50% non-white, 66% female). Over half of the participants were obese and 58% had one or more major cardiovascular risk factor: dyslipidemia, hypertension, diabetes. Reach/penetration of Humanwide components varied: pharmacogenomics testing 94%, health coaching 80%, genetic testing 72%, and digital health 64%. Interview participants (n=27) included patients (n=16), providers (n=9), and the 2 staff who were allocated dedicated time for Humanwide patient intake and orientation. Patients and providers reported Humanwide was acceptable; it engaged patients holistically, supported faster medication titration, and strengthened patient-provider relationships. All patients benefited clinically from at least one Humanwide component. Feasibility challenges included: low provider self-efficacy for interpreting genetics and pharmacogenomics; difficulties with data integration; patient technology challenges; and additional staffing needs. Patient financial burden concerns surfaced with respect to sustainability.CONCLUSION: This is the first report of implementation of a multi-component precision health model embedded in team-based primary care. We found acceptance from both patients and providers; however, feasibility barriers must be overcome to enable broad spread and sustainability. We found that barriers to implementation of precision health in a team-based primary care clinic are mundane and straightforward, though not necessarily easy to overcome. Future implementation endeavors should invest in basics: education, workflow, and reflection/evaluation. Strengthening fundamentals will enable healthcare systems to more nimbly accept the responsibility of meeting patients at the crossroads of innovative science and routinized clinical systems.

    View details for DOI 10.1186/s12875-021-01373-4

    View details for PubMedID 33530939

  • Community-Based Approaches to Reducing Health Inequities and Fostering Environmental Justice through Global Youth-Engaged Citizen Science. International journal of environmental research and public health King, A. C., Odunitan-Wayas, F. A., Chaudhury, M., Rubio, M. A., Baiocchi, M., Kolbe-Alexander, T., Montes, F., Banchoff, A., Sarmiento, O. L., Balter, K., Hinckson, E., Chastin, S., Lambert, E. V., Gonzalez, S. A., Guerra, A. M., Gelius, P., Zha, C., Sarabu, C., Kakar, P. A., Fernes, P., Rosas, L. G., Winter, S. J., McClain, E., Gardiner, P. A., On Behalf Of The Our Voice Global Citizen Science Research Network 2021; 18 (3)


    Growing socioeconomic and structural disparities within and between nations have created unprecedented health inequities that have been felt most keenly among the world's youth. While policy approaches can help to mitigate such inequities, they are often challenging to enact in under-resourced and marginalized communities. Community-engaged participatory action research provides an alternative or complementary means for addressing the physical and social environmental contexts that can impact health inequities. The purpose of this article is to describe the application of a particular form of technology-enabled participatory action research, called the Our Voice citizen science research model, with youth. An overview of 20 Our Voice studies occurring across five continents indicates that youth and young adults from varied backgrounds and with interests in diverse issues affecting their communities can participate successfully in multiple contributory research processes, including those representing the full scientific endeavor. These activities can, in turn, lead to changes in physical and social environments of relevance to health, wellbeing, and, at times, climate stabilization. The article ends with future directions for the advancement of this type of community-engaged citizen science among young people across the socioeconomic spectrum.

    View details for DOI 10.3390/ijerph18030892

    View details for PubMedID 33494135

  • Using RE-AIM to examine the potential public health impact of an integrated collaborative care intervention for weight and depression management in primary care: Results from the RAINBOW trial. PloS one Lewis, M. A., Wagner, L. K., Rosas, L. G., Lv, N., Venditti, E. M., Steinman, L. E., Weiner, B. J., Goldhaber-Fiebert, J. D., Snowden, M. B., Ma, J. 2021; 16 (3): e0248339


    BACKGROUND: An integrated collaborative care intervention was used to treat primary care patients with comorbid obesity and depression in a randomized clinical trial. To increase wider uptake and dissemination, information is needed on translational potential.METHODS: The trial collected longitudinal, qualitative data at baseline, 6 months (end of intensive treatment), 12 months (end of maintenance treatment), and 24 months (end of follow-up). Semi-structured interviews (n = 142) were conducted with 54 out of 409 randomly selected trial participants and 37 other stakeholders, such as recruitment staff, intervention staff, and clinicians. Using a Framework Analysis approach, we examined themes across time and stakeholder groups according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.RESULTS: At baseline, participants and other stakeholders reported being skeptical of the collaborative care approach related to some RE-AIM dimensions. However, over time they indicated greater confidence regarding the potential for future public health impact. They also provided information on barriers and actionable information to enhance program reach, effectiveness, adoption, implementation, and maintenance.CONCLUSIONS: RE-AIM provided a useful framework for understanding how to increase the impact of a collaborative and integrative approach for treating comorbid obesity and depression. It also demonstrates the utility of using the framework as a planning tool early in the evidence-generation pipeline.

    View details for DOI 10.1371/journal.pone.0248339

    View details for PubMedID 33705465

  • Sex Moderates Treatment Effects of Integrated Collaborative Care for Comorbid Obesity and Depression: The RAINBOW RCT. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine Lv, N. n., Xiao, L. n., Rosas, L. G., Venditti, E. M., Smyth, J. M., Lewis, M. A., Snowden, M. B., Ronneberg, C. R., Williams, L. M., Gerber, B. S., Ajilore, O. A., Patel, A. S., Ma, J. n. 2021


    Sex influences health and related behaviors due to biological and psychosocial/socioeconomic factors. Assessing sex-specific responses to integrated treatment for comorbid obesity and depression could inform intervention targeting.To test (a) whether sex moderates the effects of integrated collaborative care on weight and depression outcomes through 24 months and (b) whether treatment response at 6 months predicts 12 and 24 month outcomes by sex.Secondary data analyses on weight and depression severity (SCL-20) measured over 24 months among 409 adults with obesity and depression in the Research Aimed at Improving Both Mood and Weight trial.Men achieved significantly greater weight reductions in intervention versus usual care than women, whereas women achieved significantly greater percentage reductions in SCL-20 than men at both 12 and 24 months. In logistic models, at 80% specificity for correctly identifying participants not achieving clinically significant long-term outcomes, women who lost <3.0% weight and men who lost <4.1% weight at 6 months had ≥84% probability of not meeting 5% weight loss at 24 months. Similarly, at 80% specificity, women who reduced SCL-20 by <39.5% and men who reduced by <53.0% at 6 months had ≥82% probability of not meeting 50% decrease in SCL-20 at 24 months.Sex modified the integrated treatment effects for obesity and depression. Sex-specific responses at 6 months predicted clinically significant weight loss and depression outcomes through 24 months. Based on early responses, interventions may need to be tailored to address sex-specific barriers and facilitators to achieving healthy weight and depression outcomes at later time points.NCT02246413 (

    View details for DOI 10.1093/abm/kaaa125

    View details for PubMedID 33616188

  • Food Insecurity and Pediatric Obesity: a Double Whammy in the Era of COVID-19. Current obesity reports Tester, J. M., Rosas, L. G., Leung, C. W. 2020


    PURPOSE OF REVIEW: This review examines the current evidence about the ways in which food insecurity relates to obesity in children and adolescents, examining diet and diet-related behaviors, and taking into consideration the role of stress.RECENT FINDINGS: While living with food insecurity impacts stress and diet-related behaviors in children and adolescents, it is not clear whether food insecurity is associated with obesity above and beyond the influence of poverty. However, strategies to mitigate food insecurity and obesity are inherently connected, and recent examples from clinical practice (e.g., screening for food insecurity among patients) and advocacy (e.g., policy considerations regarding federal food programs such as the Supplemental Nutrition Assistance Program, or SNAP) are discussed. Food insecurity and obesity coexist in low-income children and adolescents in the USA. The COVID-19 pandemic exerts disproportionate burden on low-income children and families, magnifying their vulnerability to both food insecurity and pediatric obesity.

    View details for DOI 10.1007/s13679-020-00413-x

    View details for PubMedID 33064269

  • The ENGAGE-2 study: Engaging self-regulation targets to understand the mechanisms of behavior change and improve mood and weight outcomes in a randomized controlled trial (Phase 2). Contemporary clinical trials Lv, N., Ajilore, O. A., Ronneberg, C. R., Venditti, E. M., Snowden, M. B., Lavori, P. W., Xiao, L., Goldstein-Piekarski, A. N., Wielgosz, J., Wittels, N. E., Barve, A., Patel, A. S., Eckley, T. L., Stetz, P., Gerber, B. S., Smyth, J. M., Simmons, J. M., Rosas, L. G., Williams, L. M., Ma, J. 2020: 106072


    Despite evidence for effective integrated behavior therapy for treating comorbid obesity and depression, treatment response is highly variable and the underlying neurobiological mechanisms remain unknown. This hampers efforts to identify mechanistic targets in order to optimize treatment precision and potency. Funded within the NIH Science of Behavior Change (SOBC) Research Network, the 2-phased ENGAGE research project applies an experimental precision medicine approach to address this gap. The Phase 1 study focused on demonstrating technical feasibility, target engagement and potential neural mechanisms of responses to an integrated behavior therapy. This therapy combines a video-based behavioral weight loss program and problem-solving therapy for depression, with as-needed intensification of antidepressant medications, and its clinical effectiveness was demonstrated within a parent randomized clinical trial. Here, we describe the ENGAGE Phase 2 (ENGAGE-2) study protocol which builds on Phase 1 in 2 ways: (1) pilot testing of an motivational interviewing-enhanced, integrated behavior therapy in an independent, primarily minority patient sample, and (2) evaluation of a priori defined neural targets, specifically the negative affect (threat and sadness) circuits which demonstrated engagement and malleability in Phase 1, as mediators of therapeutic outcomes. Additionally, the Phase 2 study includes a conceptual and methodological extension to explore the role of microbiome-gut-brain and systemic immunological pathways in integrated behavioral treatment of obesity and depression. This protocol paper documents the conceptualization, design and the transdisciplinary methodologies in ENGAGE-2, which can inform future clinical and translational research in experimental precision medicine for behavior change and chronic disease management. Trial registration: #NCT03841682.

    View details for DOI 10.1016/j.cct.2020.106072

    View details for PubMedID 32621905

  • Patient Activation and Navigation: Utilizing Innovative Patient Engagement Strategies to Elevate Knowledge of Breast Cancer and Clinical Trials among African American Women Rajamani, G., Ahmed, L., Bezabeh, I., Gay, S., Hollis, T. M., Kassa, A., Kassa, L., McClinton-Brown, R., Mekonnen, T., Ross, R., Throvoer-Guillory, R. R., Tuttle, C. T., Waugh, J. J., Williams, L., Rosas, L. AMER ASSOC CANCER RESEARCH. 2020
  • Implementation outcomes of humanwide: A pilot project of integrated precision health in team-based primary care Brown-Johnson, C., Safaeinili, N., Baratta, J., Morris, S., Palaniappan, L., Mahoney, M., Rosas, L., Winget, M. BMC. 2020
  • First-Year Economic and Quality of Life Effects of the RAINBOW Intervention to Treat Comorbid Obesity and Depression. Obesity (Silver Spring, Md.) Goldhaber-Fiebert, J. D., Prince, L., Xiao, L., Lv, N., Rosas, L. G., Venditti, E. M., Lewis, M. A., Snowden, M. B., Ma, J. 2020


    OBJECTIVE: Obesity and depression are prevalent and often co-occurring conditions in the United States. The Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized trial demonstrated the effectiveness of an integrated intervention for adults with both conditions. Characterizing the intervention's economic effects is important for broader dissemination and implementation.METHODS: This study evaluated the cost (2018 US dollars) and health-related quality of life(HRQoL) impacts during RAINBOW's first year, comparing intervention (n=204) and usual-care groups (n=205). Outcomes included intervention delivery costs, differential changes in antidepressant medication spending compared with the pretrial year, differential changes in medical services spending compared with the pretrial year, and HRQoL changes from baseline using Euroqol-5D US utility weights.RESULTS: RAINBOW's 1-year delivery cost per person was $2,251. Compared with usual care, annual antidepressant medication days increased more (38 days [95% CI: 4 to 72]; P=0.027). Annual antidepressant medication spending had a larger, nonsignificant increase ($89 [95% CI: -$20 to $197]; P=0.109). Annual spending on medical care services had a smaller, nonsignificant decrease (-$54 [95% CI: -$832 to $941]; P=0.905). HRQoL had a nonsignificant increase (0.011 [95% CI: -0.025 to 0.047]; P=0.546).CONCLUSIONS: The RAINBOW intervention's economic value will depend on how its 1-year improvements in obesity and depression translate into long-term reduced morbidity, delayed mortality, or averted costs.

    View details for DOI 10.1002/oby.22805

    View details for PubMedID 32320533

  • Differing views regarding diet and physical activity: adolescents versus parents' perspectives. BMC pediatrics Azar, K. M., Halley, M., Lv, N., Wulfovich, S., Gillespie, K., Liang, L., Goldman Rosas, L. 2020; 20 (1): 137


    BACKGROUND: Today, approximately one in five United States adolescents age 12 to 19years is obese and just over a third are either overweight or obese. This study examines how parents and peers influence diet and physical activity behaviors of older adolescents (14-18years) with overweight or obesity to inform weight management interventions.METHODS: Adolescent participants included 14 to 18-year-olds with a Body Mass Index (BMI) greater than the 85th percentile for their age and sex who were receiving care in a large healthcare system in Northern California. Adolescents and their parents participated in separate focus groups and interviews (if not able to attend focus groups) that were held at the same time in the same location. We used qualitative thematic analysis to identify common themes discussed in the adolescent and parent focus groups as well as paired analysis of adolescent-parent dyads.RESULTS: Participants included 26 adolescents and 27 parents. Adolescent participants were 14 to 18years old. Half were female and the participants were almost evenly distributed across year in school. The majority self-identified as White (56%) and Asian (36%).Three themes were identified which included 1) parents overestimated how supportive they were compared to adolescents' perception 2) parents and adolescents had different views regarding parental influence on adolescent diet and physical activity behaviors 3) parents and adolescents held similar views on peers' influential role on lifestyle behaviors.CONCLUSION: Parents' and adolescents' differing views suggest that alignment of parent and adolescent expectations and behaviors for supporting effective weight management could be incorporated into interventions.

    View details for DOI 10.1186/s12887-020-02038-4

    View details for PubMedID 32220230

  • Understanding mechanisms of integrated behavioral therapy for co-occurring obesity and depression in primary care: a mediation analysis in the RAINBOW trial. Translational behavioral medicine Rosas, L. G., Xiao, L., Lv, N., Lavori, P. W., Venditti, E. M., Snowden, M. B., Smyth, J. M., Lewis, M. A., Williams, L. M., Suppes, T., Goldstein-Piekarski, A. N., Ma, J. 2020


    The RAINBOW trial demonstrated that an integrated collaborative care intervention was effective for improving weight and depression. This study examined mediation of the treatment effect by a priori specified lifestyle behaviors and cognitive functioning. Participants were randomized to a 12-month integrated intervention (n = 204) or usual care (n = 205). Body mass index (BMI) and 20-item Depression Symptom Check List (SCL-20) were co-primary outcomes (Y). To examine mediation, we assessed (a) the effect of the integrated intervention (X) on lifestyle behaviors (diet and physical activity) and cognitive functioning (problem-solving; M, XM path a) and (b) the association of these behaviors with BMI and SCL-20 (MY path b). Mediation existed if paths a and b were significant or if path a and the product of coefficients test (paths a and b) were significant. Compared with usual care, the intervention led to significant improvements in leisure time physical activity (201.3 MET minutes/week [SD, 1,457.6]) and total calorie intake (337.4 kcal/day [818.3]) at 6 months but not 12 months (path a). These improvements were not significantly associated with improvements in BMI or SCL-20 (path b). However, avoidant problem-solving style score and increased fruit and vegetable intake significantly correlated with improvements in BMI at 6 and 12 months, respectively. Also, increased fruit and vegetable intake, higher dietary quality, and better problem-solving abilities significantly correlated with improvements in SCL-20 at 6 and 12 months. These findings did not support the hypothesized mediation, but suggest lifestyle behaviors and cognitive functioning to target in future intervention optimization.

    View details for DOI 10.1093/tbm/ibaa024

    View details for PubMedID 32203569

  • Sex Moderates Treatment Effects in Integrated Behavior Therapy for Comorbid Obesity and Depression Lv, N., Xiao, L., Rosas, L., Venditti, E., Snowden, M., Lewis, M., Williams, L., Smyth, J., Ajilore, O., Gerber, B., Ma, J. LIPPINCOTT WILLIAMS & WILKINS. 2020
  • Reduced Nonconscious Reactivity to Threat in Amygdala Mediates Physical Activity and Energy Expenditure in Integrated Behavior Therapy for Adults With Obesity and Comorbid Depression Ma, J., Lv, N., Xiao, L., Goldstein-Piekarski, A., Wielgosz, J., Lavori, P., Stetz, P., Rosas, L., Venditti, E., Snowden, M., Smyth, J., Lewis, M., Suppes, P., Ajilore, O., Lefferts, W., Williams, L. LIPPINCOTT WILLIAMS & WILKINS. 2020
  • Employing Participatory Citizen Science Methods to Promote Age-Friendly Environments Worldwide. International journal of environmental research and public health King, A. C., King, D. K., Banchoff, A., Solomonov, S., Ben Natan, O., Hua, J., Gardiner, P., Rosas, L. G., Espinosa, P. R., Winter, S. J., Sheats, J., Salvo, D., Aguilar-Farias, N., Stathi, A., Akira Hino, A., Porter, M. M., Our Voice Global Citizen Science Research Network, O. B. 2020; 17 (5)


    The trajectory of aging is profoundly impacted by the physical and social environmental contexts in which we live. While "top-down" policy activities can have potentially wide impacts on such contexts, they often take time, resources, and political will, and therefore can be less accessible to underserved communities. This article describes a "bottom-up", resident-engaged method to advance local environmental and policy change, called Our Voice, that can complement policy-level strategies for improving the health, function, and well-being of older adults. Using the World Health Organization's age-friendly cities global strategy, we describe the Our Voice citizen science program of research that has specifically targeted older adults as environmental change agents to improve their own health and well-being as well as that of their communities. Results from 14 Our Voice studies that have occurred across five continents demonstrate that older adults can learn to use mobile technology to systematically capture and collectively analyze their own data. They can then successfully build consensus around high-priority issues that can be realistically changed and work effectively with local stakeholders to enact meaningful environmental and policy changes that can help to promote healthy aging. The article ends with recommended next steps for growing the resident-engaged citizen science field to advance the health and welfare of all older adults.

    View details for DOI 10.3390/ijerph17051541

    View details for PubMedID 32121001

  • Effect of an Intervention for Obesity and Depression on Patient-Centered Outcomes: An RCT. American journal of preventive medicine Rosas, L. G., Azar, K. M., Lv, N., Xiao, L., Goldhaber-Fiebert, J. D., Snowden, M. B., Venditti, E. M., Lewis, M. M., Goldstein-Piekarski, A. N., Ma, J. 2020


    INTRODUCTION: An integrated collaborative care intervention was successful for treating comorbid obesity and depression. The effect of the integrated intervention on secondary outcomes of quality of life and psychosocial functioning were examined, as well as whether improvements in these secondary outcomes were correlated with improvements in the primary outcomes of weight and depressive symptoms.STUDY DESIGN: This RCT compared an integrated collaborative care intervention for obesity and depression to usual care. Data were analyzed in 2018.SETTING/PARTICIPANTS: Adult primary care patients (n=409) with a BMI ≥30 (≥27 if Asian) and 9-Item Patient Health Questionnaire score ≥10 were recruited from September 30, 2014 to January 12, 2017 from primary care clinics in Northern California.INTERVENTION: The 12-month intervention integrated a behavioral weight loss program and problem-solving therapy with as-needed antidepressant medications for depression.MAIN OUTCOME MEASURES: A priori secondary outcomes included health-related quality of life (Short Form-8 Health Survey), obesity-specific quality of life (Obesity-Related Problems Scale), sleep disturbance and sleep-related impairment (Patient-Reported Outcomes Measurement Information System), and functional disability (Sheehan Disability Scale) at baseline and 6 and 12 months.RESULTS: Participants randomized to the intervention experienced significantly greater improvements in obesity-specific problems, mental health-related quality of life, sleep disturbance, sleep-related impairment, and functional disability at 6 months but not 12 months. Improvements in obesity-related problems (beta=0.01, 95% CI=0.01, 0.02) and sleep disturbance (beta= -0.02, 95% CI= -0.04, 0) were associated with lower BMI. Improvements in the physical (beta= -0.01, 95% CI= -0.01, 0) and mental health components (beta= -0.02, 95% CI= -0.03, -0.02) of the Short Form-8 Health Survey as well as sleep disturbance (beta=0.01, 95% CI=0.01, 0.02) and sleep-related impairment (beta=0.01, 95% CI=0, 0.01) were associated with fewer depressive symptoms.CONCLUSIONS: An integrated collaborative care intervention for obesity and depression that was shown previously to improve weight and depressive symptoms may also confer benefits for quality of life and psychosocial functioning over 6 months.TRIAL REGISTRATION: This study is registered at NCT02246413.

    View details for DOI 10.1016/j.amepre.2019.11.005

    View details for PubMedID 32067873

  • Comparing enhanced versus standard Diabetes Prevention Program among indigenous adults in an urban setting: a randomized controlled trial. BMC public health Rosas, L. G., Vasquez, J. J., Hedlin, H. K., Qin, F. F., Lv, N. n., Xiao, L. n., Kendrick, A. n., Atencio, D. n., Stafford, R. S. 2020; 20 (1): 139


    Indigenous people in the United States are at high risk for diabetes. Psychosocial stressors like historical trauma may impede success in diabetes prevention programs.A comparative effectiveness trial compared a culturally tailored diabetes prevention program (standard group) with an enhanced one that addressed psychosocial stressors (enhanced group) in 2015 to 2017. Participants were 207 Indigenous adults with a body mass index (BMI) of ≥30 and one additional criterion of metabolic syndrome, and were randomized to the standard or enhanced group. Both groups received a culturally tailored behavioral diabetes prevention program. Strategies to address psychosocial stressors were provided to the enhanced group only. Change in BMI over 12 months was the primary outcome. Secondary outcomes included change in quality of life, and clinical, behavioral, and psychosocial measures at 6 and 12 months.The two groups did not significantly differ in BMI change at 12 months. The two groups also did not differ in any secondary outcomes at 6 or 12 months, with the exception of unhealthy food consumption; the standard group reported a larger mean decrease (95% CI) in consumption of unhealthy food compared with the enhanced group (- 4.6 [- 6.8, - 2.5] vs. -0.7 [- 2.9, 1.4], p = 0.01). At 6 months, significant improvements in weight and the physical component of the quality of life measure were observed for both groups compared with their baseline level. Compared with baseline, at 12 months, the standard group showed significant improvement in BMI (mean [95% CI], - 0.5 [- 1.0, - 0.1]) and the enhanced group showed significant improvement in the physical component of the quality of life (2.9 [0.7, 5.2]).Adding strategies to address psychosocial barriers to a culturally tailored diabetes prevention program was not successful for improving weight loss among urban Indigenous adults.(if applicable): NCT02266576. Registered October 17, 2014 on The trial was prospectively registered.

    View details for DOI 10.1186/s12889-020-8250-7

    View details for PubMedID 32000738

  • Variability in engagement and progress in efficacious integrated collaborative care for primary care patients with obesity and depression: Within-treatment analysis in the RAINBOW trial. PloS one Lv, N., Xiao, L., Majd, M., Lavori, P. W., Smyth, J. M., Rosas, L. G., Venditti, E. M., Snowden, M. B., Lewis, M. A., Ward, E., Lesser, L., Williams, L. M., Azar, K. M., Ma, J. 2020; 15 (4): e0231743


    INTRODUCTION: The RAINBOW randomized clinical trial validated the efficacy of an integrated collaborative care intervention for obesity and depression in primary care, although the effect was modest. To inform intervention optimization, this study investigated within-treatment variability in participant engagement and progress.METHODS: Data were collected in 2014-2017 and analyzed post hoc in 2018. Cluster analysis evaluated patterns of change in weekly self-monitored weight from week 6 up to week 52 and depression scores on the Patient Health Questionnaire-9 (PHQ-9) from up to 15 individual sessions during the 12-month intervention. Chi-square tests and ANOVA compared weight loss and depression outcomes objectively measured by blinded assessors to validate differences among categories of treatment engagement and progress defined based on cluster analysis results.RESULTS: Among 204 intervention participants (50.9 [SD, 12.2] years, 71% female, 72% non-Hispanic White, BMI 36.7 [6.9], PHQ-9 14.1 [3.2]), 31% (n = 63) had poor engagement, on average completing self-monitored weight in <3 of 46 weeks and <5 of 15 sessions. Among them, 50 (79%) discontinued the intervention by session 6 (week 8). Engaged participants (n = 141; 69%) self-monitored weight for 11-22 weeks, attended almost all 15 sessions, but showed variable treatment progress based on patterns of change in self-monitored weight and PHQ-9 scores over 12 months. Three patterns of weight change (%) represented minimal weight loss (n = 50, linear beta1 = -0.06, quadratic beta2 = 0.001), moderate weight loss (n = 61, beta1 = -0.28, beta2 = 0.002), and substantial weight loss (n = 12, beta1 = -0.53, beta2 = 0.005). Three patterns of change in PHQ-9 scores represented moderate depression without treatment progress (n = 40, intercept beta0 = 11.05, beta1 = -0.11, beta2 = 0.002), moderate depression with treatment progress (n = 20, beta0 = 12.90, beta1 = -0.42, beta2 = 0.006), and milder depression with treatment progress (n = 81, beta0 = 7.41, beta1 = -0.23, beta2 = 0.003). The patterns diverged within 6-8 weeks and persisted throughout the intervention. Objectively measured weight loss and depression outcomes were significantly worse among participants with poor engagement or poor progress on either weight or PHQ-9 than those showing progress on both.CONCLUSIONS: Participants demonstrating poor engagement or poor progress could be identified early during the intervention and were more likely to fail treatment at the end of the intervention. This insight could inform individualized and timely optimization to enhance treatment efficacy.TRIAL REGISTRATION: NCT02246413.

    View details for DOI 10.1371/journal.pone.0231743

    View details for PubMedID 32315362

  • US Public Concerns About the COVID-19 Pandemic From Results of a Survey Given via Social Media. JAMA internal medicine Nelson, L. M., Simard, J. F., Oluyomi, A. n., Nava, V. n., Rosas, L. G., Bondy, M. n., Linos, E. n. 2020

    View details for DOI 10.1001/jamainternmed.2020.1369

    View details for PubMedID 32259192

  • Perspectives on Precision Health Among Racial/Ethnic Minority Communities and the Physicians That Serve Them. Ethnicity & disease Rosas, L. G., Nasrallah, C., Park, V. T., Vasquez, J. J., Duron, Y., Garrick, O., Hattin, R., Cho, M., David, S. P., Evans, J., McClinton-Brown, R., Martin, C. 2020; 30 (Suppl 1): 137–48


    Background: In order for precision health to address health disparities, engagement of diverse racial/ethnic minority communities and the physicians that serve them is critical.Methods: A community-based participatory research approach with mixed methods was employed to gain a deeper understanding of precision health research and practice among American Indian, African American, Latino, Chinese, and Vietnamese groups and physicians that serve these communities. A survey assessed demographics and opinions of precision health, genetic testing, and precision health research. Focus groups (n=12) with each racial/ethnic minority group and physicians further explored attitudes about these topics.Results: One hundred community members (American Indian [n=17], African American [n=13], Chinese [n=17], Latino [n=27], and Vietnamese [n=26]) and 14 physicians completed the survey and participated in the focus groups. Familiarity with precision health was low among community members and high among physicians. Most groups were enthusiastic about the approach, especially if it considered influences on health in addition to genes (eg, environmental, behavioral, social factors). Significant concerns were expressed by African American and American Indian participants about precision health practice and research based on past abuses in biomedical research. In addition, physician and community members shared concerns such as security and confidentiality of genetic information, cost and affordability of genetic tests and precision medicine, discrimination and disparities, distrust of medical and research and pharmaceutical institutions, language barriers, and physician's specialty.Conclusions: Engagement of racial/ethnic minority communities and the providers who serve them is important for advancing a precision health approach to addressing health disparities.

    View details for DOI 10.18865/ed.30.S1.137

    View details for PubMedID 32269455

  • Effect of a Culturally Adapted Behavioral Intervention for Latino Adults on Weight Loss Over 2 Years: A Randomized Clinical Trial. JAMA network open Rosas, L. G., Lv, N. n., Xiao, L. n., Lewis, M. A., Venditti, E. M., Zavella, P. n., Azar, K. n., Ma, J. n. 2020; 3 (12): e2027744


    Identifying effective weight loss interventions for Latino adults at risk of diabetes is of critical public health importance.To determine whether a culturally adapted behavioral intervention for Latino adults was more effective than usual care for weight loss over 24 months.In this randomized clinical trial, Latino adults with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 24 or greater and a high risk for type 2 diabetes were recruited in primary care practices in the San Francisco, California, area, randomized to receive the Vida Sana intervention or usual care, and followed up for 24 months. The study was conducted from November 2015 to May 2019, and data were analyzed from July 2019 to Septmeber 2020.The treatment group received Vida Sana, a culturally adapted lifestyle intervention that included a family-based orientation session and 22 group sessions over 12 months. Participants were encouraged to use a wearable activity tracker and mobile applications to track their physical activity and dietary intake. Participants received monthly email messages for an additional 12 months. The control group received usual care.The primary outcome was weight loss at 24 months. Secondary outcomes included weight loss at 12 months and achieving at least 5% weight loss at 12 and 24 months. Associations of baseline characteristics and intervention adherence with weight loss outcomes were also examined.Among 191 participants (mean [SD] age, 50.2 [12.2] years; 118 [61.8%] women; 107 participants [57.2%] of Mexican origin; mean [SD] baseline BMI, 32.4 [5.7]) randomized, 92 participants were randomized to the intervention and 99 participants were randomized to usual care. Of these, 185 participants (96.9%) completed 24-month follow-up. Mean (SD) weight loss did not differ significantly by group at 24 months (intervention: -1.1 [5.7] kg; control: -1.1 [7.1] kg; P = .93). However, mean (SD) weight loss was significantly greater in the intervention group (-2.6 [6.0] kg) than the control group (-0.3 [4.2] kg) at 12 months (mean difference, -2.1 [95% CI, -3.6 to -0.7] kg; P = .005). Intervention participants were more likely to achieve at least 5% weight loss than control participants at 12 months (22 participants [25.9%] vs 9 participants [9.2%]; P = .003), and participants who achieved at least 5% weight loss attended more intervention sessions than those who did not (mean [SD], 16.6 [7.6] sessions vs 12.4 [7.5] sessions; P = .03).These findings suggest that among Latino adults with high diabetes risk, a culturally adapted behavioral lifestyle intervention was effective for weight loss over 12 months but not 24 Identifier: NCT02459691.

    View details for DOI 10.1001/jamanetworkopen.2020.27744

    View details for PubMedID 33337491

  • Engaging citizen scientists to build healthy park environments in Colombia. Health promotion international Rubio, M. A., Triana, C. n., King, A. C., Rosas, L. G., Banchoff, A. W., Rubiano, O. n., Chrisinger, B. W., Sarmiento, O. L. 2020


    Colombia's Recreovía program offers community-based free physical activity (PA) classes in parks. We evaluated built and social environmental factors influencing Recreovía local park environments, and facilitated a consensus-building and advocacy process among community members, policymakers and academic researchers aimed at improving uptake and impact of the Recreovía program. We used a mixed-methods approach, with individual and contextual PA measurements and a resident-enabled participatory approach (the Our Voice citizen science engagement model). Recreovía participants were likely to be women meeting PA recommendations, and highly satisfied with the Recreovía classes. Reported facilitators of the Recreovía included its role in enhancing social and individual well-being through PA classes. Reported barriers to usage were related to park maintenance, cleanliness and safety. The Our Voice process elicited community reflection, empowerment, advocacy and action. Our Voice facilitated the interplay among stakeholders and community members to optimize the Recreovía program as a facilitator of active living, and to make park environments more welcoming.

    View details for DOI 10.1093/heapro/daaa031

    View details for PubMedID 32361761

  • Response to Gao et al., "Effect of Integrated Intervention on Obesity and Depression". American journal of preventive medicine Rosas, L. G., Xiao, L. n., Ma, J. n. 2020; 59 (3): 459–60

    View details for DOI 10.1016/j.amepre.2020.04.009

    View details for PubMedID 32828324

  • Abstract 2033: Reducing cancer caregiver burden: A user-centered design approach for an mHealth app American Association for Cancer Research Annual Meeting Oakley-Girvan, I., Divi, V., Palesh, O., Daniels, J., Goldman Rosas, L., O'Brien, D., Davis, S. W., Kamal, A. H., Kurian, A. W., Longmire, M. R. 2020
  • Using Korean Dramas as a Precision Mental Health Education Tool for Asian Americans: A Pilot Study. International journal of environmental research and public health Ta Park, V. M., Olaisen, R. H., Vuong, Q., Rosas, L. G., Cho, M. K. 2019; 16 (12)


    Precision mental health (MH) holds great potential for revolutionizing MH care and reducing the burden of mental illness. Efforts to engage Asian Americans in precision MH research is necessary to help reduce MH disparities. Korean drama ("K-drama") television shows may be an effective educational tool to increase precision MH knowledge, attitudes, and behaviors (KAB) among Asian Americans. This study determined whether KAB improved after participating in a K-drama precision MH workshop, and examined the participants' perspectives about K-dramas' utility as an educational tool. A K-drama precision MH workshop in English/Vietnamese/Korean was conducted with a convenience sample (n = 122). Pre-/post-tests on precision MH KAB (genetics and genetic testing, and MH and help-seeking) and a survey on K-dramas' utility as an educational tool were administered. Findings revealed a significant difference in the pre- and post-test KAB scores overall, by genetics and genetic testing, and by MH and help-seeking. There were also significant increases in the overall post-test KAB scores by workshop (language) participation. Overall, participants responded positively on the utility of K-dramas as a precision MH educational tool. This study demonstrates the feasibility of K-drama as an innovative and widely available health education tool to educate communities about precision MH.

    View details for DOI 10.3390/ijerph16122151

    View details for PubMedID 31216626

  • Effect of Integrated Behavioral Weight Loss Treatment and Problem-Solving Therapy on Body Mass Index and Depressive Symptoms Among Patients With Obesity and Depression: The RAINBOW Randomized Clinical Trial. JAMA Ma, J., Rosas, L. G., Lv, N., Xiao, L., Snowden, M. B., Venditti, E. M., Lewis, M. A., Goldhaber-Fiebert, J. D., Lavori, P. W. 2019; 321 (9): 869–79


    Importance: Coexisting obesity and depression exacerbate morbidity and disability, but effective treatments remain elusive.Objective: To test the hypothesis that an integrated collaborative care intervention would significantly improve both obesity and depression at 12 months compared with usual care.Design, Setting, and Participants: The Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized clinical trial enrolled 409 adults with body mass indices (BMIs) of 30 or greater (≥27 for Asian adults) and 9-item Patient Health Questionnaire (PHQ-9) scores of 10 or greater. Primary care patients at a health system in Northern California were recruited from September 30, 2014, to January 12, 2017; the date of final 12-month follow-up was January 17, 2018.Interventions: All participants randomly assigned to the intervention (n=204) or the usual care control group (n=205) received medical care from their personal physicians as usual, received information on routine services for obesity and depression at their clinic, and received wireless physical activity trackers. Intervention participants also received a 12-month intervention that integrated a Diabetes Prevention Program-based behavioral weight loss treatment with problem-solving therapy for depression and, if indicated, antidepressant medications.Main Outcomes and Measures: The co-primary outcome measures were BMI and 20-item Depression Symptom Checklist (SCL-20) scores (range, 0 [best] to 4 [worst]) at 12 months.Results: Among 409 participants randomized (mean age of 51.0 years [SD, 12.1 years]; 70% were women; mean BMI of 36.7 [SD, 6.4]; mean PHQ-9 score of 13.8 [SD, 3.1]; and mean SCL-20 score of 1.5 [SD, 0.5]), 344 (84.1%) completed 12-month follow-up. At 12 months, mean BMI declined from 36.7 (SD, 6.9) to 35.9 (SD, 7.1) among intervention participants compared with a change in mean BMI from 36.6 (SD, 5.8) to 36.6 (SD, 6.0) among usual care participants (between-group mean difference, -0.7 [95% CI, -1.1 to -0.2]; P=.01). Mean SCL-20 score declined from 1.5 (SD, 0.5) to 1.1 (SD, 1.0) at 12 months among intervention participants compared with a change in mean SCL-20 score from 1.5 (SD, 0.6) to 1.4 (SD, 1.3) among usual care participants (between-group mean difference, -0.2 [95% CI, -0.4 to 0]; P=.01). There were 47 adverse events or serious adverse events that involved musculoskeletal injuries (27 in the intervention group and 20 in the usual care group).Conclusions and Relevance: Among adults with obesity and depression, a collaborative care intervention integrating behavioral weight loss treatment, problem-solving therapy, and as-needed antidepressant medications significantly improved weight loss and depressive symptoms at 12 months compared with usual care; however, the effect sizes were modest and of uncertain clinical importance.Trial Registration: Identifier: NCT02246413.

    View details for PubMedID 30835308

  • Acting locally while thinking globally to promote physical activity, address inequalities and achieve population change Winter, S., Rosas, L., Buman, M., Sheats, J., Salvo, D., Garber, R., Sarmiento, O., Broderick, B., Banchoff, A., King, A. HUMAN KINETICS PUBL INC. 2018: S1–S2
  • The Effect of a Behavioral Weight-Loss Intervention on Depressive Symptoms Among Latino Immigrants in a Randomized Controlled Trial JOURNAL OF IMMIGRANT AND MINORITY HEALTH Figueroa, S., Stafford, R. S., Heaney, C. A., Rosas, L. G. 2018; 20 (5): 1182–89


    Evidence of whether behavioral weight-loss interventions reduce depressive symptoms among Latino immigrants is limited. The effect of a behavioral weight-loss intervention on depressive symptoms was assessed using data from a clinical trial among Latino immigrants. Participants were randomized to a usual care (UC) control (n = 41), case management (CM) alone (n = 84), or CM with community health worker support (CM+CHW) (n = 82). Generalized estimating equation models were used to compare the impact of each intervention with UC. Effect modification by poverty level was further investigated. Overall, treatment groups were not significantly associated with 24-month changes in CES-D scores. Among participants below the 100% federal poverty level (FPL), those randomized to CM+CHW had 24-month CES-D scores significantly lower (Β coefficient = 0.72; 95% CI 0.55-0.93) than those in UC (p = 0.01). A behavioral weight-loss intervention providing case management and support from a CHW reduced depressive symptoms among Latino immigrants below the 100% FPL.

    View details for PubMedID 29038966

  • A Latino Patient-Centered, Evidence-Based Approach to Diabetes Prevention JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE Rosas, L. G., Lv, N., Lewis, M. A., Venditti, E. M., Zavella, P., Luna, V., Ma, J. 2018; 31 (3): 364–74


    Cultural tailoring of evidence-based diabetes prevention program (DPP) interventions is needed to effectively address obesity and its related chronic diseases among Latinos in primary care. This article describes the patient-centered process used to adapt the DPP and reports cultural adaptations.We used a 2-stage formative research process to culturally adapt an evidence-based DPP intervention in the context of primary care. The first stage involved 5 focus groups of Latino patients and interviews with 5 stakeholders (3 with primary care physicians and 2 with medical directors) to inform a first round of adaptations. The second stage included pretesting the stage I-adapted intervention with a Latino patient advisory board to complete a second round of adaptations.Key stakeholders involved in this 2-stage adaptation process included 34 Latino patients who participated in 5 focus groups and 5 physicians and medical directors who participated in key informant interviews during stage I and 11 patients who attended the 16 advisory board meetings and their family members who attended 1 of the meetings during stage II. Using this patient-centered stakeholder-engaged approach, we found the original intervention was largely congruent with the cultural values of the study population. To further strengthen the cultural relevance of the intervention, salient cultural values emphasized by patients and stakeholders underscored the importance of family and community support for behavior change. Accordingly, key adaptations were made to (1) invite family members to the orientation session and at 2 other key timepoints to facilitate family support, (2) provide participants support from the coach and each other via smartphone applications, and (3) provide healthy, easy, low-cost culturally appropriate meals at each group session.The 2-stage approach actively engaging patients, family members, providers, and health care system leaders reinforced the cultural congruence of the existing intervention while further strengthening it with adaptations promoting Latino family and community support.

    View details for PubMedID 29743220

  • UNDERSTANDING TREATMENT RESPONSE TO INTEGRATED BEHAVIOR THERAPY FOR COMORBID OBESITY AND DEPRESSION IN PRIMARY CARE Ma, J., Lv, N., Rosas, L., Xiao, L., Lavori, P., Venditti, E., Lewis, M., Snowden, M., Ward, E., Smyth, J., Suppes, T., Goldstein-Piekarski, A., Williams, L. OXFORD UNIV PRESS INC. 2018: S129
  • A framework for examining the function of digital health technologies for weight management TRANSLATIONAL BEHAVIORAL MEDICINE Azar, K. J., Bennett, G. G., Nolting, L. A., Rosas, L., Burke, L. E., Ma, J. 2018; 8 (2): 280–94


    Research is rapidly extending its focus to develop and evaluate weight management interventions that incorporate eHealth technologies. Comparative effectiveness of eHealth interventions is partly limited by the extensive heterogeneity in intervention design, variation in use of eHealth tools, and expanding development of novel tools to promote weight management. We closely examined, characterized, and categorized the use and function of eHealth tools across a wide range of eHealth interventions for weight management in order to first create a novel schematic framework for eHealth interventions and, second, to evaluate eHealth interventions using this framework. We examined 49 randomized controlled trials from two systematic reviews evaluating the effectiveness of eHealth interventions for weight loss. Further characterization of each intervention identified common use and function of eHealth tools represented within interventions and thus important to include in the proposed framework. This resulted in six descriptive domains. We then categorized each eHealth intervention within the context of the newly developed framework. Last, we examined efficacious interventions in the context of the framework. Twenty-five randomized controlled trials reported significantly more weight loss between the intervention group utilizing eHealth, compared to a non-eHealth control intervention and/or within an eHealth intervention group. Of these 25 interventions, 15 (60%) used automated feedback (Domain 1), 13 (52%) used non-eHealth tailored feedback by a health care provider (Domain 5), and 8 (32%) used tailored feedback from a health care professional through an electronic channel (Domain 2). The proposed schematic framework offers an alternative and novel approach for comparing across interventions and informing the development and evaluation of eHealth interventions.

    View details for PubMedID 29385564

  • HOMBRE: A randomized controlled trial to compare two approaches to weight loss for overweight and obese Latino men (Hombres con Opciones para Mejorar el Bienestar y bajar el Riesgo de Enfermedades cronicas; men with choices to improve well-being and decrease chronic disease risk). Contemporary clinical trials Rosas, L. G., Lv, N., Azar, K. M., Xiao, L., Hooker, S. P., Lewis, M. A., Zavella, P., Venditti, E. M., Ma, J. 2018; 68: 23–34


    Latino men bear a disproportionate burden of obesity, diabetes, and cardiovascular disease.However, limited behavioral lifestyle intervention research has focused on Latino men. This trial compares two approaches to weight loss for overweight and obese Latino men: 1) HOMBRE is a culturally adapted intervention that provides individual choice of either self-directed online videos, coach-facilitated in-person groups, and coach-facilitated online groups; and 2) a minimal intensity intervention that uses online videos with a coach available, if solicited by the participant.Latino men with a Body Mass Index (BMI) of ≥27 kg/m2 and one or more cardiometabolic risk factors (n = 424) will be randomly assigned to receive one of the two approaches.The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework guides the planned evaluations.The primary aim is to determine the effectiveness of the HOMBRE intervention (the "E" in RE-AIM) on clinically significant weight loss (≥5% of baseline weight) at 18 months. We hypothesize that a significantly higher proportion of HOMBRE participants will maintain ≥5% of weight loss compared with those in the minimal intensity intervention.Secondary aims are to determine the effectiveness of HOMBRE on cardiometabolic risk factors (e.g., blood pressure, waist circumference), health behaviors (e.g., diet and physical activity), and psychosocial well-being (e.g., quality of life and depressive symptoms) and to evaluate the other attributes of RE-AIM. These findings have real word applicability with value to clinicians, patients, and other decision makers considering effective diabetes prevention programs for Latino men in primary care.

    View details for PubMedID 29505867

  • The ENGAGE study: Integrating neuroimaging, virtual reality and smartphone sensing to understand self-regulation for managing depression and obesity in a precision medicine model. Behaviour research and therapy Williams, L. M., Pines, A. n., Goldstein-Piekarski, A. N., Rosas, L. G., Kullar, M. n., Sacchet, M. D., Gevaert, O. n., Bailenson, J. n., Lavori, P. W., Dagum, P. n., Wandell, B. n., Correa, C. n., Greenleaf, W. n., Suppes, T. n., Perry, L. M., Smyth, J. M., Lewis, M. A., Venditti, E. M., Snowden, M. n., Simmons, J. M., Ma, J. n. 2018; 101: 58–70


    Precision medicine models for personalizing achieving sustained behavior change are largely outside of current clinical practice. Yet, changing self-regulatory behaviors is fundamental to the self-management of complex lifestyle-related chronic conditions such as depression and obesity - two top contributors to the global burden of disease and disability. To optimize treatments and address these burdens, behavior change and self-regulation must be better understood in relation to their neurobiological underpinnings. Here, we present the conceptual framework and protocol for a novel study, "Engaging self-regulation targets to understand the mechanisms of behavior change and improve mood and weight outcomes (ENGAGE)". The ENGAGE study integrates neuroscience with behavioral science to better understand the self-regulation related mechanisms of behavior change for improving mood and weight outcomes among adults with comorbid depression and obesity. We collect assays of three self-regulation targets (emotion, cognition, and self-reflection) in multiple settings: neuroimaging and behavioral lab-based measures, virtual reality, and passive smartphone sampling. By connecting human neuroscience and behavioral science in this manner within the ENGAGE study, we develop a prototype for elucidating the underlying self-regulation mechanisms of behavior change outcomes and their application in optimizing intervention strategies for multiple chronic diseases.

    View details for PubMedID 29074231

  • Profiles of sociodemographic, behavioral, clinical and psychosocial characteristics among primary care patients with comorbid obesity and depression. Preventive medicine reports Ma, J., Xiao, L., Lv, N., Rosas, L. G., Lewis, M. A., Goldhaber-Fiebert, J. D., Venditti, E. M., Snowden, M. B., Lesser, L., Ward, E. 2017; 8: 42–50


    The objective of this study is to characterize profiles of obese depressed participants using baseline data collected from October 2014 through December 2016 for an ongoing randomized controlled trial (n=409) in Bay Area, California, USA. Four comorbidity severity categories were defined by interaction of the binary levels of body mass index (BMI) and depression Symptom Checklist 20 (SCL20) scores. Sociodemographic, behavioral, clinical and psychosocial characteristics were measured. Mean (SD) age was 51 (12.1) years, BMI 36.7 (6.4) kg/m2, and SCL20 1.5 (0.5). Participants in the 4 comorbidity severity categories had similar sociodemographic characteristics, but differed significantly in the other characteristics. Two statistically significant canonical dimensions were identified. Participants with BMI≥35 and SCL20≥1.5 differed significantly from those with BMI<35 and SCL20<1.5 on dimension 1, which primarily featured high physical health (e.g., central obesity, high blood pressure and impaired sleep) and mental health comorbidities (e.g., post-traumatic stress and anxiety), poor health-related quality of life (in general and problems specifically with obesity, anxiety, depression, and usual daily activities), and an avoidance problem-solving style. Participants with BMI<35 and SCL20≥1.5 differed significantly from those with BMI≥35 and SCL20<1.5 on dimension 2, which primarily included fewer Hispanics, less central obesity, and more leisure-time physical activity, but greater anxiety and post-traumatic stress and poorer obesity- or mental health-related quality of life. In conclusion, patients with comorbid obesity and depression of varying severity have different profiles of behavioral, clinical and psychosocial characteristics. This insight may inform analysis of treatment heterogeneity and development of targeted intervention strategies. Trial #NCT02246413.

    View details for PubMedID 28840096

  • Personalized Hypertension Management Using Patient-Generated Health Data Integrated With Electronic Health Records (EMPOWER-H): Six-Month Pre-Post Study JOURNAL OF MEDICAL INTERNET RESEARCH Lv, N., Xiao, L., Simmons, M. L., Rosas, L. G., Chan, A., Entwistle, M. 2017; 19 (9): e311


    EMPOWER-H (Engaging and Motivating Patients Online With Enhanced Resources-Hypertension) is a personalized-care model facilitating engagement in hypertension self-management utilizing an interactive Web-based disease management system integrated with the electronic health record. The model is designed to support timely patient-provider interaction by incorporating decision support technology to individualize care and provide personalized feedback for patients with chronic disease. Central to this process were patient-generated health data, including blood pressure (BP), weight, and lifestyle behaviors, which were uploaded using a smartphone.The aim of this study was to evaluate the program among patients within primary care already under management for hypertension and with uncontrolled BP.Using a 6-month pre-post design, outcome measures included office-measured and home-monitored BP, office-measured weight, intervention contacts, diet, physical activity, smoking, knowledge, and health-related quality of life.At 6 months, 55.9% of participants (N=149) achieved office BP goals (<140/90 mm Hg; P<.001) and 86.0% achieved clinically meaningful reduction in office BP (reduction in systolic BP [SBP] ≥5 mm Hg or diastolic BP [DBP] ≥3 mm Hg). At baseline, 25.2% of participants met home BP goals (<135/85 mm Hg), and this percentage significantly increased to 71.4% (P<.001) at 6 months. EMPOWER-H also significantly reduced both office and home SBP and DBP, decreased office-measured weight and consumption of high-salt and high-fat foods (all P<.005), and increased intake of fruit and vegetables, minutes of aerobic exercise, and hypertension knowledge (all P<.05). Patients with higher home BP upload frequencies had significantly higher odds of achieving home BP goals. Patients receiving more total intervention, behavioral, pharmaceutical contacts had significantly lower odds of achieving home BP goals but higher improvements in office BP (all P<.05).EMPOWER-H significantly improved participants' office-measured and home-monitored BP, weight, and lifestyle behaviors, suggesting that technologically enabled BP home-monitoring, with structured use of patient-generated health data and a personalized care-plan facilitating patient engagement, can support effective clinical management. The experience gained in this study provides support for the feasibility and value of using carefully managed patient-generated health data in the day-to-day clinical management of patients with chronic conditions. A large-scale, real-world study to evaluate sustained effectiveness, cost-effectiveness, and scalability is warranted.

    View details for PubMedID 28928111

  • Behavioral lifestyle interventions for moderate and severe obesity: A systematic review PREVENTIVE MEDICINE Lv, N., Azar, K. J., Rosas, L., Wulfovich, S., Xiao, L., Ma, J. 2017; 100: 180–93


    Moderate and severe obesity (BMI ≥35 kg/m2) affect 15% of US adults, with a projected increase over the next two decades. This study reviews evidence of behavioral lifestyle interventions for weight loss in this population. We searched PubMed, PsychInfo, CINAHL®, and Scopus through February 2016 for experimental and quasi-experimental studies that tested a dietary and/or physical activity intervention with a behavioral modification component versus a comparator; and had ≥six-month follow-up and a weight-related primary outcome. Twelve studies representing 1862 participants (mean BMI 37.5-48.3, mean age 30-54 years) were included. Nine studies compared different behavioral interventions and three tested behavioral intervention(s) versus pharmacological or surgical treatments. Among the 25 behavioral interventions in the 12 studies, 18 reported percent of participants achieving clinically significant weight loss up to 12months (32-97% achieving 5% or 3-70% achieving 10%). Three studies measured other cardiometabolic risk factors, but showed no significant risk reduction. Seven interventions with greater effectiveness (i.e., at least 31% achieving ≥10% or 62% achieving ≥5% weight loss up to one year) included multiple components (diet, physical activity, and behavioral strategies), long duration (e.g., one year), and/or intensive contacts (e.g., inpatient stays for clinic-based interventions, weekly contacts for community-based ones). Evidence for the effectiveness of behavioral interventions versus pharmacological or surgical treatment was limited. Comprehensive and intensive behavioral interventions can result in clinically significant, albeit modest, weight loss in this obese subpopulation but may not result significant improvements in other cardiometabolic risk factors. More research on scalable and sustainable interventions is needed.

    View details for PubMedID 28450123

    View details for PubMedCentralID PMC5503454

  • MECHANISTIC SELF-REGULATION TARGETS IN INTEGRATED BEHAVIOR THERAPY FOR OBESE AND DEPRESSED ADULTS: RAINBOW-ENGAGE STUDY Ma, J., Rosas, L., Snowden, M., Wandell, B., Bailenson, J., Greenleaf, W., Dagum, P., Lavori, P., Suppes, T., Lewis, M., Smyth, J., Williams, L. SPRINGER. 2017: S1596–S1597
  • Latino Adults' Perspectives on Treating Tobacco Use Via Social Media. JMIR mHealth and uHealth Anguiano, B., Brown-Johnson, C., Rosas, L. G., Pechmann, C., Prochaska, J. J. 2017; 5 (2)


    Latinos are the largest minority group in the United States, and in California they outnumber non-Hispanic whites. Smoking cessation programs tailored for Latino culture, and this population's specific smoking patterns, are needed. Online social networks for smoking cessation have high potential for Latinos, but have not been tested to date.Building a research program on social media apps for cancer prevention in diverse populations, this qualitative study assessed acceptability of tobacco treatment that was distributed via social media for Latino smokers.We conducted three focus groups with Latino adults who were former and current smokers recruited from Santa Clara County, California in 2015 (N=32). We assessed participants' smoking histories, attempts to quit, social media exposure, and receptivity to a social media-based smoking cessation intervention. Audio transcripts were translated and coded for themes.Participants reported factors driving their tobacco use and motivations to quit, and emphasized the importance of community and family in influencing their smoking initiation, cravings and triggers, attempts to quit, and abstinence. Participants valued the communal aspect of social media and suggested strategically tailoring groups based on key features (eg, age, gender, language preference). Participants reported preferring visual, educational, and motivational messages that were connected with existing services.Participants generally voiced acceptability of a social media-delivered intervention to help them quit smoking, viewed the intervention as well-equipped for catering to the strong community orientation of Latinos, and suggested that the platform was able to address variation within the population through strategic group creation. As a group member reflected, "Podemos hacerlo juntos" (We can do it together).

    View details for DOI 10.2196/mhealth.6684

    View details for PubMedID 28179217

    View details for PubMedCentralID PMC5322200

  • Validation of Clinic Weights from Electronic Health Records Against Standardized Weight Measurements in Weight Loss Trials OBESITY Xiao, L., Lv, N., Rosas, L. G., Au, D., Ma, J. 2017; 25 (2): 363–69


    To validate clinic weights in electronic health records against researcher-measured weights for outcome assessment in weight loss trials.Clinic and researcher-measured weights from a published trial (BE WELL) were compared using Lin's concordance correlation coefficient, Bland and Altman's limits of agreement, and polynomial regression model. Changes in clinic and researcher-measured weights in BE WELL and another trial, E-LITE, were analyzed using growth curve modeling.Among BE WELL (n = 330) and E-LITE (n = 241) participants, 96% and 90% had clinic weights (mean [SD] of 5.8 [6.1] and 3.7 [3.9] records) over 12 and 15 months of follow-up, respectively. The concordance correlation coefficient was 0.99, and limits of agreement plots showed no pattern between or within treatment groups, suggesting overall good agreement between researcher-measured and nearest-in-time clinic weights up to 3 months. The 95% confidence intervals for predicted percent differences fell within ±3% for clinic weights within 3 months of the researcher-measured weights. Furthermore, the growth curve slopes for clinic and researcher-measured weights by treatment group did not differ significantly, suggesting similar inferences about treatment effects over time, in both trials.Compared with researcher-measured weights, close-in-time clinic weights showed high agreement and inference validity. Clinic weights could be a valid pragmatic outcome measure in weight loss studies.

    View details for PubMedID 28059466

    View details for PubMedCentralID PMC5269438

  • Physical education policy compliance and Latino children's fitness: Does the association vary by school neighborhood socioeconomic advantage? PloS one Sanchez-Vaznaugh, E. V., Goldman Rosas, L., Fernández-Peña, J. R., Baek, J., Egerter, S., Sánchez, B. N. 2017; 12 (6)


    To investigate the contribution of school neighborhood socioeconomic advantage to the association between school-district physical education policy compliance in California public schools and Latino students' physical fitness.Cross-sectional Fitnessgram data for public-school students were linked with school- and district-level information, district-level physical education policy compliance from 2004-2005 and 2005-2006, and 2000 United States Census data. Multilevel logistic regression models examined whether income and education levels in school neighborhoods moderated the effects of district-level physical education policy compliance on Latino fifth-graders' fitness levels.Physical education compliance data were available for 48 California school districts, which included 64,073 Latino fifth-graders. Fewer than half (23, or 46%) of these districts were found to be in compliance, and only 16% of Latino fifth-graders attended schools in compliant districts. Overall, there was a positive association between district compliance with physical education policy and fitness (OR, 95%CI: 1.38, 1.07, 1.78) adjusted for covariates. There was no significant interaction between school neighborhood socioeconomic advantage and physical education policy compliance (p>.05): there was a positive pattern in the association between school district compliance with physical education policy and student fitness levels across levels of socioeconomic advantage, though the association was not always significant.Across neighborhoods with varying levels of socioeconomic advantage, increasing physical education policy compliance in elementary schools may be an effective strategy for improving fitness among Latino children.

    View details for DOI 10.1371/journal.pone.0178980

    View details for PubMedID 28591139

  • Use of a motivational interviewing-informed strategy in group orientations to improve retention and intervention attendance in a randomized controlled trial HEALTH EDUCATION RESEARCH Xiao, L., Lv, N., Rosas, L. G., Karve, S., Luna, V., Jameiro, E., Wittels, N., Ma, J. 2016; 31 (6): 729–37


    High retention and treatment adherence are essential to ensure the quality of evidence from clinical trials. Strategies for improving these have been explored but actual rates in lifestyle intervention trials indicate challenges. This study examined the use of a motivational interviewing-informed strategy during interactive group orientations prior to obtaining informed consent, collecting baseline data and randomization in a healthy dietary pattern intervention trial for asthma control in adults. The themes generated from small group discussions and echoed in large group discussions during the orientation sessions helped potential participants better understand the scientific rationale of the research design and procedures and the practical implications for them to participate in the study. Potential participants reported significantly lower confidence of completing the study after the group orientation. This suggests that the group orientations helped potential participants identify challenges to completing the study, have more realistic expectations about participation and be prepared if enrolled. Both retention (92% of 90 participants at 6 months) and intervention attendance (99% of 46 intervention participants attended 80% of 11 weekly group/individual sessions) were high, suggesting the motivation interviewing-informed group orientation strategy may help improve retention and adherence in clinical trials.

    View details for PubMedID 27923862

  • Harnessing Technology and Citizen Science to Support Neighborhoods that Promote Active Living in Mexico. Journal of urban health : bulletin of the New York Academy of Medicine Rosas, L. G., Salvo, D., Winter, S. J., Cortes, D., Rivera, J., Rodriguez, N. M., King, A. C. 2016: -?


    Middle- and low-income countries bear 80 % of the global chronic disease burden. Population-level, multi-sectoral approaches to promoting healthful lifestyles that take into local physical, socioeconomic, and sociocultural characteristics of both the environment and the population are needed. The "Nuestra Voz (Our Voice)" is one such approach that involves neighborhood residents acting as "citizen scientists" to systematically gather information on the barriers and facilitators of physical activity in their neighborhoods and then use their data to collectively advocate for local environmental- and policy-level changes to support active living. We pilot tested this approach in Cuernavaca, Mexico with adults and adolescents. This community-engaged and participatory approach is driven by residents, who utilize a GPS-enabled electronic tablet-based application with simple audio-based instructions to take photographs and record audio narratives of facets of their neighborhood that promote or hinder active living. After collecting these data, the citizen scientists come together in a community meeting and use their data to prioritize realistic, multi-level changes for promoting active living in their neighborhoods. A survey assessed participants' acceptability of the approach. Participating citizen scientists included 32 adults and 9 adolescents. The citizen scientists rated the acceptability of five of the nine acceptability survey items with an average of 4.0 or higher out of 5.0, indicating they thought it was "fun," were comfortable carrying the tablet, were likely to use it again, and would recommend it to friends and family. Items with average scores of less than 4 were all related to safety concerns. The most common barriers reported by citizen scientists using the tablet were poor sidewalk quality, presence of trash, negative characteristics of the streets, unpleasant aesthetics (e.g., graffiti), and presence of parks and recreational facilities. The Our Voice citizen scientist approach using the Discovery Tool has high potential for assisting communities in diverse settings to begin to identify both local barriers to active living as well as potentially useful strategies for promoting physical activity in culturally congruent ways that are appropriate and feasible in the local context.

    View details for PubMedID 27752825

  • Development and evaluation of an enhanced diabetes prevention program with psychosocial support for urban American Indians and Alaska natives: A randomized controlled trial CONTEMPORARY CLINICAL TRIALS Rosas, L. G., Vasquez, J. J., Naderi, R., Jeffery, N., Hedlin, H., Qin, F., LaFromboise, T., Megginson, N., Pasqua, C., Flores, O., McClinton-Brown, R., Evans, J., Stafford, R. S. 2016; 50: 28-36


    Diabetes is highly prevalent, affecting over 25 million adults in the US, yet it can be effectively prevented through lifestyle interventions, including the well-tested Diabetes Prevention Program (DPP). American Indian/Alaska Native (AIAN) adults, the majority of whom live in urban settings, are more than twice as likely to develop diabetes as non-Hispanic whites. Additionally, prevalent mental health issues and psychosocial stressors may facilitate progression to diabetes and hinder successful implementation of lifestyle interventions for AIAN adults. This 2-phased study first engaged community stakeholders to develop culturally-tailored strategies to address mental health concerns and psychosocial stressors. Pilot testing (completed) refined those strategies that increase engagement in an enhanced DPP for urban AIAN adults. Second, the enhanced DPP will be compared to a standard DPP in a randomized controlled trial (ongoing) with a primary outcome of body mass index (BMI) and a secondary outcome of quality of life (QoL) over 12months. Obese self-identified AIAN adults residing in an urban setting with one or more components of the metabolic syndrome (excluding waist circumference) will be randomized to the enhanced or standard DPP (n=204). We hypothesize that addressing psychosocial barriers within a culturally-tailored DPP will result in clinical (BMI) and superior patient-centered (QoL) outcomes as compared to a standard DPP. Exploratory outcomes will include cardiometabolic risk factors (e.g., waist circumference, blood pressure, fasting glucose) and health behaviors (e.g., diet, physical activity). Results of this trial may be applicable to other urban AIAN or minority communities or even diabetes prevention in general.

    View details for DOI 10.1016/j.cct.2016.06.015

    View details for Web of Science ID 000385321600005

    View details for PubMedID 27381232

  • Acceptability and feasibility of the 'DASH for Asthma' intervention in a randomized controlled trial pilot study PUBLIC HEALTH NUTRITION Blonstein, A. C., Lv, N., Camargo, C. A., Wilson, S. R., Buist, A., Rosas, L. G., Strub, P., Ma, J. 2016; 19 (11): 2049–59


    'DASH for Asthma' (n 90) was a 6-month randomized controlled trial that demonstrated potential benefits of a DASH (Dietary Approaches to Stop Hypertension) behavioural intervention for improving diet quality and asthma control by comparing intervention to usual care in adults with uncontrolled asthma. The present study examined acceptability and feasibility of the intervention from the perspective of intervention participants and lifestyle coaches.Grounded in Social Cognitive Theory, the 3-month intensive stage, including three individual and eight group sessions, focused on diet modifications and behavioural self-regulation. The 3-month maintenance stage contained telephone consultations. Participants and lifestyle coaches completed surveys including 5-point Likert scales and open-ended questions. We analysed data using descriptive and inductive content analyses.Forty-six intervention participants (survey response rate was 65-72 %) and two lifestyle coaches.Participants and lifestyle coaches were highly satisfied (all mean ratings >4) with individual and group sessions. Participants identified mastery of knowledge and skills (awareness, goal setting, self-monitoring, problem solving), social learning (class members sharing experiences and ideas) and good coaching skills (reflective listening, empathy, motivational counselling) as important contributors to self-efficacy and programme satisfaction. Participants also valued personalized feedback received in individual sessions. Lifestyle coaches viewed participant engagement as a facilitator to effective sessions. Finally, participants and lifestyle coaches identified food tasting as beneficial for observational learning and facilitation of participant engagement. High class attendance and self-monitoring rate also reflected the high engagement among participants.The DASH behavioural intervention was feasible and highly acceptable to participants with uncontrolled asthma and lifestyle coaches.

    View details for PubMedID 26653101

  • Maternal Depression and Childhood Overweight in the CHAMACOS Study of Mexican-American Children MATERNAL AND CHILD HEALTH JOURNAL Audelo, J., Kogut, K., Harley, K. G., Rosas, L. G., Stein, L., Eskenazi, B. 2016; 20 (7): 1405–14


    Objective Although previous studies have examined the impact of maternal depression on child overweight and obesity, little is known about the relationship in Latino families, who suffer from high risks of depression and obesity. We prospectively investigated the association between depressive symptoms in women with young children and child overweight and obesity (overweight/obesity) at age 7 years among Latino families. Methods Participants included 332 singletons with anthropometric measures obtained at 7 years from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) study, a birth cohort study. Maternal depression was assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale when the children were 1, 3.5, and 7 years. Overweight and obesity was measured by body mass index (kg/m(2)) at age 7 years. Results 63 % of women had CES-D scores consistent with depression in at least one of the 3 given assessments. Compared to children whose mothers were never depressed, children whose mothers were depressed at all three assessments had 2.4 times the adjusted odds of overweight/obesity at age 7 years (95 % CI 1.1-5.6). However, a single positive maternal depression screen was not associated with child overweight/obesity and there was no difference in the odds of overweight/obesity by the age of the child when maternal depression occurred. Conclusion Chronic maternal depression during a child's early life was associated with child overweight/obesity at 7 years. Addressing maternal depression is a critical component of comprehensive obesity prevention and treatment strategies for Latino children.

    View details for PubMedID 27007986

  • Leveraging Citizen Science and Wearable Technologies for Population Physical Activity Promotion King, A. C., Winter, S. J., Sheats, J. L., Rosas, L. G., Buman, M. P., Salvo, D., Rodriguez, N. M., Seguin, R. A., Moran, M., Garber, R., Broderick, B., Zieff, S. G., Sarmiento, O., Gonzalez, S. A., Banchoff, A. W., Rivera, D. HUMAN KINETICS PUBL INC. 2016: S99–S100
  • Leveraging Citizen Science and Information Technology for Population Physical Activity Promotion. Translational journal of the American College of Sports Medicine King, A. C., Winter, S. J., Sheats, J. L., Rosas, L. G., Buman, M. P., Salvo, D., Rodriguez, N. M., Seguin, R. A., Moran, M., Garber, R., Broderick, B., Zieff, S. G., Sarmiento, O. L., Gonzalez, S. A., Banchoff, A., Dommarco, J. R. 2016; 1 (4): 30-44


    While technology is a major driver of many of society's comforts, conveniences, and advances, it has been responsible, in a significant way, for engineering regular physical activity and a number of other positive health behaviors out of people's daily lives. A key question concerns how to harness information and communication technologies (ICT) to bring about positive changes in the health promotion field. One such approach involves community-engaged "citizen science," in which local residents leverage the potential of ICT to foster data-driven consensus-building and mobilization efforts that advance physical activity at the individual, social, built environment, and policy levels.The history of citizen science in the research arena is briefly described and an evidence-based method that embeds citizen science in a multi-level, multi-sectoral community-based participatory research framework for physical activity promotion is presented.Several examples of this citizen science-driven community engagement framework for promoting active lifestyles, called "Our Voice", are discussed, including pilot projects from diverse communities in the U.S. as well as internationally.The opportunities and challenges involved in leveraging citizen science activities as part of a broader population approach to promoting regular physical activity are explored. The strategic engagement of citizen scientists from socio-demographically diverse communities across the globe as both assessment as well as change agents provides a promising, potentially low-cost and scalable strategy for creating more active, healthful, and equitable neighborhoods and communities worldwide.

    View details for PubMedID 27525309

  • Precision Lifestyle Medicine A New Frontier in the Science of Behavior Change and Population Health AMERICAN JOURNAL OF PREVENTIVE MEDICINE Ma, J., Rosas, L. G., Lv, N. 2016; 50 (3): 395–97

    View details for PubMedID 26651423

    View details for PubMedCentralID PMC4762748

  • Pilot randomised trial of a healthy eating behavioural intervention in uncontrolled asthma EUROPEAN RESPIRATORY JOURNAL Ma, J., Strub, P., Lv, N., Xiao, L., Camargo, C. A., Buist, A. S., Lavori, P. W., Wilson, S. R., Nadeau, K. C., Rosas, L. G. 2016; 47 (1): 122-132


    Rigorous research on the benefit of healthy eating patterns for asthma control is lacking.We randomised 90 adults with objectively confirmed uncontrolled asthma and a low-quality diet (Dietary Approaches to Stop Hypertension (DASH) scores <6 out of 9) to a 6-month DASH behavioural intervention (n=46) or usual-care control (n=44). Intention-to-treat analyses used repeated-measures mixed models.Participants were middle-aged, 67% female and multiethnic. Compared with controls, intervention participants improved on DASH scores (mean change (95% CI) 0.6 (0, 1.1) versus -0.3 (-0.8, 0.2); difference 0.8 (0.2, 1.5)) and the primary outcome, Asthma Control Questionnaire scores (-0.2 (-0.5, 0) versus 0 (-0.3, 0.3); difference -0.2 (-0.5, 0.1)) at 6 months. The mean group differences in changes in Mini Asthma Quality of Life Questionnaire overall and subdomain scores consistently favoured the intervention over the control group: overall 0.4 (95% CI 0, 0.8), symptoms 0.5 (0, 0.9), environment 0.4 (-0.1, 1.0), emotions 0.4 (-0.2, 0.9) and activities 0.3 (0, 0.7). These differences were modest, but potentially clinical significant.The DASH behavioural intervention improved diet quality with promising clinical benefits for better asthma control and functional status among adults with uncontrolled asthma. A full-scale efficacy trial is warranted.

    View details for DOI 10.1183/13993003.00591-2015

    View details for Web of Science ID 000367443900018

    View details for PubMedCentralID PMC5136475

  • Pilot randomised trial of a healthy eating behavioural intervention in uncontrolled asthma. The European respiratory journal Ma, J. n., Strub, P. n., Lv, N. n., Xiao, L. n., Camargo, C. A., Buist, A. S., Lavori, P. W., Wilson, S. R., Nadeau, K. C., Rosas, L. G. 2016; 47 (1): 122–32


    Rigorous research on the benefit of healthy eating patterns for asthma control is lacking.We randomised 90 adults with objectively confirmed uncontrolled asthma and a low-quality diet (Dietary Approaches to Stop Hypertension (DASH) scores <6 out of 9) to a 6-month DASH behavioural intervention (n=46) or usual-care control (n=44). Intention-to-treat analyses used repeated-measures mixed models.Participants were middle-aged, 67% female and multiethnic. Compared with controls, intervention participants improved on DASH scores (mean change (95% CI) 0.6 (0, 1.1) versus -0.3 (-0.8, 0.2); difference 0.8 (0.2, 1.5)) and the primary outcome, Asthma Control Questionnaire scores (-0.2 (-0.5, 0) versus 0 (-0.3, 0.3); difference -0.2 (-0.5, 0.1)) at 6 months. The mean group differences in changes in Mini Asthma Quality of Life Questionnaire overall and subdomain scores consistently favoured the intervention over the control group: overall 0.4 (95% CI 0, 0.8), symptoms 0.5 (0, 0.9), environment 0.4 (-0.1, 1.0), emotions 0.4 (-0.2, 0.9) and activities 0.3 (0, 0.7). These differences were modest, but potentially clinical significant.The DASH behavioural intervention improved diet quality with promising clinical benefits for better asthma control and functional status among adults with uncontrolled asthma. A full-scale efficacy trial is warranted.

    View details for PubMedID 26493792

  • Service-Based Learning for Residents: A Success for Communities and Medical Education. Family medicine Gefter, L., Merrell, S. B., Rosas, L. G., Morioka-Douglas, N., Rodriguez, E. 2015; 47 (10): 803-806


    Community-based service-learning opportunities could support residents' acquisition of Accreditation Council for Graduate Medical Education (ACGME) competencies, but this concept has not been tested, and such programs are difficult to find. The objective of this work was to assess the value and the ACGME competency relevance of a service-learning program for residents that could be easily replicated nationally.Forty-one family medicine residents from three training programs participated in the Stanford Youth Diabetes Coaches Program at six high schools in California and Georgia serving minority students of low socioeconomic status. Residents completed online surveys to provide qualitative feedback and assess the program's impact on their acquisition of residency program competencies and self-management support proficiencies, including prior use and planned use of action plans-a key self-management support strategy.Ninety-five percent of residents indicated that the program was a valuable experience that contributed to acquisition of residency program competencies, including interpersonal and communication skills and communication with teens. Compared with baseline, significantly more residents reported intention to use action plans with patients following participation. Themes from qualitative feedback included: valuing the overall experience, increasing opportunities to practice teaching, enhancing their ability to communicate with adolescents, contributing to the health of the community, recognizing the potential of action plans, and increasing intent to use action plans.This pilot demonstrated that a brief service-learning program can enhance standard residency curriculum by encouraging acquisition of ACGME competencies and promoting utilization of self-management support in clinical practice.

    View details for PubMedID 26545059

  • Nativity, US Length of Residence, and BMI Among Diverse Asian American Ethnic Groups. Journal of immigrant and minority health Rosas, L. G., Sanchez-Vaznaugh, E. V., Sánchez, B. N. 2015; 17 (5): 1496-1503


    Little is known about body mass index (BMI) patterns by nativity and length of US residence among Asian American ethnic groups. We used linear regression to examine the association of BMI with nativity and length of residence across six ethnic groups (Filipinos, Japanese, Chinese, Koreans, South Asians, and Vietnamese) using data from the California Health Interview Study. There was significant heterogeneity in the nativity/length of residence patterns in unadjusted BMI across ethnic groups (p < 0.001). In fully adjusted models, heterogeneity was attenuated (p = 0.05) with BMI among all US-born ethnic groups significantly higher than BMI for immigrants with the exception of South Asians. Longer US residence was positively associated with BMI among all groups, though only significant among Filipinos and Koreans. Programs targeting Asian Americans should take into consideration BMI patterns by nativity and US length of residence among diverse Asian American ethnic groups.

    View details for DOI 10.1007/s10903-014-0096-6

    View details for PubMedID 25192818

  • Pica during pregnancy among Mexican-born women: a formative study. Maternal and child nutrition Lin, J. W., Temple, L., Trujillo, C., Mejia-Rodriquez, F., Rosas, L. G., Fernald, L., Young, S. L. 2015; 11 (4): 550-558


    Although pica, the craving and purposive consumption of non-food substances, is common among many populations, especially during pregnancy, the health consequences are not well understood. Further, very little is known about pica among Mexican populations in the United States and Mexico. Therefore, we conducted formative research to understand pica in this understudied population. Our objectives were to identify the frequency and types of pica behaviours, to understand perceived aetiologies and consequences of pica and to ascertain if the behaviour was common enough to warrant a larger study. We held nine focus group discussions (three in the Salinas Valley, California; six in Xoxocotla, Morelos, Mexico) with 76 Mexican-born women who were currently pregnant or had delivered within the past 2 years. Earth, adobe, bean stones and ice were the most commonly reported pica substances. Twenty-eight of the 76 participants (37%) reported ever engaging in pica; 22 participants (29%) reported doing so during pregnancy. The proportion of women reporting pica in the United States and Mexico was 43% and 34%, respectively. Women attributed pica to the overwhelming organoleptic appeal of pica substances (especially smell and texture) and to micronutrient deficiencies. Perceived consequences of unfulfilled pica cravings were birthmarks or fetal loss; fulfilled pica cravings were also thought to be generally harmful to the mother or child, with several women specifying toxic lead, pesticides or 'worms'. In sum, pica among Mexican women is common enough to warrant a larger epidemiologic study of its sociodemographic correlates and physiological consequences.

    View details for DOI 10.1111/mcn.12120

    View details for PubMedID 24784797

    View details for PubMedCentralID PMC4216644

  • Applying the Pragmatic-Explanatory Continuum Indicator Summary Model in a Primary Care-Based Lifestyle Intervention Trial AMERICAN JOURNAL OF PREVENTIVE MEDICINE Rosas, L. G., Lv, N., Azar, K., Xiao, L., Yank, V., Ma, J. 2015; 49 (3): S208-S214


    The majority of adults in the U.S. can be classified as overweight or obese (68%), putting them at risk for Type 2 diabetes, cardiovascular diseases, and other adverse health outcomes. The U.S. Preventive Services Task Force recommends that providers offer or refer obese adults to intensive, multicomponent lifestyle interventions. However, there is a critical need for interventions that have been shown to be pragmatic and effective among diverse populations, scalable across different clinical settings and systems, and sustainable over time. The Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) tool can be used to assess the degree to which trials of behavioral lifestyle interventions provide evidence to support this need. We used our recently completed trial, Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care (E-LITE), as a case study and assessed the domains of PRECIS to explore the degree to which we felt it achieved its intended pragmatic design (completed in December 2014). Overall, the systematic assessment using the PRECIS tool revealed that the E-LITE trial design was very pragmatic in nature. Its results and the subsequent adoption of the intervention into actual practice also suggest high potential for implementation of primary care interventions.

    View details for DOI 10.1016/j.amepre.2015.05.011

    View details for Web of Science ID 000359878100011

  • Applying the Pragmatic-Explanatory Continuum Indicator Summary Model in a Primary Care-Based Lifestyle Intervention Trial. American journal of preventive medicine Rosas, L. G., Lv, N., Azar, K., Xiao, L., Yank, V., Ma, J. 2015; 49 (3): S208-14


    The majority of adults in the U.S. can be classified as overweight or obese (68%), putting them at risk for Type 2 diabetes, cardiovascular diseases, and other adverse health outcomes. The U.S. Preventive Services Task Force recommends that providers offer or refer obese adults to intensive, multicomponent lifestyle interventions. However, there is a critical need for interventions that have been shown to be pragmatic and effective among diverse populations, scalable across different clinical settings and systems, and sustainable over time. The Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) tool can be used to assess the degree to which trials of behavioral lifestyle interventions provide evidence to support this need. We used our recently completed trial, Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care (E-LITE), as a case study and assessed the domains of PRECIS to explore the degree to which we felt it achieved its intended pragmatic design (completed in December 2014). Overall, the systematic assessment using the PRECIS tool revealed that the E-LITE trial design was very pragmatic in nature. Its results and the subsequent adoption of the intervention into actual practice also suggest high potential for implementation of primary care interventions.

    View details for DOI 10.1016/j.amepre.2015.05.011

    View details for PubMedID 26296556

  • Research aimed at improving both mood and weight (RAINBOW) in primary care: A type 1 hybrid design randomized controlled trial. Contemporary clinical trials Ma, J., Yank, V., Lv, N., Goldhaber-Fiebert, J. D., Lewis, M. A., Kramer, M. K., Snowden, M. B., Rosas, L. G., Xiao, L., Blonstein, A. C. 2015; 43: 260-278


    Effective interventions targeting comorbid obesity and depression are critical given the increasing prevalence and worsened outcomes for patients with both conditions. RAINBOW is a type 1 hybrid design randomized controlled trial. The objective is to evaluate the clinical and cost effectiveness and implementation potential of an integrated, technology-enhanced, collaborative care model for treating comorbid obesity and depression in primary care. Obese and depressed adults (n=404) will be randomized to usual care enhanced with the provision of a pedometer and information about the health system's services for mood or weight management (control) or with the Integrated Coaching for Better Mood and Weight (I-CARE) program (intervention). The 12-month I-CARE program synergistically integrates two proven behavioral interventions: problem-solving therapy with as-needed intensification of pharmacotherapy for depression (PEARLS) and standardized behavioral treatment for obesity (Group Lifestyle Balance™). It utilizes traditional (e.g., office visits and phone consults) and emerging care delivery modalities (e.g., patient web portal and mobile applications). Follow-up assessments will occur at 6, 12, 18, and 24months. We hypothesize that compared with controls, I-CARE participants will have greater improvements in weight and depression severity measured by the 20-item Depression Symptom Checklist at 12months, which will be sustained at 24months. We will also assess I-CARE's cost-effectiveness and use mixed methods to examine its potential for reach, adoption, implementation, and maintenance. This study offers the potential to change how obese and depressed adults are treated-through a new model of accessible and integrative lifestyle medicine and mental health expertise-in primary care.

    View details for DOI 10.1016/j.cct.2015.06.010

    View details for PubMedID 26096714

    View details for PubMedCentralID PMC4537656

  • The Effectiveness of Two Community-Based Weight Loss Strategies among Obese, Low-Income US Latinos JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS Rosas, L. G., Thiyagarajan, S., Goldstein, B. A., Drieling, R. L., Romero, P. P., Ma, J., Yank, V., Stafford, R. S. 2015; 115 (4): 537-U300


    Latino immigrants have high rates of obesity and face barriers to weight loss.To evaluate the effectiveness of a case-management (CM) intervention with and without community health workers (CHWs) for weight loss.This was a 2-year, randomized controlled trial comparing two interventions with each other and with usual care (UC).Eligible participants included Latinos with a body mass index of 30 to 60 and one or more heart disease risk factors. The 207 participants recruited during 2009-2010 had a mean age of 47 years and were mostly women (77%). At 24 months, 86% of the sample was assessed.The CM+CHW (n=82) and CM (n=84) interventions were compared with each other and with UC (n=41). Both included an intensive 12-month phase followed by 12 months of maintenance. The CM+CHW group received home visits.Weight change at 24 months.Generalized estimating equations using intent-to-treat.At 6 months, mean weight loss in the CM+CHW arm was -2.1 kg (95% CI -2.8 to -1.3) or -2% of baseline weight (95% CI -1% to -2%) compared with -1.6 kg (95% CI -2.4 to -0.7; % weight change, -2%, -1%, and -3%) in CM and -0.9 kg (95% CI -1.8 to 0.1; % weight change, -1%, 0%, and -2%) in UC. By 12 and 24 months, differences narrowed and CM+CHW was no longer statistically distinct. Men achieved greater weight loss than women in all groups at each time point (P<0.05). At 6 months, men in the CM+CHW arm lost more weight (-4.4 kg; 95% CI -6.0 to -2.7) compared with UC (-0.4 kg; 95% CI -2.4 to 1.5), but by 12 and 24 months differences were not significant.This study demonstrated that incorporation of CHWs may help promote initial weight loss, especially among men, but not weight maintenance. Additional strategies to address social and environmental influences may be needed for Latino immigrant populations.

    View details for DOI 10.1016/j.jand.2014.10.020

    View details for Web of Science ID 000351779000008

    View details for PubMedID 25578925

    View details for PubMedCentralID PMC4380577

  • Randomized Trial Of Healthy Eating Pattern In Adults With Uncontrolled Asthma Ma, J., Xiao, L., Lv, N., Camargo, C. A., Wilson, S. R., Buist, S., Lavori, P., Strub, P., Nadeau, K. C., Rosas, L. G. AMER THORACIC SOC. 2015
  • Process Evaluation Of The "dash For Asthma" Intervention In A Randomized Controlled Trial Pilot Study Lv, N., Blonstein, A. C., Camargo, C. A., Wilson, S. R., Buist, S., Lavori, P., Strub, P., Nadeau, K. C., Xiao, L., Rosas, L. G., Ma, J. AMER THORACIC SOC. 2015
  • Training at-risk youth to become diabetes self-management coaches for family members: partnering family medicine residents with underserved schools. Diabetes educator Gefter, L., Rosas, L. G., Rodriguez, E., Morioka-Douglas, N. 2014; 40 (6): 786-796


    The purpose of this study is to evaluate the impact of a school-based health program in which family medicine residents trained healthy at-risk adolescents to become diabetes self-management coaches for family members with diabetes.A mixed methods study included 97 adolescents from 3 San Francisco Bay Area high schools serving primarily ethnic minority youth of low socioeconomic status. Physicians came to schools once a week for 8 weeks and trained 49 adolescents to become coaches. Student coaches and 48 nonparticipant students completed pre- and posttest intervention questionnaires, and 15 student coaches and 9 family members with diabetes gave in-depth interviews after participation. Linear regression was used to determine differences in knowledge and psychosocial assets on pre- and posttests between student coaches and nonparticipant students, and NVIVO was used to analyze interview transcripts.After controlling for initial score, sex, grade, and ethnicity, student coaches improved from pre- to posttest significantly compared to nonparticipants on knowledge, belonging, and worth scales. Student coaches reported high satisfaction with the program. Articulated program benefits included improvement in diet, increased physical activity, and improved relationship between student coach and family member.Overall, this program can increase diabetes knowledge and psychosocial assets of at-risk youth, and it holds promise to promote positive health behaviors among at-risk youth and their families.

    View details for DOI 10.1177/0145721714549676

    View details for PubMedID 25208725

  • Acceptability of health information technology aimed at environmental health education in a prenatal clinic PATIENT EDUCATION AND COUNSELING Rosas, L. G., Trujillo, C., Camacho, J., Madrigal, D., Bradman, A., Eskenazi, B. 2014; 97 (2): 244-247


    To describe the acceptability of an interactive computer kiosk that provides environmental health education to low-income Latina prenatal patients.A mixed-methods approach was used to assess the acceptability of the Prenatal Environmental Health Kiosk pregnant Latina women in Salinas, CA (n=152). The kiosk is a low literacy, interactive touch-screen computer program with an audio component and includes graphics and an interactive game.The majority had never used a kiosk before. Over 90% of women reported that they learned something new while using the kiosk. Prior to using the kiosk, 22% of women reported their preference of receiving health education from a kiosk over a pamphlet or video compared with 57% after using the kiosk (p<0.01). Qualitative data revealed: (1) benefit of exposure to computer use; (2) reinforcing strategy of health education; and (3) popularity of the interactive game.The Prenatal Environmental Health Kiosk is an innovative patient health education modality that was shown to be acceptable among a population of low-income Latino pregnant women in a prenatal care clinic.This pilot study demonstrated that a health education kiosk was an acceptable strategy for providing Latina prenatal patients with information on pertinent environmental exposures.

    View details for DOI 10.1016/j.pec.2014.07.018

    View details for Web of Science ID 000344824800014

    View details for PubMedCentralID PMC4520806

  • Community Resource Utilization, Psychosocial Health, and Sociodemographic Factors Associated with Diet and Physical Activity among Low-Income Obese Latino Immigrants JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS Drieling, R. L., Rosas, L. G., Ma, J., Stafford, R. S. 2014; 114 (2): 257-265


    Low-socioeconomic-status (SES) Latinos are disproportionately represented among the 78 million obese Americans. Tailored behavioral weight-loss interventions show promise, but there is limited adaptation to lower-SES Latino immigrants. This study provides guidance for tailoring obesity-reduction strategies for this population by evaluating food security, educational community resource utilization, education level, depression, sex, and length of US residence as predictors of diet and physical activity. The cross-sectional study used baseline data collected in July 2009 through September 2010 for a weight-loss trial among lower-SES obese (body mass index 30 to 55) Latino immigrants who were enrolled at a community health clinic (n=207). Physical activity was measured using 7-day pedometer recording. Dietary intake was measured using an interviewer-administered food frequency questionnaire. Factors assessed by questionnaire included education community resource use (nutrition and physical activity classes), education level, US residence (years), food security, and depressive symptoms. Data were analyzed using multivariate-adjusted linear regression models. More than one third of participants were sedentary (<5,000 steps/day), and 41% had low fruit and vegetable intake (<5 servings/day). In multivariate-adjusted models, educational community resource use, male sex, less education, fewer depressive symptoms, and shorter US residence time were associated with more physical activity (all, P ≤ 0.05). Educational community resource use was positively associated with fruit and vegetable intake (P=0.05). Male sex was associated with more sweet-beverage intake (P=0.02) and fast-food intake (P=0.04). Fewer depressive symptoms were associated with lower sweet-beverage intake (P=0.05). In conclusion, obesity-reduction strategies among low-SES Latino immigrants might effectively emphasize educational community resource use and interventions tailored for psychosocial and sociodemographic characteristics.

    View details for DOI 10.1016/j.jand.2013.07.025

    View details for Web of Science ID 000331853100012

    View details for PubMedID 24119533

    View details for PubMedCentralID PMC3947013

  • Short-term weight loss patterns, baseline predictors, and longer-term follow-up within a randomized controlled trial OBESITY Yank, V., Xiao, L., Wilson, S. R., Stafford, R. S., Rosas, L. G., Ma, J. 2014; 22 (1): 45-51


    OBJECTIVE: To examine weight loss patterns and predictors among participants in a primary care-based translation study of the Diabetes Prevention Program lifestyle intervention. DESIGN AND METHODS: Cluster analysis identified short-term (12-week) weight loss patterns among 72 intervention participants. Analysis of variance assessed cluster differences in weight loss maintenance at 15-month follow-up. Discriminant analysis identified baseline characteristics that best differentiated between clusters. RESULTS: Participants had baseline mean (SD) age of 55.0 (10.8) years and BMI of 31.9 (5.2) kg/m(2) . Cluster analysis identified three short-term weight loss patterns: modest (n=15; 21%), moderate-and-steady (n=43; 60%), and substantial-and-early (n=14; 19%). Only participants with the latter two patterns achieved clinically significant (≥ 5%) short-term weight loss and maintained it at 15 months. On discriminant analysis, the modest cluster was most differentiated from other clusters by high friend encouragement for dietary change, high obesity-related problems, and low physical well-being. The moderate-and-steady cluster was differentiated by lower physical activity, family encouragement, and depression symptoms. CONCLUSION: Results provide insight into the heterogeneity of response to an effective lifestyle intervention by identifying short-term weight loss patterns and their baseline predictors and relationship to 15-month success. If replicated, results may help tailor strategies for participant subgroups in weight loss programs.

    View details for DOI 10.1002/oby.20510

    View details for Web of Science ID 000329613600011

    View details for PubMedID 23740619

  • Associations between perinatal factors and adiponectin and leptin in 9-year-old Mexican-American children PEDIATRIC OBESITY Volberg, V., Harley, K. G., Aguilar, R. S., Rosas, L. G., Huen, K., Yousefi, P., Dave, V., Nguyet Phan, N., Lustig, R. H., Eskenazi, B., Holland, N. 2013; 8 (6): 454-463


    Mexican-American children are at particularly high risk of obesity. Features of the perinatal environment, including maternal nutrition, anthropometry, glucose tolerance and growth rate during infancy are implicated in programming of obesity in the offspring.Greater rate of weight or length gain in the first 6 months of life is associated with lower 9-year child adiponectin levels, adjusting for 9-year child BMI. Nine-year-old child adipokine levels are strongly related to those of their mothers'.To (i) determine whether perinatal factors (including maternal anthropometry and nutrition and early life growth measures) are associated with adiponectin and leptin levels in 9-year-old children, and (ii) assess relationships between adiponectin, leptin and concurrent lipid profile in these children.We measured plasma adiponectin and leptin for 146 mothers-9-year-old child pairs from the ongoing longitudinal birth cohort followed by the Center for the Health Assessment of Mothers and Children of Salinas. Data on perinatal factors, including sociodemographics, maternal anthropometry and nutrition, and early life child growth were collected during pregnancy, birth and 6-month visits.Greater rate of weight and length gain during the first 6 months of life were associated with lower adiponectin in 9-year-olds (β = -2.0, P = 0.04; β = -8.2, P = 0.02, respectively) adjusting for child body mass index (BMI). We found no associations between child adipokine levels and either maternal calorie, protein, total fat, saturated fat, fibre, sugar-sweetened beverage consumption during pregnancy or children's concurrent sugar-sweetened beverage and fast food intake. Lipid profile in 9-year-old children closely reflected adiponectin but not leptin levels after adjustment for child BMI. Additionally, we report that child adipokine levels were closely related to their mothers' levels at the 9-year visit.Overall, our results support the hypothesis that early life factors may contribute to altered adipokine levels in children.

    View details for DOI 10.1111/j.2047-6310.2012.00127.x

    View details for Web of Science ID 000327212400008

    View details for PubMedCentralID PMC3633700

  • Translating an evidence-based lifestyle intervention program into primary care: lessons learned. Health promotion practice Blonstein, A. C., Yank, V., Stafford, R. S., Wilson, S. R., Rosas, L. G., Ma, J. 2013; 14 (4): 491-497


    The E-LITE (Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care) trial evaluated the feasibility and potential effectiveness of translating an evidence-based lifestyle intervention for the management of obesity and related risk factors in a primary care setting. Delivered by allied health care providers, the intervention promoted at least 7% weight loss and at least 150 minutes per week of moderate-intensity physical activity through gradual, sustainable lifestyle changes. Activities included interactive group lessons, food tasting, guided physical activity, and technology-mediated self-monitoring and behavioral counseling. This article discusses insights and potential areas for improvement to strengthen program implementation for dissemination of the E-LITE program to other primary care settings. We focus on (a) the role of allied health professionals in program delivery, (b) strengthening program integration within a primary care clinic, and (c) the use of information technology to extend the reach and impact of the program. Our experience shows the feasibility of implementing an evidence-based lifestyle intervention program combining group-delivered nutrition and behavioral counseling, physical activity training, and technology-mediated follow-up in a primary care setting. Challenges remain, and we offer possible solutions to overcome them.

    View details for DOI 10.1177/1524839913481604

    View details for PubMedID 23539264

  • Pregnancy Glycemia in Mexican-American Women Without Diabetes or Gestational Diabetes and Programming for Childhood Obesity AMERICAN JOURNAL OF EPIDEMIOLOGY Ehrlich, S. F., Rosas, L. G., Ferrara, A., King, J. C., Abrams, B., Harley, K. G., Hedderson, M. M., Eskenazi, B. 2013; 177 (8): 768-775


    In the present study, we estimated the association between pregnancy glucose levels and offspring body mass index (BMI) z scores at 2, 3.5, 5, and 7 years of age, as well as z score trajectories across this age range, among Mexican-American women without diabetes or gestational diabetes. Beginning in 1999-2000, the Center for the Health Assessment of Mothers and Children of Salinas prospectively followed women from Monterey County, California (52 obese and 214 nonobese women) and their children. Plasma glucose values obtained 1 hour after a 50-g oral glucose load comprised the exposure. Offspring BMIs were compared with national data to calculate z scores. Increasing pregnancy glucose levels were associated with increased offspring BMI z scores at 7 years of age; a 1-mmol/L increase in glucose corresponded to an increase of 0.11 (standard deviation = 0.044) z-score units (P < 0.05). In nonobese women only, the mean z score over this age range increased with increasing glucose levels. The average BMI z score at 4.5 years of age increased by 0.12 (standard error, 0.059) units for each 1-mmol/L increase in glucose (P = 0.04). In obese women only, increasing glucose was associated with increases in BMI z score over time (P = 0.07). Whether interventions to reduce glucose values in women free of disease could mitigate childhood obesity remains unknown.

    View details for DOI 10.1093/aje/kws312

    View details for Web of Science ID 000317435600006

    View details for PubMedID 23504745

    View details for PubMedCentralID PMC3668427

  • Translating the Diabetes Prevention Program Lifestyle Intervention for Weight Loss Into Primary Care A Randomized Trial JAMA INTERNAL MEDICINE Ma, J., Yank, V., Xiao, L., Lavori, P. W., Wilson, S. R., Rosas, L. G., Stafford, R. S. 2013; 173 (2): 113-121


    The Diabetes Prevention Program (DPP) lifestyle intervention reduced the incidence of type 2 diabetes mellitus (DM) among high-risk adults by 58%, with weight loss as the dominant predictor. However, it has not been adequately translated into primary care.We evaluated 2 adapted DPP lifestyle interventions among overweight or obese adults who were recruited from 1 primary care clinic and had pre-DM and/or metabolic syndrome. Participants were randomized to (1) a coach-led group intervention (n = 79), (2) a self-directed DVD intervention (n = 81), or (3) usual care (n = 81). During a 3-month intensive intervention phase, the DPP-based behavioral weight-loss curriculum was delivered by lifestyle coach-led small groups or home-based DVD. During the maintenance phase, participants in both interventions received lifestyle change coaching and support remotely-through secure email within an electronic health record system and the American Heart Association Heart360 website for weight and physical activity goal setting and self-monitoring. The primary outcome was change in body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) from baseline to 15 months.At baseline, participants had a mean (SD) age of 52.9 (10.6) years and a mean BMI of 32.0 (5.4); 47% were female; 78%, non-Hispanic white; and 17%, Asian/Pacific Islander. At month 15, the mean ± SE change in BMI from baseline was -2.2 ± 0.3 in the coach-led group vs -0.9 ± 0.3 in the usual care group (P < .001) and -1.6 ± 0.3 in the self-directed group vs usual care (P = .02). The percentages of participants who achieved the 7% DPP-based weight-loss goal were 37.0% (P = .003) and 35.9% (P = .004) in the coach-led and self-directed groups, respectively, vs 14.4% in the usual care group. Both interventions also achieved greater net improvements in waist circumference and fasting plasma glucose level.Proven effective in a primary care setting, the 2 DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health Identifier: NCT00842426.

    View details for DOI 10.1001/2013.jamainternmed.987

    View details for Web of Science ID 000317239700008

    View details for PubMedID 23229846

  • Baseline reach and adoption characteristics in a randomized controlled trial of two weight loss interventions translated into primary care: A structured report of real-world applicability CONTEMPORARY CLINICAL TRIALS Yank, V., Stafford, R. S., Rosas, L. G., Ma, J. 2013; 34 (1): 126-135


    Although the Diabetes Prevention Program (DPP) lifestyle intervention reduced type 2 diabetes incidence by 58% among high-risk adults at academic centers, it requires translation into typical primary care settings. Using baseline data from the Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care (E-LITE) randomized controlled trial, we evaluated the potential of its two DPP-based interventions to reach their target populations and be adopted into routine use.Overweight/obese adults with increased cardiometabolic risk enrolled from one primary care clinic. Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model, we assessed reach with data on patient identification, participation, and representativeness, and adoption with data on intervention feasibility and potential for organizational diffusion.The target population was identified by searching electronic health records. Contact was attempted for 2391 patients who completed initial screening by phone (56% uptake) or online (44%). Most (88%) of those screened ineligible were not within the target population; 12% were excluded because of research requirements. Conservatively estimated participation rate was 44%. Participants (n=241) included 54% men and had a mean (SD) age of 52.9 years (10.6) and body mass index of 32 kg/m(2) (5.4). Regarding adoption, all clinic physicians agreed to participate. The feasibility of intervention implementation and dissemination was enhanced by leveraging existing intervention, training, and primary care resources.E-LITE's lifestyle interventions had fair-to-good potential for primary care reach and adoption. Our trial evidence and structured reporting may inform real-world implementation of translational trials by health networks, physicians, and payers.

    View details for DOI 10.1016/j.cct.2012.10.007

    View details for Web of Science ID 000314448300016

    View details for PubMedID 23124047

    View details for PubMedCentralID PMC3645977

  • Pregnancy Glucose Levels in Women without Diabetes or Gestational Diabetes and Childhood Cardiometabolic Risk at 7 Years of Age JOURNAL OF PEDIATRICS Ehrlich, S. F., Rosas, L. G., Ferrara, A., King, J. C., Abrams, B., Harley, K. G., Hedderson, M. M., Eskenazi, B. 2012; 161 (6): 1016-1021


    To estimate the association between pregnancy glucose values in women without recognized pregestational diabetes or gestational diabetes and cardiometabolic risk in their children.This longitudinal cohort study of 211 Mexican American mother-child pairs participating in the Center for the Health Assessment of Mothers and Children of Salinas study used multiple logistic regression to estimate the children's risk of nonfasting total cholesterol, nonfasting triglycerides, blood pressure (BP), and waist circumference (WC) ≥75th percentile at 7 years of age associated with a 1-mmol/L (18-mg/dL) increase in maternal pregnancy glucose level, measured 1 hour after a 50-g oral glucose load.The ORs for children in the upper quartile of diastolic BP, systolic BP, and WC associated with a 1-mmol/L increase in pregnancy glucose level were 1.39 (95% CI, 1.10-1.75), 1.38 (95% CI, 1.10-1.73), and 1.25 (95% CI, 1.02-1.54), respectively. Prepregnancy obesity was independently associated with increased odds of children belonging to the upper quartile of WC; maternal sugar-sweetened beverage consumption and gestational weight gain prior to the glucose test were not independently associated with any of the cardiometabolic outcomes.In Mexican American women without recognized pregestational diabetes or gestational diabetes, we found an association between increasing pregnancy glucose values and the children's diastolic and systolic BPs and WC at 7 years of age. Whether interventions to reduce pregnancy glucose values, even if below levels diagnostic of overt disease, will mitigate high BP and abdominal obesity in late childhood remains to be determined.

    View details for DOI 10.1016/j.jpeds.2012.05.049

    View details for Web of Science ID 000311348400011

    View details for PubMedID 22790183

  • Practical Research Strategies for Reducing Social and Racial/Ethnic Disparities in Obesity. International journal of obesity Rosas, L. G., Stafford, R. S. 2012; 2012 (2): s16-s22


    Adult and childhood obesity and related adverse outcomes are most common among racial/ethnic minorities and socio-economically disadvantaged populations in the United States . Research approaches to obesity developed in mainstream populations and deploying new information technologies may exacerbate existing disparities in obesity. Current obesity management and prevention research priorities will not maximally impact this critical problem unless investigators explicitly focus on discovering innovative strategies for preventing and managing obesity in the disadvantaged populations that are most affected. On the basis of our research experience, four key research approaches are needed: (1) elucidating the underlying social forces that lead to disparities; (2) directly involving community members in the development of research questions and research methods; (3) developing flexible strategies that allow tailoring to multiple disadvantaged populations; and (4) building culturally and socio-economically tailored strategies specifically for populations most affected by obesity. Our experience with a community-based longitudinal cohort study and two health center-based clinical trials illustrate these principles as a contrast to traditional research priorities that can inadvertently worsen existing social inequities. If obesity research does not directly address healthcare and health-outcome disparities, it will contribute to their perpetuation.

    View details for PubMedID 23667289

  • Physical Education Policy Compliance and Children's Physical Fitness AMERICAN JOURNAL OF PREVENTIVE MEDICINE Sanchez-Vaznaugh, E. V., Sanchez, B. N., Rosas, L. G., Baek, J., Egerter, S. 2012; 42 (5): 452-459


    Physical education policies have received increased attention as a means for improving physical activity levels, enhancing physical fitness, and contributing to childhood obesity prevention. Although compliance at the school and district levels is likely to be critical for the success of physical education policies, few published studies have focused on this issue.This study investigated whether school district-level compliance with California physical education policies was associated with physical fitness among 5th-grade public-school students in California.Cross-sectional data from FITNESSGRAM(®) 2004-2006, district-level compliance with state physical education requirements for 2004-2006, school- and district-level information, and 2000 U.S. Census data were combined to examine the association between district-level compliance with physical education policies and children's fitness levels. The analysis was completed in 2010.Of the 55 districts with compliance data, 28 (50%) were in compliance with state physical education mandates; these districts represented 21% (216) of schools and 18% (n=16,571) of students in the overall study sample. Controlling for other student-, school-, and district-level characteristics, students in policy-compliant districts were more likely than students in noncompliant districts to meet or exceed physical fitness standards (AOR=1.29, 95% CI=1.03, 1.61).Policy mandates for physical education in schools may contribute to improvements in children's fitness levels, but their success is likely to depend on mechanisms to ensure compliance.

    View details for DOI 10.1016/j.amepre.2012.01.008

    View details for Web of Science ID 000302963300009

    View details for PubMedID 22516484