Wei-ting Chen, PhD

All Publications

• The Effectiveness of Recipe4Health: A Quasi-Experimental Evaluation. American journal of preventive medicine Rosas, L. G., Chen, S., Xiao, L., Baiocchi, M., Ng, E., Emmert-Aronson, B. O., Chen, W. T., Thompson-Lastad, A., Martinez, E., Perez, J., Melendez, E., Markle, E., Radtke, M. D., Tester, J. 2024

  Abstract

  Food as Medicine is increasingly recognized as an important strategy for addressing the related challenges of food insecurity and nutrition-related chronic conditions. Food as Medicine refers to integration of food-based nutrition interventions into healthcare to prevent and treat disease. However, there is limited evidence to understand the effectiveness of Food as Medicine.Recipe4Health, a comprehensive Food as Medicine program, was implemented in 4 Federally Qualified Health Centers in California for patients with food insecurity and/or nutrition-related chronic conditions. Patients were referred by a healthcare provider to a 'Food Farmacy' (16 weekly produce home deliveries) alone or in combination with a 'Behavioral Pharmacy' (16 weekly group visits). A quasi-experimental study with pre/post surveys (4 months) and propensity score matched controls for Electronic Health Record (EHR) outcomes over 12 months was conducted. Participants were 2,643 Recipe4Health patients and 2,643 controls identified from 1/2020 to 12/2022; data were analyzed from 2023-2024.There was a significant increase in produce consumption from baseline to four months (0.41 servings/day [0.11, 0.72], p=0.007) in the Food Farmacy in combination with Behavioral Pharmacy. Compared to controls, there were improvements in non-HDL cholesterol for the Food Farmacy alone (-17.1 mg/dl[-26.9, -7.2], p<0.001) and in combination with Behavioral Pharmacy (-17 mg/dl [-28.3, -5.8], p=0.003) at 12 months. Compared to controls, HbA1c significantly decreased in the Food Farmacy alone at 12 months (-0.37%, 95% CI [-0.65, -0.08]; p=0.01), but not the Food Farmacy with Behavioral Pharmacy.Recipe4Health resulted in improvements in diet and multiple clinical health outcomes, such as non-HDL cholesterol and HbA1c.

  View details for DOI 10.1016/j.amepre.2024.10.020

  View details for PubMedID 39491775

• Addressing diabetes by elevating access to nutrition (ADELANTE) - A multi-level approach for improving household food insecurity and glycemic control among Latinos with diabetes: A randomized controlled trial. Contemporary clinical trials Radtke, M. D., Chen, W. T., Xiao, L., Espinosa, P. R., Orizaga, M., Thomas, T., Venditti, E., Yaroch, A. L., Zepada, K., Rosas, L. G., Tester, J. 2024: 107699

  Abstract

  Latinx adults are disproportionately impacted by the interrelated challenges of food insecurity and nutrition sensitive chronic diseases. Food and nutrition insecurity can exacerbate the development and progression of chronic diseases, such as diabetes. Sustainable, effective interventions aimed at improving food insecurity and diabetes management for Latinx populations are needed.This hybrid type 1 trial evaluates the effectiveness of a multi-level intervention that includes a medically supportive food and behavioral lifestyle program on the primary outcome of Hemoglobin A1c (HbA1c) at 6 months. Latinx adults (n = 355) with type 2 diabetes (HbA1c of 6.0-12.0 %), overweight/obesity (BMI > 25 kg/m2), and self-reported risk of food insecurity will be randomized 1:1 to intervention (12 weekly deliveries of vegetables, fruits, and whole-grain foods + culturally-modified behavioral lifestyle program) versus control (food deliveries after a 6-month delay). Outcome asessments will occur at 0, 6 and 12 months, and include HbA1c, dietary intake, psychosocial health outcomes, and diabetes-related stressors. In addition, food insecurity and the impact of the intervention on up to two household members will be measured. Qualitative interviews with patients, healthcare providers, and community partners will be conducted in accordance with Reach, Effectivenes, Adoption, Implementation, and Maintenence (RE-AIM) framework to identify barriers and best practices for future dissemination.The ADELANTE trial will provide novel insight to the effectiveness of a multi-level intervention on diabetes-related outcomes in Latinx adults. The mixed-method approach will also identity the reach of this 'Food is Medicine' intervention on additional household members to inform diabetes prevention efforts.NCT05228860.

  View details for DOI 10.1016/j.cct.2024.107699

  View details for PubMedID 39322114

• Vida Sana y Completa: A randomized controlled trial to examine the effectiveness of diabetes prevention with and without medically supportive groceries among Latina women. Contemporary clinical trials Rosas, L. G., Perez, J. A., Chen, W. T., Xiao, L., Espinosa, P. R., Venditti, E. M., Lewis, M. A., Gardner, C. D., Marti, A., Martinez, E., Murthy, M., Hauser, M. 2024: 107582

  Abstract

  Latina women have a high prevalence of obesity and obesity-related chronic diseases, such as diabetes. Approximately half of Latinas with obesity will also experience food insecurity, or a lack of access to enough food for an active and healthy life. Food insecurity is a barrier for effective prevention and management of obesity-related chronic diseases. The goal of this type 1 hybrid comparative effectiveness trial is to compare a culturally-tailored diabetes prevention intervention with and without medically supportive groceries. Adult Latina women (n = 412) with obesity (Body Mass Index (BMI) of >30 kg/m2) and food insecurity will be 1:1 randomized to the Vida Sana intervention (control), or to Vida Sana y Completa (intervention plus integrated treatment for food insecurity). Vida Sana is an evidence-based culturally tailored, 12-month diabetes prevention intervention that targets at least 5% weight loss and at least 150 min/week of moderate-to-vigorous physical activity. Participants enrolled in Vida Sana y Completa will also receive 12 weekly deliveries of medically supportive groceries. Those in Vida Sana alone will receive information on local food resources. Participants will be assessed at baseline and every 6 months for 24 months. The primary outcome is weight loss at 12 months. Secondary outcomes include weight loss maintenance, diet quality, and quality of life. Barriers and facilitators of implementation will be assessed using mixed methods according to the Consolidated Framework for Implementation Research. This study will provide critical evidence for addressing the combination of obesity and food insecurity in primary care for diabetes prevention. Trial Registration: NCT052111.

  View details for DOI 10.1016/j.cct.2024.107582

  View details for PubMedID 38810932

• Community of Practice of Promotoras de Salud to address health inequities during and beyond the COVID-19 pandemic. Frontiers in public health Rodriguez Espinosa, P., Martinez Mulet, Y., Chen, W. T., Kirk, C., Tran, C., Gonzalez, M., Rosas, L. G. 2023; 11: 1260369

  Abstract

  Using principles of Community-Based Participatory Research, we describe a community of practice for community health workers and promotoras (CHW/Ps) to address COVID-19 inequities in the Latinx community. We offer a concrete example of how programs can engage CHW/Ps as full partners in the research process, and how programs can support CHW/Ps' capacity and workforce development during implementation. We conducted four focus groups with CHW/Ps (n = 31) to understand needs and invited 15 participants to the community of practice to work on issues identified by the group. We examined impact according to number of community members reached, types of outreach activities, surveys, and online views of educational materials. Process evaluation involved two focus groups with seven organizations and a Ripple Effects Mapping session with the CHW/Ps. Our community of practice has built CHW/Ps' capacity via 31 workshop and co-created culturally and linguistically relevant COVID-19 materials that have reached over 40,000 community members and over 3 million people online. The community of practice proved effective in supporting CHW/Ps to address COVID-19 inequities in the Latinx community. Our evaluations demonstrated benefits for community-academic partnerships, for CHW/Ps, and for the community. This model represents an innovative workforce training model to address health inequities and can be applied to other health topics.

  View details for DOI 10.3389/fpubh.2023.1260369

  View details for PubMedID 38026325

  View details for PubMedCentralID PMC10679433

• Addressing food insecurity and chronic conditions in community health centres: protocol of a quasi-experimental evaluation of Recipe4Health. BMJ open Rosas, L. G., Chen, S., Xiao, L., Emmert-Aronson, B. O., Chen, W., Ng, E., Martinez, E., Baiocchi, M., Thompson-Lastad, A., Markle, E. A., Tester, J. 2023; 13 (4): e068585

  Abstract

  INTRODUCTION: Chronic conditions, such as diabetes, obesity, heart disease and depression, are highly prevalent and frequently co-occur with food insecurity in communities served by community health centres in the USA. Community health centres are increasingly implementing 'Food as Medicine' programmes to address the dual challenge of chronic conditions and food insecurity, yet they have been infrequently evaluated.METHODS AND ANALYSIS: The goal of this quasi-experimental study was to evaluate the effectiveness of Recipe4Health, a 'Food as Medicine' programme. Recipe4Health includes two components: (1) a 'Food Farmacy' that includes 16 weekly deliveries of produce and (2) a 'Behavioural Pharmacy' which is a group medical visit. We will use mixed models to compare pre/post changes among participants who receive the Food Farmacy alone (n=250) and those who receive the Food Farmacy and Behavioural Pharmacy (n=140). The primary outcome, fruit and vegetable consumption, and secondary outcomes (eg, food security status, physical activity, depressive symptoms) will be collected via survey. We will also use electronic health record (EHR) data on laboratory values, prescriptions and healthcare usage. Propensity score matching will be used to compare Recipe4Health participants to a control group of patients in clinics where Recipe4Health has not been implemented for EHR-derived outcomes. Data from surveys, EHR, group visit attendance and produce delivery is linked with a common identifier (medical record number) and then deidentified for analysis with use of an assigned unique study ID. This study will provide important preliminary evidence on the effectiveness of primary care-based strategies to address food insecurity and chronic conditions.ETHICS AND DISSEMINATION: This study was approved by the Stanford University Institutional Review Board (reference protocol ID 57239). Appropriate study result dissemination will be determined in partnership with the Community Advisory Board.

  View details for DOI 10.1136/bmjopen-2022-068585

  View details for PubMedID 37024257

• COVID-19 Preventive Measures in Northern California Jails: Perceived Deficiencies, Barriers, and Unintended Harms. Frontiers in public health Liu, Y. E., LeBoa, C., Rodriguez, M., Sherif, B., Trinidad, C., Del Rosario, M., Allen, S., Clifford, C., Redding, J., Chen, W. T., Rosas, L. G., Morales, C., Chyorny, A., Andrews, J. R. 2022; 10: 854343

  Abstract

  Carceral facilities are high-risk settings for COVID-19 transmission. Little is known about the hidden burden of infection or practical barriers to infection control in these settings, especially in jails. There is also limited research on the mental health impacts of the pandemic among people living and working in carceral facilities.Between July 8, 2020 and April 30, 2021, we performed SARS-CoV-2 rapid antibody testing and administered a questionnaire among residents and staff of four Northern California jails. We utilized multivariable logistic regression, adjusting for demographic and carceral characteristics, to analyze factors associated with prior infection, including perceived likelihood of prior infection and access to new masks. We additionally assessed the implementation of, perceptions toward, and impacts of COVID-19 policies in practice. We engaged stakeholder representatives, including incarcerated individuals, to guide study design, procedures, and results interpretation.We enrolled 788 jail residents and 380 jail staff. Nearly half of residents and two-thirds of staff who were antibody-positive had not previously tested positive for COVID-19. Among residents without a prior COVID-19 diagnosis, antibody positivity was significantly associated with perceived likelihood of prior infection (adjusted OR = 8.9; 95% CI, 3.6-22.0). Residents who had flu-like illness in jail cited inadequate responses to reported illness and deterrents to symptom reporting, including fears of medical isolation and perceptions of medical neglect. Residents also disclosed deficient access to face masks, which was associated with antibody positivity (adjusted OR = 13.8, 95% CI, 1.8-107.0). Worsened mental health was pervasive among residents, attributed not only to fear of COVID-19 and unsanitary jail conditions but also to intensified isolation and deprivation due to pandemic restrictions on in-person visitation, programs, and recreation time.Carceral settings present significant challenges to maintaining infection control and human rights. Custody officials should work diligently to transform the conditions of medical isolation, which could mitigate deterrents to symptom reporting. Furthermore, they should minimize use of restrictive measures like lockdowns and suspension of visitation that exacerbate the mental health harms of incarceration. Instead, custody officials should ensure comprehensive implementation of other preventive strategies like masking, testing, and vaccination, in conjunction with multisector efforts to advance decarceration.

  View details for DOI 10.3389/fpubh.2022.854343

  View details for PubMedID 35774562

  View details for PubMedCentralID PMC9237366

• Participants' Experiences of the 2018-2019 Government Shutdown and Subsequent Supplemental Nutrition Assistance Program (SNAP) Benefit Disruption Can Inform Future Policy. Nutrients Gosliner, W., Chen, W., Johnson, C., Esparza, E. M., Price, N., Hecht, K., Ritchie, L. 2020; 12 (6)

  Abstract

  The federal government shutdown from 22 December 2018 to 25 January 2019 created an unprecedented disruption in Supplemental Nutrition Assistance Program (SNAP) benefits. We conducted a cross-sectional qualitative study to begin to capture how the disruption affected food security and wellbeing among a small sample of California SNAP participants. We collected data from 26 low-income adults in four focus groups in four diverse California counties. We found that participants routinely struggle to secure an adequate and healthy diet in the context of high costs of living, the shutdown and benefit disruption added to participants' stress and uncertainty and exacerbated food insecurity, and it diminished some participants' faith in government. Participants reported that, while having additional benefits in January felt like a relief from typical end-of-month deprivation, the subsequent extended gap between benefit distributions and a lack of clarity about future benefits caused cascading effects as participants later had to divert money from other expenses to buy food and faced added uncertainty about future economic stability. Additionally, the shutdown highlighted challenges related to the availability, timing, and tone of communications between participants and SNAP agencies. Participants recommended that SNAP adjust benefit and eligibility levels to better address costs of living, improve customer service, and avoid future disruptions.

  View details for DOI 10.3390/nu12061867

  View details for PubMedID 32585839

• From "Junk Food" to "Treats" HOW POVERTY SHAPES FAMILY FOOD PRACTICES FOOD CULTURE & SOCIETY Chen, W. 2016; 19 (1): 151-170

  View details for DOI 10.1080/15528014.2016.1145008

  View details for Web of Science ID 000372719200008