Selected publications

• The Effect of Growing Up WILD™ Training on Early Childhood Professionals’ Beliefs, Attitudes, and Intentions Toward Outdoor Education

  Early Childhood Education Journal · 2024-12-10 · 2 citations

  articleSenior author
  PublisherDOI

• Design, protocol and baseline data of Nurturing Healthy Teachers, a cluster non-randomized controlled trial to improve the health, well-being, and food security of preschool and elementary school teachers in Houston, Texas

  Preventive Medicine Reports · 2024-03-01 · 1 citations

  articleOpen access

  Background: We present the conceptual framework, design, and study measures of Nurturing Healthy Teachers, a quasi-experimental study to examine the short- and long-term effectiveness of the Nurturing Healthy Teachers (NHT) nutrition intervention on food insecurity, dietary behaviors, mental health and cardiometabolic health among preschool and elementary school teachers. Methods: A convenience sample of 28 elementary schools with pre-kindergarten and elementary classrooms were recruited in Houston, Texas. Nurturing Healthy Teacher intervention includes Brighter Bites, an evidence-based coordinated school health program that combines access to fresh produce and nutrition education, and Create Healthy Futures, a web-based nutrition education program that targets nutrition knowledge, self-efficacy, mindfulness, and social support to create healthy habits among teachers. The primary outcome is food insecurity. Secondary outcomes include diet quality, mental health, and cardiometabolic health. Metabolic markers and skin carotenoid levels were assessed using in-person assessments, while all other measures were obtained via questionnaire. Results: At baseline, most of the participants were female, 63 % identified as Hispanic, were highly educated, and had a mean age of 42.6 years. Overall, 50 % of teachers were classified as being obese and 20 % had high cholesterol. At baseline teachers had a mean HbA1c (%) of 5.6 %. Moderate to severe depression was experienced by 18 % of teachers and 23 % of teachers experienced moderate to severe anxiety. Conclusions: The results of this study will inform next steps towards future implementation and evaluation of teacher-focused interventions.

  PublisherDOI

• Design, Protocol and Baseline Data of Nurturing Healthy Teachers, a Cluster Non-Randomized Controlled Trial to Improve the Health, Well-Being, and Food Security Of Pre-Kindergarten And Elementary School Teachers

  SSRN Electronic Journal · 2024-01-01

  preprintOpen access
  PublisherDOI

• Prevalence of Weight Stigma in Medical Settings Among Reproductive-Aged Women in the All of Us Study

  Obstetrics and Gynecology · 2024-05-23 · 4 citations

  articleOpen access

  OBJECTIVE: To analyze health care treatment experiences among a diverse cohort of reproductive-aged women from the All of Us study, focusing on variations due to body mass index (BMI). METHODS: We conducted a cross-sectional study that used data from the All of Us Research Program. We analyzed weight bias among reproductive-aged women aged 18-44 years. Weight bias was assessed using a proxy 7-item survey that evaluated discrimination in health care experiences, including courtesy, respect, service quality, being treated as competent, displaying fear, being treated as inferior, and being listened to during health care visits. RESULTS: Overall, 16,791 reproductive-aged women (mean [SD] age, 35.8 [6.3]) were included in the study. Of 11,592 patients with data available on BMI, 582 were Asian (5.0%), 1,984 (17.1%) were Hispanic or Latinx, 1,007 (8.7%) were non-Hispanic Black, and 7,370 (63.6%) were non-Hispanic White. Approximately 24.2% of participants (n=2,878) had obesity, and 11.1% of participants (n=1,292) had severe obesity. In general, participants in higher BMI categories had negative experiences in the health care setting. Women with severe obesity were 1.5 to 2 times more likely to report poor experiences with their health care clinicians compared with women with healthy weight. CONCLUSION: Results show significant disparities in the health care experiences among reproductive-aged women. As participants' BMI category increased, so did their negative experiences in the health care setting. These findings underscore the urgent need for targeted interventions to address these inequities. Health care systems must prioritize strategies to ensure that all individuals, regardless of weight or BMI, receive equitable and respectful care.

  PublisherOA PDFDOI

• Interactive associations of eczema with glutathione S-transferase genes in relation to autism spectrum disorder and its severity in Jamaican children

  Research in autism spectrum disorders · 2023-05-17

  articleOpen access
  PublisherOA PDFDOI

• Are there sex differences in interactive associations of environmental exposure to Lead (Pb), Mercury (Hg), and Manganese (Mn) with GST Genes (GSTP1, GSTT1, and GSTM1) in relation to ASD in Jamaican children?

  Research in autism spectrum disorders · 2023-04-28

  articleOpen access
  PublisherOA PDFDOI

• Ambient Temperature Increases and Preschoolers’ Outdoor Physical Activity

  JAMA Pediatrics · 2023 · 16 citations

  • Medicine
  • Environmental health
  • Physical therapy

  This cross-sectional study evaluates the association of high outdoor temperatures with children’s engagement in physical activity during play.

  PublisherOA PDFDOI

• Design for a Cluster Randomized Controlled Trial to Evaluate the Effects of the CATCH Healthy Smiles School-Based Oral Health Promotion Intervention Among Elementary School Children

  SSRN Electronic Journal · 2022-01-01 · 2 citations

  articleOpen access
  PublisherDOI

• Additive or Interactive Associations of Food Allergies with Glutathione S-Transferase Genes in Relation to ASD and ASD Severity in Jamaican Children

  Journal of Autism and Developmental Disorders · 2022-11-27

  article
  PublisherDOI

• Design for a cluster randomized controlled trial to evaluate the effects of the CATCH Healthy Smiles school-based oral health promotion intervention among elementary school children

  Contemporary Clinical Trials Communications · 2022-11-04 · 5 citations

  articleOpen access

  Background: The top two oral diseases (tooth decay and gum disease) are preventable, yet dental caries is the most common childhood disease with 68% of children entering kindergarten having tooth decay. CATCH Healthy Smiles is a coordinated school health program to prevent cavities for students in kindergarten, 1st, and 2nd grade, and is based on the framework of Coordinated Approach to Child Health (CATCH), an evidence-based coordinated school health program. CATCH has undergone several cluster-randomized controlled trials (CRCT) demonstrating sustainable long-term effectiveness in incorporating the factors surrounding children, in improving eating and physical activity behaviors, and reductions in obesity prevalence among low-income, ethnically diverse children. The aim of this paper is to describe the design of the CATCH Healthy Smiles CRCT to determine the effectiveness of an oral health school-based behavioral intervention in reducing incidence of dental caries among children. Methods: In this CRCT, 30 schools serving low-income, ethnically-diverse children in greater Houston area are recruited and randomized into intervention and comparison groups. From which, 1020 kindergarten children (n = 510 children from 15 schools for each group) will be recruited and followed through 2nd grade. The intervention consists of four components (classroom curriculum, toothbrushing routine, family outreach, and schoolwide coordinated activities) will be implemented for three years in the intervention schools, whereas the control schools will be offered free trainings and materials to implement a sun safety curriculum in the meantime. Outcome evaluation will be conducted at four time points throughout the study period, each consists of three components: dental assessment, child anthropometric measures, and parent survey. The dental assessment will use International Caries Detection and Assessment System (ICDAS) to measures the primary outcome of this study: incidence of dental caries in primary teeth as measured at the tooth surface level (dfs). The parent self-report survey measures secondary outcomes of this study, such as oral health related behavioral and psychosocial factors. A modified crude caries increment (mCCI) will be used to calculate the primary outcome of the CATCH Healthy Smiles CRCT, and a two-tailed test of the null hypothesis will be conducted to evaluate the intervention effect, while considering between- and within-cluster variances through computing the weighted-average of the mCCI ratios by cluster. Conclusion: If found to be effective, a platform for scalability, sustainability and dissemination of CATCH already exists, and opens a new line of research in school oral health. Clinical trials identifier: At ClinicalTrials.gov - NCT04632667.

  PublisherDOI