Bio

Academic Appointments


Professional Education


  • MPH, University of California Berkeley, Maternal and Child Health (2002)
  • PhD, University of California Berkeley, Epidemiology (2008)

Community and International Work


  • Vivamos Activos Fair Oaks, Redwood City, CA

    Topic

    Obesity

    Partnering Organization(s)

    Fair Oaks Community Health Center

    Populations Served

    Latinos

    Location

    Bay Area

    Ongoing Project

    No

    Opportunities for Student Involvement

    Yes

Research & Scholarship

Current Research and Scholarly Interests


1. Latino Immigrant Health: Binational approach to understanding health of Latino immigrant populations by studying groups in sending communities (primarily Mexico) and receiving communities in the US with a focus on modifiable risk factors and preventable environmental exposures.

2. Childhood and adolescent obesity: Design, implementation and analysis of community-based observational studies aimed at understanding determinants of dietary intake, obesity and metabolic syndrome among children and adolescents of primarily Mexican descent both in the US and Mexico with a focus on social, familial, and environmental determinants as well as early-life/in utero exposures.

3. Multi-level community-based intervention strategies: Design and evaluation of community-driven intervention strategies including innovative individual-level health education, family-based behavior change, community-wide health promotion, and health policies particularly in the areas of prenatal health, diet, physical activity, and environmental health.

4, Socioeconomic and racial/ethnic health disparities: Epidemiologic and qualitative approach to documenting and understanding disparities in disease risk factors and outcomes as well as toxic environmental exposures, with a focus on immigrant populations.

Publications

Journal Articles


  • Practical Research Strategies for Reducing Social and Racial/Ethnic Disparities in Obesity. International journal of obesity (2005) Rosas, L. G., Stafford, R. S. 2012; 2012 (2): s16-s22

    Abstract

    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

  • Factors Associated with Overweight and Obesity among Children of Mexican Descent: Results of a Binational Study JOURNAL OF IMMIGRANT AND MINORITY HEALTH Rosas, L. G., Guendelman, S., Harley, K., Fernald, L. C., Neufeld, L., Mejia, F., Eskenazi, B. 2011; 13 (1): 169-180

    Abstract

    The prevalence of childhood obesity is high among young children of Mexican origin in the United States, however, the determinants are poorly understood. We conducted a binational study with a sample from California (CA) and Mexico (MX), to identify and compare the most important factors associated with overweight and obesity among children of Mexican descent. Significantly more children were classified as overweight or obese in CA compared to MX (53.3 vs. 14.9%, P < 0.01). In CA and MX, having an obese mother was significantly associated with being overweight or obese. In MX, male gender, high socioeconomic status and very low food insecurity were associated with being overweight or obese. These data offer hypotheses for how migration may influence the high prevalence of overweight among the Mexican children in California.

    View details for DOI 10.1007/s10903-010-9332-x

    View details for Web of Science ID 000286202100022

    View details for PubMedID 20217234

  • Maternal Perception of Child Weight Among Mexicans in California and Mexico MATERNAL AND CHILD HEALTH JOURNAL Rosas, L. G., Harley, K. G., Guendelman, S., Fernald, L. C., Mejia, F., Eskenazi, B. 2010; 14 (6): 886-894

    Abstract

    The prevalence of childhood overweight is high in Mexican immigrant communities in the United States. Understanding mother's perceptions of child weight in immigrants' country of origin may help to understand this high prevalence. The goal of this study was to examine and compare mothers' perception of weight in Mexico (MX) and in an immigrant community in California (CA). We assessed perceptions of child weight using a pictorial scale with 314 mothers of 5-year-old children in MX and 60 mothers of 5 year-old-children in CA. We compared maternal reports with children's objectively measured weight. Using chi-square and Analysis of Variance, we investigated associations of maternal perception of and satisfaction with weight according to socio-demographic characteristics. Mothers were more likely to underestimate their children's weight in CA than in MX. On average, CA mothers wanted their children to be smaller than they currently were and mothers in MX wanted their children to be bigger than they currently were. This differed by weight status in CA with mothers of normal weight and at-risk-for-overweight children wanting them to be bigger and mothers of overweight children wanting them to be smaller. In order for programs to be effective, mothers must be able to recognize their children as overweight and want to address it. Because underestimation of weight and a desire for a larger size is common in this population, programs to address overweight may be more effective if they focus on alternative benefits of weight control strategies, such as healthy child development.

    View details for DOI 10.1007/s10995-009-0534-6

    View details for Web of Science ID 000283361700007

    View details for PubMedID 19911262

  • Dietary Associations of Household Food Insecurity among Children of Mexican Descent: Results of a Binational Study JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Rosas, L. G., Harley, K., Fernald, L. C., Guendelman, S., Mejia, F., Neufeld, L. M., Eskenazi, B. 2009; 109 (12): 2001-2009

    Abstract

    Children of Mexican descent frequently experience household food insecurity both in the United States and Mexico. However, little is known about the associations of food insecurity with dietary intake. This study aimed to understand the level of perceived food insecurity and its association with dietary intake among children of Mexican descent residing in the United States and Mexico.This cross-sectional study utilized data from a 2006 binational study of 5-year-old children of Mexican descent living in migrant communities in California and Mexico.In California, children were 301 participants from the Center for the Health Assessment of Mothers and Children of Salinas study, a longitudinal birth cohort in a Mexican immigrant community. Mexican children (n=301) were participants in the Proyecto Mariposa study, which was designed to capture a sample of women and their children living in Mexico who closely resembled the California sample, yet who never migrated to the United States. Household food insecurity was measured using the US Department of Agriculture Food Security Scale and dietary intake was assessed with food frequency questionnaires. Analysis of variance was used to examine unadjusted and adjusted differences in total energy, nutrient intake, and consumption of food groups by household food security status.Approximately 39% of California mothers and 75% of Mexico mothers reported low or very low food security in the past 12 months (P<0.01). Children in the United States experiencing food insecurity consumed more fat, saturated fat, sweets, and fried snacks than children not experiencing food insecurity. In contrast, in Mexico food insecurity was associated with lower intake of total carbohydrates, dairy, and vitamin B-6.Programs and policies addressing food insecurity in the United States and Mexico may need to take steps to address dietary intake among children in households experiencing food insecurity, possibly through education and programs to increase resources to obtain healthful foods.

    View details for DOI 10.1016/j.jada.2009.09.004

    View details for Web of Science ID 000272258000007

    View details for PubMedID 19942017

  • 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

    Abstract

    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
  • Pregnancy glucose levels in women without diabetes or gestational diabetes and childhood cardiometabolic risk at 7 years of age In press: Pediatrics Ehrlich S, Rosas LG, Ferrara A, King Jc, Abrams B, Harley K, Hedderson M, Eskenazi B
  • Pregnancy glycemia in Mexican- American Women Without Diabetes or Gestational Diabetes and programming for Childhood Obesity In Press: American Jounal or Epidemiology Ehrlich S, Rosas LG, Ferrara A, King Jc, Abrams B, Harley K, Hedderson M, Eskenazi B
  • An employer-based online tool for providing appropriate asprin use advice. In Press: Prim Prev Insights Stafford RS, Thiyagarajan S, Fields AK, Rosas LG
  • Translating the diabetes prevention program lifestyle intervention into primary care: a randomized trial In Press: Arch Intern Med Ma J, Yank V, Xia L, Lavori P, Wilson SR, Rosas LG, Stafford RS.
  • 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

    Abstract

    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

    Abstract

    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

  • 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

    Abstract

    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 impact.clinicaltrials.gov 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

    Abstract

    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

  • 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

    Abstract

    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

  • 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

    Abstract

    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

  • A Systematic Approach to Selecting an Appropriate Measure of Self-Reported Physical Activity or Sedentary Behavior JOURNAL OF PHYSICAL ACTIVITY & HEALTH Sternfeld, B., Goldman-Rosas, L. 2012; 9: S19-S28

    Abstract

    Numerous instruments to measure self-reported physical activity (PA) exist, but there is little guidance for determining the most appropriate choice.To provide a systematic framework for researchers and practitioners to select a self-reported PA instrument.The framework consists of 2 components: a series of questions and a database of instruments. The questions encourage users to think critically about their specific needs and to appreciate the strengths and limitations of the available options. Instruments for the database were identified through existing literature and expert opinion.Ten questions, ranging from study aim and study design to target population and logistical consideration, guide the researcher or practitioner in defining the criteria for an appropriate PA instruments for a given situation. No one question on its own determines the optimal choice, but taken together, they narrow the potential field. The database currently includes 38 different self-reported PA instruments, characterized by 18 different parameters.The series of questions presented here, in conjunction with a searchable database of self-report PA instruments, provides a needed step toward the development of guiding principles and good practices for researchers and practitioners to follow in making an informed selection of a self-reported PA instrument.

    View details for Web of Science ID 000299764400004

    View details for PubMedID 22287444

  • A Comparison of PBDE Serum Concentrations in Mexican and Mexican-American Children Living in California ENVIRONMENTAL HEALTH PERSPECTIVES Eskenazi, B., Fenster, L., Castorina, R., Marks, A. R., Sjoedin, A., Rosas, L. G., Holland, N., Guerra, A. G., Lopez-Carillo, L., Bradman, A. 2011; 119 (10): 1442-1448

    Abstract

    Polybrominated diphenyl ethers (PBDE), which are used as flame retardants, have been found to be higher in residents of California than of other parts of the United States.We aimed to investigate the role of immigration to California on PBDE levels in Latino children.We compared serum PBDE concentrations in a population of first-generation Mexican-American 7-year-old children (n = 264), who were born and raised in California [Center for Health Analysis of Mothers and Children of Salinas (CHAMACOS) study], with 5-year-old Mexican children (n = 283), who were raised in the states in Mexico where most CHAMACOS mothers had originated (Proyecto Mariposa).On average, PBDE serum concentrations in the California Mexican-American children were three times higher than their mothers' levels during pregnancy and seven times higher than concentrations in the children living in Mexico. The PBDE serum concentrations were higher in the Mexican-American children regardless of length of time their mother had resided in California or the duration of the child's breast-feeding. These data suggest that PBDE serum concentrations in these children resulted primarily from postnatal exposure.Latino children living in California have much higher PBDE serum levels than their Mexican counterparts. Given the growing evidence documenting potential health effects of PBDE exposure, the levels in young children noted in this study potentially present a major public health challenge, especially in California. In addition, as PBDEs are being phased out and replaced by other flame retardants, the health consequences of these chemical replacements should be investigated and weighed against their purported fire safety benefits.

    View details for DOI 10.1289/ehp.1002874

    View details for Web of Science ID 000295402400030

    View details for PubMedID 21498147

  • The Pine River Statement: Human Health Consequences of DDT Use ENVIRONMENTAL HEALTH PERSPECTIVES Eskenazi, B., Chevrier, J., Rosas, L. G., Anderson, H. A., Bornman, M. S., Bouwman, H., Chen, A., Cohn, B. A., de Jager, C., Henshel, D. S., Leipzig, F., Leipzig, J. S., Lorenz, E. C., Snedeker, S. M., Stapleton, D. 2009; 117 (9): 1359-1367

    Abstract

    Dichlorodiphenyltrichloroethane (DDT) was used worldwide until the 1970s, when concerns about its toxic effects, its environmental persistence, and its concentration in the food supply led to use restrictions and prohibitions. In 2001, more than 100 countries signed the Stockholm Convention on Persistent Organic Pollutants (POPs), committing to eliminate the use of 12 POPs of greatest concern. However, DDT use was allowed for disease vector control. In 2006, the World Health Organization and the U.S. Agency for International Development endorsed indoor DDT spraying to control malaria. To better inform current policy, we reviewed epidemiologic studies published from 2003 to 2008 that investigated the human health consequences of DDT and/or DDE (dichlorodiphenyldichloroethylene) exposure.We conducted a PubMed search in October 2008 and retrieved 494 studies.Use restrictions have been successful in lowering human exposure to DDT, but blood concentrations of DDT and DDE are high in countries where DDT is currently being used or was more recently restricted. The recent literature shows a growing body of evidence that exposure to DDT and its breakdown product DDE may be associated with adverse health outcomes such as breast cancer, diabetes, decreased semen quality, spontaneous abortion, and impaired neurodevelopment in children.Although we provide evidence to suggest that DDT and DDE may pose a risk to human health, we also highlight the lack of knowledge about human exposure and health effects in communities where DDT is currently being sprayed for malaria control. We recommend research to address this gap and to develop safe and effective alternatives to DDT.

    View details for DOI 10.1289/ehp.11748

    View details for Web of Science ID 000269479900022

    View details for PubMedID 19750098

  • Pesticides and child neurodevelopment CURRENT OPINION IN PEDIATRICS Rosas, L. G., Eskenazi, B. 2008; 20 (2): 191-197

    Abstract

    This review summarizes the recent research on pesticide exposure and child neurobehavioral development with a focus on in-utero exposure to organochlorine and organophosphate pesticides.Recent studies on in-utero exposure to the organochlorine pesticide dichlorodiphenyltrichloroethane and its breakdown product, dichlorodiphenyldichloroethene, indicate that exposure is associated with poorer infant (6 months and older) and child neurodevelopment. Yet, the studies differ on the domain of development that is affected. Research on organophosphate pesticide exposure and neurodevelopment is limited but suggests some negative association of exposure and neurodevelopment at certain ages. Two reports agree that increased levels of organophosphate exposure in utero result in greater numbers of abnormal reflexes in neonates and studies in older infants and young children also point to a negative association with development. In young children (2-3 years) two separate studies observed an increase in maternally reported pervasive developmental disorder with increased levels of organophosphate exposure.Given that the literature suggests a link between organochlorine and in-utero pesticide exposure and impaired child neurodevelopment, clinicians should educate parents about prevention of exposure, especially in populations living in agricultural areas or where household use is common.

    View details for Web of Science ID 000254792900015

    View details for PubMedID 18332717

  • Pesticide toxicity and the developing brain BASIC & CLINICAL PHARMACOLOGY & TOXICOLOGY Eskenazi, B., Rosas, L. G., Marks, A. R., Bradman, A., Harley, K., Holland, N., Johnson, C., Fenster, L., Barr, D. B. 2008; 102 (2): 228-236

    Abstract

    Organochlorine pesticides are used in some countries for malaria control and organophosphate pesticides are widely used in agriculture and in homes. Previous literature documents children's exposure to these chemicals both in utero and during development. Animal studies suggest that many of these chemicals are neurodevelopmental toxicants even in moderate doses, but there are few studies in human beings. Associations of children's pesticide exposure with neurodevelopment from studies being conducted worldwide are summarized. In addition, we present the work of the CHAMACOS study, a longitudinal birth cohort study of Mexican-American children living in the Salinas Valley of California. In this study, we investigated the relationship of children's neurodevelopment with maternal dichlorodiphenyltrichloroethane and dichlorodiphenyldichloroethylene serum levels, as well as prenatal and child organophosphate urinary metabolite levels. We have examined the association with children's performance on the Brazelton Neonatal Assessment Scales and at 6, 12 and 24 months on the Bayley Scales of Infant Development (mental development and psychomotor development) and mothers report on the Child Behaviour Checklist. We observed a negative association of prenatal dichlorodiphenyltrichloroethane exposure and child mental development. We also observed adverse associations of prenatal but not postnatal organophosphate pesticide exposure with mental development and pervasive developmental disorder at 24 months.

    View details for DOI 10.1111/j.1742-7843.2007.00171.x

    View details for Web of Science ID 000252588900023

    View details for PubMedID 18226078

  • Introducing birth plans in Mexico: An exploratory study in a hospital serving low-income Mexicans BIRTH-ISSUES IN PERINATAL CARE Yam, E. A., Grossman, A. A., Goldman, L. A., Garcia, S. G. 2007; 34 (1): 42-48

    Abstract

    Increased medicalization of childbirth in Mexico has not always translated into more satisfactory childbirth experiences for women. In developed countries, pregnant women often prepare written birth plans, outlining how they would like their childbirth experiences to proceed. The notion of expressing childbirth desires with a birth plan is novel in the developing world. We conducted an exploratory study to assess the feasibility and acceptability of introducing birth plans in a hospital serving low-socioeconomic status Mexicans and to document women's and health practitioners' perspectives on the advantages and barriers in implementing a birth plan program.We invited 9 pregnant women to prepare birth plans during their antenatal care visits. The women also participated in interviews before and after childbirth. We also conducted in-depth interviews with 4 women who had given birth in the past year, and with 2 nurses, 2 social workers, and 1 physician to learn about their perspectives on the benefits and challenges of implementing a birth plan program.All 9 women who completed a birth plan found the experience highly satisfying, despite the fact that in some cases, their childbirths did not proceed as they had specified in their plans. Interviewed practitioners believed that birth plans could improve the childbirth experience for women and health care practitioners, but facilities often lacked space and financial incentives for birth plan programs.Our findings suggest that birth plans are acceptable and feasible in this study population. Facility administrators would need to commit to provide the physical space and financial incentives necessary to ensure successful implementation.

    View details for Web of Science ID 000244527100008

    View details for PubMedID 17324177

  • Analizing successful condom use among factory workers and students in Mexico and the Dominican Republic. Gaceta médica de México Goldman, L., Richmond, K., Garcia, S. G., Yam, E. A., Becker, D. 2006; 142: 117-127

    Abstract

    Although condoms can prevent sexually transmitted infections and unwanted pregnancies, use remains low worldwide. Rather than continue to investigate the barriers to use, this study sought to obtain information from students and factory workers who identify themselves as successful condom users. After developing a novel successful condom use scale, we conducted 793 interviews among students and factory workers in Ciudad Juárez, Mexico and Santo Domingo, Dominican Republic. We compared successful users to unsuccessful users and invited successful users to participate in focus group discussions. Among students, successful condom users were more likely to be from Mexico. Factory workers identified as successful condom users were more likely to have had fewer casual sexual partners. Focus group participants cited condoms' accessibility, security, and cleanliness as reasons for use. Use differed by partner type, stable versus casual. These findings should be considered when developing condom promotion campaigns.

    View details for PubMedID 19031688

  • Valuable safeguard or unnecessary burden? Characterization of physician consultations for oral contraceptive use in Mexico City CONTRACEPTION Tatum, C., Garcia, S. G., Goldman, L., Becker, D. 2005; 71 (3): 208-213

    Abstract

    Given the safety and efficacy of oral contraceptives (OCs), many health professionals believe that these should be widely available over-the-counter (OTC). Opponents of OTC availability argue that without a physician's consultation, women will not be properly screened and will not use OCs correctly, thereby compromising safety and efficacy. However, little is known about the content or quality of physicians' consultations.Trained simulated patients (SPs) attended 45 appointments with Mexico City public and private physicians to request a prescription for OCs. Immediately following each appointment, the SPs filled out a checklist regarding the information provided and examinations performed by physicians.Both public and private physicians asked a few questions and provided little information regarding screening, pill-taking instructions, side effect information and warning sign information. Despite the fact that all SPs were appropriate OC candidates, women were denied a prescription in seven (15.6%) appointments mostly because of their age (regarded as either too old or too young).In general, Mexican physicians are not providing women thorough information and screening in OC consultations, calling into question the assumption that a physician's appointment is necessary for or will ensure safe, proper OC use.

    View details for DOI 10.1016/j.contraception.2004.08.018

    View details for Web of Science ID 000227639800010

    View details for PubMedID 15722072

  • Brazilian obstetrician-gynecologists and abortion: a survey of knowledge, opinions and practices. Reproductive health Goldman, L. A., García, S. G., Díaz, J., Yam, E. A. 2005; 2: 10-?

    Abstract

    Abortion laws are extremely restrictive in Brazil. The knowledge, opinions of abortion laws, and abortion practices of obstetrician-gynecologists can have a significant impact on women's access to safe abortion.We conducted a mail-in survey with a 10% random sample of obstetrician-gynecologists affiliated with the Brazilian Federation of Obstetricians and Gynecologists. We documented participants' experiences performing abortion under a range of legal and illegal circumstances, and asked about which abortion techniques they had experience with. We used chi-square tests and crude logistic regression models to determine which sociodemographic, knowledge-related, or practice-related variables were associated with physician opinion.Of the 1,500 questionnaires that we mailed out, we received responses from 572 (38%). Less than half (48%) of the respondents reported accurate knowledge about abortion law and 77% thought that the law should be more liberal. One-third of respondents reported having previous experience performing an abortion, and very few of these physicians reported having experience with manual vacuum aspiration (MVA) or with misoprostol with either mifepristone or methotrexate. Physicians that favored liberalization of the law were more likely to have correct knowledge about abortion law, and to be in favor of public funding for abortion services.Brazilian obstetrician-gynecologists need more information on abortion laws and on safe, effective abortion procedures.

    View details for PubMedID 16288647

  • Risk behaviors for pesticide exposure among pregnant women living in farmworker households in Salinas, California AMERICAN JOURNAL OF INDUSTRIAL MEDICINE Goldman, L., Eskenazi, B., Bradman, A., Jewell, N. P. 2004; 45 (6): 491-499

    Abstract

    Farmworkers and their families are at risk for pesticide exposure, however, little is known about behaviors that increase their risk. We determined the frequency of risky behaviors among pregnant farmworkers and characterized those at greatest risk.Participants included 153 pregnant farmworkers and 248 pregnant non-farmworkers who resided with farmworkers from the CHAMACOS (Center for the Health Assessment of Mothers and Children of Salinas) study. We examined risky behaviors relating to handwashing, bathing, protective clothing, house cleaning, laundering of work clothes, wearing of work clothes and shoes into the home, and eating produce from the fields.Between 25 and 60% of women demonstrated risky behavior on each item. Practices of households with pregnant farmworkers and non-farmworkers did not differ. Women who lived in the United States longer, and in crowded households demonstrated the most risky behavior overall.Pregnant farmworkers and those living with farmworkers need to be educated to reduce potential take-home pesticide exposure.

    View details for DOI 10.1002/ajim.20012

    View details for Web of Science ID 000221708900002

    View details for PubMedID 15164393

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