Carol Macera

San Diego State University | SDSU · Graduate School of Public Health

1 Background With suicide rising in the United States, identifying and preventing suicides is increasingly important. To provide a valuable step toward achieving effective suicide risk assessment, this study examines the agreement between self‐report measures and psychiatrist documentation of suicidal ideation and behaviors (SI) at a Veterans Admin...

Introduction: To determine the association between four measures of kyphosis and incident and injurious falls in older persons. Methods: Community-dwelling adults aged 65 and older (n = 72) residing in southern California were invited to participate in a prospective cohort study. Participants had kyphosis assessed four ways. Two standing measure...

Background: Hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality. Studies suggest that the use of folic acid may lower the risk of hypertensive disorders in pregnant women. Aim: The aim of this study was to assess the effects of timing and duration of folic acid-containing supplement use on the ris...

Background: Characterizing HIV infection and associated risk behaviors within military populations is critical for understanding the epidemic and informing prevention activities. However, the prevalence of HIV and related risk behaviors is often unknown. Further, militaries may not have the systems in place or the staff expertise to conduct HIV su...

Introduction: Strong scientific evidence supports voluntary medical male circumcision as part of an overall HIV prevention strategy, but self-report information on circumcision status may be inaccurate. The study objectives were to obtain estimates of male circumcision within the Rwanda Defense Force (RDF), to assess the ability of soldiers to cor...

Background: Compared with the general population in low- and middle-income countries, military members tend to be male, young, travel more frequently away from their main sexual partners, drink more alcohol and have a consistent source of income. All of these factors may lead to an increased risk of contracting HIV. Objective: In response, the D...

Background: Military HIV prevention programs and healthy living programs were developed in the mid-1980s to manage and support newly HIV-positive military personnel in the US military. Since then, a program developed by the Centers for Disease Control and Prevention with support from the Department of Defense HIV/AIDS Prevention Program (DHAPP), ca...

Background: Shortened leukocyte telomere length (LTL), a purported marker of cellular aging, is associated with morbidity and mortality. However, the association of physical activity, a modifiable lifestyle behavior, with LTL has not been adequately studied among older adults. Methods: In this cross-sectional study, we examined associations of v...

Few studies have assessed the association of sedentary time with leukocyte telomere length (LTL). In a cross-sectional study conducted in 2012–2013, we examined associations of accelerometer-measured and self-reported sedentary time with LTL in a sample of 1,481 older white and African-American women from the Women's Health Initiative and determine...

PurposeThis study aimed to examine the association between discontinued and continued use of antidepressants and risk for gestational hypertension (GH) and preeclampsia (PE). Methods Data from the MotherToBaby pregnancy studies from 2004 to 2014 were analyzed to compare women who discontinued antidepressant use ˂20 weeks of gestation (discontinuers...

Objectives: To examine associations of maternal age at childbirth and parity with survival to age 90 years (longevity). Methods: We performed a prospective study among a multiethnic cohort of postmenopausal US women in the Women's Health Initiative recruited from 1993 to 1998 and followed through August 29, 2014. We adjusted associations with lo...

Background No study has evaluated whether genetic factors are associated with longevity in African Americans or Hispanics, and it is unclear whether genetic factors are associated with healthy aging. Methods In this prospective study, we determined whether 14 genetic variants previously associated with longevity in genome-wide association studies...

Objective: The aim of the present study was to investigate associations between reproductive factors and survival to age 90 years. Methods: This was a prospective study of postmenopausal women from the Women's Health Initiative recruited from 1993 to 1998 and followed until the last outcomes evaluation on August 29, 2014. Participants included 1...

This study describes the prevalence and factors of depressive symptoms among a sample of persons who inject drugs (PWID) with a history of deportation from the US in Tijuana, Mexico. In 2014, 132 deported PWID completed a structured questionnaire. Depressive symptoms were measured using the Center for Epidemiologic Studies Short Depression Scale (C...

Objective: Problematic policing practices are an important driver of HIV infection among persons who inject drugs (PWID) in the U.S.-Mexico border region. This study identifies factors associated with recent (i.e., past 6 months) police victimization (e.g., extortion, physical and sexual violence) in the border city of Tijuana, Mexico. Method: F...

Physical activity is an important component of a healthy lifestyle for all adults and especially for older adults. Using information from the updated 2008 Physical Activity Guidelines, 3 dimensions of physical activity are identified for older adults. These include increasing aerobic activity, increasing muscle-strengthening activity, and reducing...

We examined human papillomavirus (HPV) vaccine awareness and acceptance between United States-born and US foreign-born women by utilizing California Health Interview Survey data from 1,672 women (age:18-27) and 2,994 mothers (age:28-65). Foreign-born women and mothers had lower vaccine awareness. Foreign-born young adult Latinas had greater vaccine...

Suicide prevention in the clinical setting is focused on evaluating risk in the coming hours to days, yet little is known about which factors increase acute risk. To determine the prevalence of factors that may serve as warnings of heightened acute risk. Veterans attending an urgent care psychiatric clinic (n=473) completed a survey on suicidal ide...

The association between self-reported smoking and overuse injury in a cohort of young men (n=900) and women (n=597) undergoing 12 weeks of standardized military instruction, after adjustment for physical activity, health history, and incoming fitness tests was examined. The outcome includes all International Classification of Diseases, 9th Revision...

Background: As more women are deployed into combat environments, preliminary findings have been inconsistent regarding gender differences in symptoms of posttraumatic stress disorder (PTSD) following deployment. Very little is known about the experiences of Navy and Marine Corps personnel deployed to combat zones. Methods: The study population c...

This study evaluated whether obese patients who lost weight before their total joint replacement and kept it off post-operatively were at lower risk of surgical site infection (SSI) and re-admission compared with those who remained the same weight. We reviewed 444 patients who underwent a total hip replacement and 937 with a total knee replacement...

Context: Although prevalence of obesity and incidence of total joint arthroplasty (TJA) have dramatically increased over the last two decades in the U.S., little is known of the preoperative and postoperative weight patterns of patients undergoing TJA. Objective: To describe the preoperative and postoperative weight patterns of patients undergoi...

Objective: To empirically identify latent classes of service members according to persistent postconcussive symptom patterns and to characterize the identified classes relative to other postdeployment variables including posttraumatic stress disorder (PTSD) and mild traumatic brain injury (TBI) screening results. Such comparisons may directly info...

To investigate geographical and socioeconomic variation in performance of lymph node dissection for the evaluation of patients with early-stage epithelial ovarian cancer. A population-based, retrospective cohort study was conducted using data from the National Cancer Institute's SEER Program for 15 geographic registries and county-level measures. W...

This study characterized a cohort of obese total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients (1/1/2008-12/31/2010) and evaluated whether a clinically significant amount of pre-operative weight loss (5% decrease in body weight) is associated with a decreased risk of surgical site infections (SSI) and readmissions post-surgery....

Background: Less nocturnal blood pressure (BP) dipping has been associated with greater odds for the metabolic syndrome (MetS), a constellation of risk factors associated with cardiovascular disease (CVD). Little work has examined this association in Hispanics, who have elevated rates of MetS, or investigated differences in this relationship by le...

Servicemembers with combat-related limb loss often require substantial rehabilitative care. The prevalence of traumatic brain injury (TBI), which may impair cognitive and functional abilities, among servicemembers has increased. The primary objectives of this study were to determine the frequency of TBI among servicemembers with traumatic amputatio...

The purpose of this study was to describe career performance outcomes after combat blast injury and to examine the relationship between the injury severity and type of military discharge. A retrospective cohort study of 4,255 male servicemembers injured in a combat blast as a part of Operation Iraqi Freedom was completed. In the total sample, 37.8%...

Assessment of acute mild traumatic brain injury (mTBI) symptoms after a combat blast could aid diagnosis and guide follow-up care. Our objective was to document acute mTBI symptoms following a combat blast and to examine associations between acute symptoms and mental health and service discharge outcomes. A retrospective cohort study was conducted...

This prospective study evaluated the association of self-reported health habits and behaviors in 2,930 Navy recruits with poor training outcomes, defined as graduating late or separating from training. Although 17% of the men and 21% of the women had a poor training outcome, results suggest that some self-reported measures were associated with poor...

Purpose: The objective of this study was to ascertain whether a relationship exists between pre-diagnostic serum levels of 25-hydroxyvitamin D (25(OH)D) and risk of breast cancer in young women. Methods: About 600 incident cases of breast cancer were matched to 600 controls as part of a nested case-control study that utilized pre-diagnostic sera...

Military members screening positive for blast-related traumatic brain injury (TBI) may subsequently screen positive for posttraumatic stress disorder (PTSD) or depression. The role of sleep as a mediating factor in the development of mental health symptoms was explored. Prospective study with symptoms evaluated at two time points. Postdeployment se...

In Operation Iraqi Freedom and Operation Enduring Freedom, blast-related injuries associated with combat are frequent and can result in traumatic brain injury (TBI) symptoms that may be difficult to distinguish from psychological problems. Using data from the Post-Deployment Health Assessment and Reassessment, we identified 12,046 male U.S. Navy sa...

Breast cancer (BC) is the most common cancer and the second leading cause of cancer-related deaths in women. However, a disproportionate number of BC deaths occur among minorities. To date, the majority of BC disparity studies have focused on African-American women. Fewer have looked directly at BC survival in US Hispanics and of these studies, the...

Objectives: To target improvement in older adult sexuality by understanding how a myriad of partnered and individual physical and mental health factors, often associated with aging, affect sexual unwellness. Method: Data from the Wisconsin Longitudinal Study were used to conduct a case-control study on the risk factors for sexual unwellness (i.e...

Research supports the favorable effects of exercise on physical and psychosocial outcomes in those with arthritis. Few easily disseminated, multi-component, arthritis-specific programs have been evaluated using both physical function and psychosocial measures. Fitness and Exercise for People with Arthritis (FEPA) is a new community-based, 3-month,...

A wide range of epidemiologic and laboratory studies combined provide compelling evidence of a protective role of vitamin D on risk of breast cancer. This review evaluates the scientific evidence for such a role in the context of the A.B. Hill criteria for causality, in order to assess the presence of a causal, inverse relationship, between vitamin...

Background: Built environment attributes are associated with physical activity and obesity, but their association with other outcomes is less clear. Neighborhood satisfaction has been found to be correlated with mental health and quality of life. Therefore, it is worthwhile to better understand the relationship between the environment and satisfact...

Low serum levels of 25-hydroxyvitamin D [25(OH)D] have been associated with a high risk of breast cancer. Since publication of the most current meta-analysis of 25(OH)D and breast cancer risk, two new nested case-control studies have emerged. A PubMed search for all case-control studies on risk of breast cancer by 25(OH)D concentration identified 1...

To examine whether dietary self-monitoring is related to weight loss in overweight children and whether perceived social support or dietary self-efficacy affects this relation. Design. Longitudinal, behavioral intervention study. The study population included 153 children, aged 7-12 years, with daily food records from a 20-week weight loss program...

Cigarette smoking has been reported to be higher among deployed military men than among similarly aged civilian or nondeployed men, but the short-term effect of smoking on physical fitness among these young healthy men is unclear. This study examined self-reported smoking status and change in objectively measured fitness over 1-4 years while contro...

The objective of this study was to identify changes in weight that occurred during deployment to Iraq or Kuwait between 2005 and 2008. Data on length and type of deployment among 16,365 male U.S. Navy personnel were combined with weight measurements before and after deployment from the Physical Readiness Information Management System. Weight measur...

To explore the cross-sectional association of nutrient intake with adiponectin in Filipino-American women who had completed a validated food frequency questionnaire. One hundred and sixty-one Filipino women aged 40 to 82 years were recruited from the University of California, San Diego Filipino Women's Health Study. Dietary information was assessed...

Nomograms are tools used in clinical practice to predict cancer outcomes and to help make decisions regarding management of disease. Since its conception, utility of the prostate cancer nomogram has more than tripled. Limited information is available on the relation between the nomograms' predicted probabilities and obesity. The purpose of this stu...

Although Korean American women show high levels of involvement in religious practices and high prevalence of alcohol consumption, no studies have assessed the association between religious denomination and alcohol intake among this group of women. This cross-sectional study examined the associations of religious denomination and religious commitmen...

To determine the associations between deployment in support of the wars in Iraq and Afghanistan and sleep quantity and quality. Longitudinal cohort study The Millennium Cohort Study survey is administered via a secure website or US mail. Data were from 41,225 Millennium Cohort members who completed baseline (2001-2003) and follow-up (2004-2006) sur...

While physical activity is useful in improving function, maintaining joint health, and reducing the co-morbidities associated with inactivity in individuals with arthritis, the prevalence of regular exercisers among this population is lower than people without arthritis. This 2007 study examined the effects of a community-based exercise program on...

This prospective study determined whether selected anatomic measures identified women at increased risk of patellofemoral pain syndrome (PFPS) and shin splints (SS). Ten anatomic measures were performed on 748 women before basic training at the Marine Corps Recruit Depot (MCRD), Parris Island, South Carolina. Recruits were then followed throughout...

Self-rated health (SRH) is a predictor of several clinical outcomes, including mortality. Physical activity is associated with SRH; however, the specific role that resistance training (RT) plays in this relationship is unknown. We explored the independent association between self-reported RT and SRH in a cross-sectional survey (National Physical Ac...

Infants in utero during the terrorist attacks of September 11, 2001 may have been negatively affected by maternal stress. Studies to date have produced contradictory results. Data for this retrospective cohort study were obtained from the Department of Defense Birth and Infant Health Registry and included up to 164,743 infants born to active-duty m...

It is a public health recommendation to accumulate at least 150 minutes per week of moderate intensity physical activity. Although pedometers are widely used as a physical activity-monitoring tool, they are unable to measure activity intensity. Translating current physical activity recommendations into a pedometer-based guideline could increase the...

Research into the accuracy of self-reported measures used to quantify physical inactivity has been limited. The purposes of the current report were to examine the reliability of a survey question assessing time spent watching television and to describe associations between television watching and physical activity and health risk factors. Data from...

The association of overall obesity and abdominal adiposity in predicting risk of all-cause mortality in white and black adults was compared. This prospective study included a national sample of 3219 non-Hispanic white and 2,561 non-Hispanic black adults 30 to 64 years of age enrolled in the third National Health and Nutrition Examination Survey dur...

Results of studies comparing overall obesity and abdominal adiposity or body fat distribution with risk of mortality have varied considerably. We compared the relative importance and joint association of overall obesity and body fat distribution in predicting risk of mortality. Participants included 5,799 men and 6,429 women aged 30-102 years enrol...

According to the National Osteoporosis Foundation, 5% of African American women over 50 years of age have osteoporosis and an additional 35% have osteopenia, which puts them at risk for osteoporosis and fractures. Weight-bearing exercise has been shown to maintain bone mineral density (BMD) in white women, but little research has been reported in A...

The stress of military deployment may compound occupational stress experienced in the military and manifest in maladaptive coping behaviors such as cigarette smoking. The current study describes new smoking among never-smokers, smoking recidivism among past smokers, and change in daily smoking among smokers in relation to military deployment. The M...

Previous studies of leptin with cardiovascular disease (CVD) risk factors have been limited by clinical samples or lack of representation of the general population. This cross-sectional study, designed to examine whether leptin or insulin may mediate the endogenous relation of obesity with metabolic, inflammatory, and thrombogenic cardiovascular ri...