Elizabeth Goodman

• MD, MBA
• Director Outcomes Research at Merck

Eliminating health disparities, including those that are a result of socioeconomic status (SES), is one of the overarching goals of Healthy People 2010. This article reports on the development of a new, adolescent-specific measure of subjective social status (SSS) and on initial exploratory analyses of the relationship of SSS to adolescents' physic...

Adolescent obesity is a strong predictor of adult obesity, and adult obesity has been associated with depression, especially in women. Studies have also suggested an association between depression in adolescence and higher body mass index (BMI) in adulthood. Whether depression leads to obesity or obesity causes depression is unclear. To determine i...

Factor analyses suggest that the structure underlying metabolic syndrome is similar in adolescents and adults. However, adolescence is a period of intense physiological change, and therefore stability of the underlying metabolic structure and clinical categorization based on metabolic risk is uncertain. We analyzed data from 1098 participants in th...

Background There remains a lack of evidence demonstrating a potential relationship between vitamin D and cardiometabolic risk among children. Objective We examined the effect of three different doses of vitamin D on cardiometabolic risk factors among children at risk for deficiency. Design Racially diverse schoolchildren aged 8–15 years were rand...

This study examined the associations of subjective social status (SSS) with physical activity (PA) and sedentary time (ST) among adolescents. The study population consisted of 420 Finnish adolescents aged 13 to 14 years. The adolescents reported their own SSS within their school (school SSS) and their family’s social position within society (societ...

Historically, research examining health status disparities between members in different socioeconomic status and racial/ethnic groups often focused on adults and the concurrent lifestyle factors that might explain health differentials. Recent years have witnessed an explosion of interest in the developmental origins of adult health and disease, and...

The physiological relevance C-3 epimer of 25-hydroxyvitamin D (3-epi-25(OH)D) is not well understood among youth. The objective of this study was to assess whether demographic/physiologic characteristics were associated with 3-epi-25(OH)D3 concentrations in youth. Associations between 3-epi-25(OH)D3 and demographics and between 3-epi-25(OH)D3, tota...

Objective We investigated the daily dose of vitamin D needed to achieve serum 25-hydroxyvitamin D [25(OH)D] sufficiency among schoolchildren at-risk for deficiency. Study Design The Daily D Health Study was a randomized double-blind vitamin D supplementation trial among racially/ethnically diverse schoolchildren (n=685) in the northeastern U.S. Ch...

Health disparities in the United States related to socioeconomic status are persistent and pervasive. This review highlights how social disadvantage, particularly low socioeconomic status and the health burden it brings, is passed from 1 generation to the next. First, we review current frameworks for understanding the intergenerational transmission...

Purpose: National guidelines recommend adolescents achieve 60 minutes of moderate-to-vigorous physical activity (MVPA)/day, yet few adolescents meet these guidelines. Methods: We piloted a novel quasi-randomized physical activity intervention to promote adolescent's use of their surrounding built environment among 30 intervention and 30 control...

We show that, up to Lagrangian isotopy, there is a unique Lagrangian torus inside each of the following uniruled symplectic four-manifolds: the symplectic vector space $\mathbb{R}^4$, the projective plane $\mathbb{C}P^2$, and the monotone $S^2 \times S^2$. The result is proven by studying pseudoholomorphic foliations while performing the splitting...

We show that, up to Lagrangian isotopy, there is a unique Lagrangian torus inside each of the following uniruled symplectic four-manifolds: the symplectic vector space $\mathbb{R}^4$, the projective plane $\mathbb{C}P^2$, and the monotone $S^2 \times S^2$. The result is proven by studying pseudoholomorphic foliations while performing the splitting...

Physical activity is a health-enhancing behavior, but few adolescents achieve the recommended levels of moderate-to-vigorous physical activity. Understanding how adolescents use different built environment spaces for physical activity and activity varies by location could help in designing effective interventions to promote moderate-to-vigorous phy...

Highlights Different measures of social position capture unique dimensions of relative rank among youth. Youth-specific measures of social position may be important in identifying the most at-risk for obesity. Lower social status youth are more likely to be at-risk for obesity-related behaviors compared to those with a higher rank. This cross-sect...

Objective: To evaluate whether depressive symptoms predict change in fasting insulin among adolescents followed into young adulthood. We hypothesized that higher depressive symptoms would predict increased insulin and that puberty and race/ethnicity would moderate this relationship. Methods: Data came from the Princeton School District Study, a...

Background: The aim of this study was to determine whether engagement in more physical education (PE) classes during one high school year is associated with change in physical activity (PA) from adolescence to young adulthood. Methods: Data were from 1774 participants in Waves 2 (high school, 1996) and 4 (young adulthood, 2008) of the National L...

Intake of sugar-sweetened beverages (SSBs) is linked to greater cardiometabolic risk in adults. Although longitudinal evidence is sparse among children, SSB intake reduction is targeted to reduce cardiometabolic risk factors in this group. We investigated characteristics associated with consumption of SSBs in a multi-ethnic sample of children/adole...

Subjective social status (SSS), a person's sense of their (or for youth, their family's) position in the socioeconomic hierarchy, is strongly related to health in adults but not health in adolescence. Understanding this developmental discrepancy requires first understanding the developmental trajectory of SSS. The objective of this study was to ide...

Multi-component interventions combining educational and environmental strategies have proved effective in increasing children and adolescents’ fruit and vegetable intake. However such interventions are complex and difficult to implement and several studies report poor implementation. There is a need for knowledge on the role of dose for behaviour c...

Social networks reflect the structure of our interpersonal relationships. The effect of social networks on health is a topic of growing interest, particularly in an increasingly connected world. This review provides an overview of how social relations shape obesity risk and the effectiveness of network-based obesity interventions across the lifecou...

Objective The biological relevance of the 3‐epimer of 25‐hydroxyvitamin D (25OHD) is not well classified. Our goal was to examine associations between serum 3‐epimer and demographics and blood lipids in diverse school‐aged children. Methods Multivariate logistic and linear regression models were used to examine relationships between having detecta...

Purpose: To explore the association between developmental assets (characteristics, experiences, and relationships that shape healthy development) and food insecurity among adolescents from a low-income urban community. Methods: This mixed-methods study occurred in two phases. In phase 1, using a census approach, 2,350 6th to 12th graders from th...

An extensive literature documents the existence of pervasive and persistent child health, development, and health care disparities by race, ethnicity, and socioeconomic status (SES). Disparities experienced during childhood can result in a wide variety of health and health care outcomes, including adult morbidity and mortality, indicating that it i...

Background: Metabolic syndrome (MetS) is a clustering of risks associated with cardiometabolic disease in adults. Obesity is considered the major etiologic factor. However, unlike obesity, the natural history of MetS as adolescents transition to adulthood is unknown. Objective: The purpose of this study was to characterize the typology of MetS a...

Adequate physical activity promotes physical and mental health and decreases obesity risk. However, most adolescents do not attain recommended physical activity levels and effective interventions are lacking. Physical activity trials rarely incorporate built environment use patterns. This paper describes the design and rationale of the Children's U...

To describe levels of perceived lifetime discrimination among young adults and determine its role in understanding this racial/ethnic disparity. Data were from the Princeton School District study, a 10-year cohort study in which investigators followed 545 non-Hispanic black (46%) and white initial 5-12 graders. Perceived lifetime racial discriminat...

Background: While rarely used for supplementation trials in the United States, schools present a practical alternative to a clinical setting. Purpose: We describe the successful recruitment and retention of urban schoolchildren into a 6-month randomized, double-blind vitamin D3 supplementation trial. Methods: Boston-area urban schoolchildren,...

Lifecourse trajectories of clinical or anthropological attributes are useful for identifying how our early-life experiences influence later-life morbidity and mortality. Researchers often use growth mixture models (GMMs) to estimate such phenomena. It is common to place constrains on the random part of the GMM to improve parsimony or to aid converg...

Objectives: Care coordination and the medical home may ensure access to specialty care. Children with special health care needs (CSHCN) have higher rates of specialty care use and unmet need compared with the general pediatric population. We hypothesized that care coordination, regardless of whether it was provided in a medical home, would decreas...

Background: Intakes of sugar-sweetened beverages (SSB) and added sugars have been targeted in efforts to reduce childhood obesity and cardiovascular disease risk factors in children. Although evidence is sparse in children, overconsumption of SSB and added sugars has been linked to greater dyslipidemia in adults. Objectives: To examine the associat...

Background: Physician counseling on lifestyle factors has been recommended as one way to help combat the obesity epidemic in the United States. The aim of this study was to examine the frequency of lifestyle counseling among healthy weight, overweight, and obese adolescents and determine the contributions of adolescent weight and physical activity...

To understand obese adolescent girls’ perspectives regarding their weight and health we studied video intervention/prevention assessment audiovisual narratives created by 14 obese girls ages 12 to 20 years. The narratives included interviews, monologues, and daily activities. Themes included illness conceptualizations, health concerns, health misin...

Childhood obesity is a significant risk factor for cardiovascular disease in adulthood. Although ventricular remodeling has been reported in obese youth, early tissue-level markers within the myocardium that precede organ-level alterations have not been described. We studied 21 obese adolescents (mean age, 17.7±2.6 years; mean body mass index [BMI]...

Background: Socioeconomic disadvantage and other social stressors in childhood have been linked with cardiometabolic diseases in adulthood; however the mechanisms underlying these observed associations and the timing of their emergence are unclear. The aim of this review was to evaluate research that examined relationships between socioeconomic di...

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Prior studies evaluating housing programs have found varied results for the impact of improved housing on maternal mental health. This study evaluated data from 169 families who participated in Hawaii's Healthy Start Program. The study's objective was to determine whether receipt of Section 8 rental assistance in the first year of a child's life de...

Objective To determine whether lower socioeconomic status (SES), broadly defined, is associated with increased inflammation in adolescence and whether adiposity mediates these relationships.Methods Fasting blood samples from 941 non-Hispanic black and white adolescents enrolled in a suburban, Midwestern school district were assayed for proinflammat...

Despite the significant attention and resources committed to the prevention and treatment of childhood obesity, the epidemic shows no sign of abating.1 Although all children are at risk for obesity, there are marked disparities by race/ethnicity, socioeconomic status, neighborhood, and access to health care.2 Any successful approach to addressing t...

Purpose: Dispositional optimism is a psychological trait associated with cardiovascular disease outcomes in adults. However, it is not known whether these associations are present in adolescents. We attempted to determine whether an association exits between optimism and 9 biomarkers of cardiometabolic risk during adolescence. Because cardiometabo...

Dietary factors vary widely among ethnic groups. However, the effect of specific nutrients on cardiometabolic risk is not well understood, especially in children. Four dietary factors known to influence cardiometabolic risk (ie, carbohydrate, saturated, monounsaturated, and polyunsaturated fat intake) were assessed by the Block Kids 2004 Food Frequ...

Background: Understanding the risk for type 2 diabetes (T2D) early in the life course is important for prevention. Whether genetic information improves prediction models for diabetes from adolescence into adulthood is unknown. Methods: With the use of data from 1030 participants in the Bogalusa Heart Study aged 12 to 18 followed into middle adul...

Low serum vitamin D, which largely affects ethnic minorities, is associated with obesity and other chronic diseases. Little is known about racial/ethnic differences in intake, particularly in children, or if any differences are associated with differences in serum 25-hydroxyvitamin D (25(OH)D). The objective of the present study was to determine wh...

Workplace injuries can have a substantial economic impact. Rates of workplace injuries differ across age groups, yet occupations/industry sectors at highest risk within age groups have not been identified. We examined workplace injury risk across industry sectors for three age groups using nationally representative U.S. data. Data from 1997 to 2009...

Background Prediction of type 2 diabetes (T2D) early in the life course, before metabolic derangements occur, might facilitate prevention. In middle-aged adults, genotype risk scores (GRS) predict incident T2D but do not outperform prediction models consisting of clinical variables such as family history, body-mass index (BMI), and routine laborato...

Massachusetts (MA) mandated body mass index (BMI) screening in schools in 2010. However, little is known about pediatricians' views on school-based screening or how the pediatricians' perspectives might affect the school-based screening process. We assessed MA pediatricians' knowledge, attitudes, beliefs, and practices concerning BMI screening. An...

The obesity-psychological distress relationship remains controversial. This study aims to assess whether adolescents' psychological distress was associated with body mass index (BMI) class membership determined by latent class analysis. Distress (anxiety, depression) and BMI were measured annually for 4 years in 1,528 adolescents. Growth mixture mo...

Background: Young workers (<24 years) are at increased risk for injury and possibly negative health behaviors (e.g. early tobacco or drug use); at the same time, research has shown that young people who work may attain higher employment rates and better wages as long as a decade after high school graduation. Methods: Using data derived from the Nat...

To assess whether dispositional optimism is associated with adiposity and to explore whether dispositional optimism mediates the relationship between parent education and adiposity (body mass index [BMI] z-score). Multivariate regression analyses of data were collected from 1,298 non-Hispanic black and white adolescents aged 12-19 years from a sing...

Objective: Work-related injuries comprise one-third of all injuries and can have a substantial economic impact. Rates and nature of work-related injuries at extremes of work-life differ from those of middle-age group, yet occupations at highest risk within each age group have not been identified. We examined work-related injury risk across industry...

Introduction: The number of Single mother households in the U.S. is higher than ever before. Though the annual income and employment among this group has increased, self-reported health has declined. The purpose of the study was to investigate differences in healthcare utilization and access among employed and unemployed single mothers. Methods:...

OBJECTIVE: Illicit drug use that commences during young adulthood represents an important public health concern. The social, economic, and health consequences of illicit drug use in adolescence may persist throughout young adulthood and negatively impact employment opportunities. We examine the association between employment status, occupation type...

Correlational research has shown that lower social standing is associated with poorer health, but it is unknown if this association is causal. Two experiments tested whether randomly assigned low subjective social status would promote ruminative coping, a mechanism leading to the development of poor health outcomes. Participants were college female...

To determine the relationship between serum vitamin D levels and cardiometabolic risk factors independent of adiposity in urban schoolchildren. We assessed the relationships among serum 25-hydroxyvitamin D [25(OH)D], adiposity measured by body mass index (BMI) z-score (BMIz), and 6 cardiometabolic risk factors (total cholesterol, high-density lipop...

Some markers of social disadvantage are associated robustly with depressive symptoms among adolescents: female gender and lower socioeconomic status (SES), respectively. Others are associated equivocally, notably Black v. White race/ethnicity. Few studies examine whether markers of social disadvantage by gender, SES, and race/ethnicity jointly pred...

Little is known about the relationship between severe obesity and depressive symptoms, particularly in community as opposed to clinic-based samples. This study determined the relationship of severe obesity and depressive symptoms over 3 years in a community-based sample of non-Hispanic black and white adolescents in grades 7-12 at baseline. The nes...

Todays youth face health risks associated with living in a highly technological, fast- paced world. Many also face risks associated with disadvantaged environments that contribute to health disparities. Solving the childhood obesity epidemic requires not only individual behavioral change, but also changes to the context in which young people grow a...

Research on the prevalence of health indicators by employment status among young US adults is limited. We analyzed data from a nationally representative sample of young adults aged 18 to 24 years to document the prevalence of five health behaviors (cigarette smoking, risky drinking, leisure-time physical activity, and fruit and French fries consump...

Objective: The prevalence of cardiovascular disease and its risk factors differs by occupational group. This study assessed the differences in prevalence and risk of the metabolic syndrome by occupational group using nationally representative data of US workers. Research design and methods: Data from 8,457 employed adults (representing 131 millio...

Differences in the prevalence of cardiovascular disease (CVD) and its risk factors among occupational groups have been found in several studies. Certain types of workers (such as shift workers) may have a greater risk for metabolic syndrome, a precursor of CVD. The objective of this study was to assess the differences in prevalence and risk of meta...

This study explores whether the relationship between lower socioeconomic status and insulin resistance in adolescents is mediated by both physiological and psychological factors associated with increased cardiometabolic risk. School-based longitudinal cohort study of 1222 healthy, non-Hispanic black and white teens. Parent education (PE), youth-spe...

This study assessed the relationship between employment status and mortality over a 2-year period among a nationally representative sample of young adults aged 18 to 24 years (n = 121,478, representing more than 21 million US young adults). By using data from the 1986-2000 National Health Interview Survey and its public-use mortality follow-up thro...

Chronic disease management is an increasingly important aspect of caring for adolescents. Strength-based approaches hold tremendous promise in the face of current challenges. Recent clinical innovations and research findings that provide evidence of the efficacy of strength-based approaches and represent a fundamental evolution in the clinical appr...

To examine the relationship between sexual orientation and past-year reports of bullying victimization and perpetration in a large sample of American youth. Survey data from 7,559 adolescents aged 14-22 who responded to the 2001 wave questionnaire of the Growing Up Today Study were examined cross-sectionally. Multivariable generalized estimating eq...

To address the critical shortage of physician scientists in the field of adolescent medicine, a conference of academic leaders and representatives from foundations, National Institutes of Health, Maternal and Child Health Bureau, and the American Board of Pediatrics was convened to discuss training in transdisciplinary research, facilitators and ba...

Background and objectives: Adolescent reproductive health (ARH) policies often impact the practice of adolescent medicine. However, physicians' understanding of their roles as advocates and the extent to which adolescent medicine physicians have a voice in the policy sphere are unclear. This study explores the ways in which adolescent medicine phys...

To study maternal obesity as a risk factor for preterm delivery. Maine State Birth Records Database from 1996 through 2006 was evaluated to investigate obese pregnant women compared with normal weight women regarding risk for preterm delivery. Multiple risk factors and outcomes were studied in univariable and multivariable models. Among 58,112 preg...

To test the fit and stability of 3 alternative models of the metabolic syndrome's factor structure across 3 developmental stages. With data from the Fels Longitudinal Study, confirmatory factor analyses tested 3 alternative models of the factor structure underlying relationships among 8 metabolic syndrome-associated risks. Models tested were a 1-fa...

To examine the patterns of change in cardiometabolic risk factors associated with the metabolic syndrome in children and adolescents between the ages of 8 to 19 years. Data of children and adolescents who participated in the Fels Longitudinal Study were analyzed. Body mass index, waist circumference, fasting insulin, fasting glucose, triglycerides,...

To determine whether maternal obesity in early pregnancy is associated with low neonatal 5-min Apgar scores while adjusting for confounders. Data were obtained from Maine State Birth Records Database. Analyses were restricted to information on 58,089 white women and their newborns. Maternal weight status was defined using the recorded early second...

Global climate change and recent studies on early-life origins of well-being suggest that climate events early in life might affect health later in life. The study tested hypotheses about the association between the level and variability of rain and temperature early in life on the height of children and adolescents in a foraging-farming society of...

The epidemic of childhood overweight and obesity is characterized by known disparities. Less is known about how these disparities vary across and within the state in which a child lives. To examine the magnitude and patterns of across- and within-state differences in the prevalence of childhood overweight and obesity according to children's insuran...

America’s increasing obesity problem requires federal, state, and local lawyers, policymakers, and public health practitioners to consider legal strategies to encourage healthy eating and physical activity. The complexity of the legal landscape as it affects obesity requires an analysis of coordination across multiple sectors and disciplines. Gover...

This paper is the companion to the “Assessment of Coordination of Legal-Based Efforts across Jurisdictions and Sectors for Obesity Prevention and Control” paper, and the third of four papers outlining action options that policymakers can consider as discussed as part of the National Summit on Legal Preparedness for Obesity Prevention and Control. T...

This chapter will explore socioeconomic risks for the development and persistence of overweight and obesity among children and adolescents. These factors are part of the social environment in which the developing child is immersed. In childhood and adolescence, health and development are inextricably linked. However, although the influence of the s...

To assess, among overweight non-hispanic black adolescents the relationship of changes in plasma retinol binding protein 4 (RBP4) over 3 years to changes in insulin resistance (IR) and 4 associated cardiometabolic risks. Nested, retrospective study of 51 overweight, post-pubertal non-Hispanic black participants in the Princeton School District Stud...

Studies suggest that breastfeeding is protective for later obesity; however, this association has not held among all racial and socioeconomic status groups. Racial and socioeconomic status differences in breastfeeding behavior have also been noted. In this study, we formally test whether breastfeeding mediates the relationship between race and soci...

Obesity is an important risk factor for cardiovascular disease (CVD) that affects health throughout an individual’s life. Despite these well-established associations of risk throughout the life course, debate continues over how to best assess this risk in pediatric populations. This article discusses the state of the art in this field, comprising t...

To determine whether subjective social standing in school predicts a change in body mass index (BMI) in adolescent girls during a 2-year period. Prospective cohort study. Self-report questionnaires from a community-based population of adolescent girls living across the United States from 1999 to 2001. Of 5723 girls aged 12 to 18 years participating...

The cognitive, social, and biological transitions of adolescence suggest that subjective perceptions of social position based on the socioeconomic hierarchy may undergo important changes during this period; yet how such perceptions develop is poorly understood, and no studies have assessed whether changes in such perceptions influence adolescents'...

Background: Foods of Minimal Nutritional Value (FMNV) in public schools may contribute to child and adolescent obesity. Many Massachusetts public schools have decreased the amount of FMNV available to students, but much still remains. Although the Wellness Policy took effect in 2006, local districts and schools continue to make their own decisions...

A 4-year longitudinal study was conducted to determine the prevalence of overweight, detect shifts in body mass index (BMI) distribution, and determine which adolescents were at risk for pathologic weight gain. BMI was analyzed in 1746 adolescents in years 1 (2001-2002) through 4 (2004-2005) of a school-based study. Changes in BMI-Z according to ba...

We compare blood pressure and hypertension between adult men on the USA mainland and in Puerto Rico born during 1886-1930 to test hypotheses about the link between cardiovascular health and large socioeconomic and political changes in society: (a) 8853 men surveyed in Puerto Rico in 1965 and (b) 1449 non-Hispanic White men surveyed on the mainland...

The links between adult height and socioeconomic-political marginality are controversial. We test hypotheses by comparing secular trends between two groups of USA adult male citizens born during 1886-1930: (a) 9805 men surveyed in Puerto Rico during 1965 and (b) 3064 non-Hispanic Whites surveyed on the mainland during 1971-1975. Puerto Rico provide...

To investigate whether psychological resources influenced the association between parent education (PE), a marker of socioeconomic status (SES), and perceived stress. Cross-sectional analyses were conducted in a sample of 1167 non-Hispanic black and white junior and senior high school students from a Midwestern public school district in 2002-2003....

The objectives of this study were to determine whether lower socioeconomic status (SES) is associated with changes in insulin resistance in adolescents over a 3-year period and explore moderators of this effect. A total of 1167 healthy non-Hispanic black and white participants in the Princeton School District Study, a longitudinal study of fifth to...

Adolescent smoking is associated with increased perceived stress and lower social status, but past research has not explored links between lower social status, stress, and smoking risk. This study examined whether the relation between social status and perceived stress could explain the association between lower social status and increased risk of...

We examine the association between exposure to the market and Western society on the height of adult Tsimane', a foraging-farming society in the Bolivian Amazon. As with other contemporary native peoples, we find little evidence of a significant secular change in height during 1920-1980. Female height bore a positive association with own schooling...