Milagros C. Rosal

Milagros C. Rosal
University of Massachusetts Medical School | UMMS · Department of Medicine

MS, PhD

About

233
Publications
23,466
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11,305
Citations
Additional affiliations
March 1994 - March 2016
University of Massachusetts Medical School
Position
  • Tenured Professor

Publications

Publications (233)
Article
Vaccine hesitancy is a long-standing public health issue. The present work describes parental perceptions of COVID-19 vaccination for 5- to 11-year-old children, to aid in vaccination efforts. Parents of 5- to 11-year-old children residing in Worcester, Massachusetts, were recruited through community partner outreach to participate in semi-structur...
Article
Background Racial differences in metabolomic profiles may reflect underlying differences in social determinants of health by self-reported race and may be related to racial disparities in coronary heart disease (CHD) among women in the United States. However, the magnitude of differences in metabolomic profiles between Black and White women in the...
Article
Full-text available
We explored perspectives of clinicians in central and western Massachusetts about efforts to vaccinate pediatric patients against COVID-19 as well as best practices and challenges for vaccine delivery. We conducted semi-structured qualitative interviews (n=16) with family practice and pediatric clinicians between late October and early December, 20...
Article
Objectives To identify frequency and correlates of hypertension in a low income, ethnically diverse, sample of children as well as to assess parental awareness of hypertension.Methods This cross-sectional study included parent-child dyads (n = 228), from which physical measurements of the child, and parent reported survey measures were collected. C...
Article
Background Negative emotional eating (EE) is associated with unfavorable behavioral and health outcomes. Understanding its association with positive factors, such as optimism, may shed light into novel interventions. We examined the association between optimism and negative EE in US Caribbean Latinx adults, a population disproportionately exposed t...
Article
Background: Although adherence to the American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity for Cancer Prevention associates with lower risk of obesity-related cancer (ORC) incidence and mortality, evidence in Black and Latina women is limited. This association was examined in Black and Latina participants in the Women's Heal...
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Objectives Rates of perinatal depression and pregnancy hyperglycemia are higher in Hispanic women as compared to non-Hispanic white women. In turn, depressive symptoms may reduce a woman’s ability to engage in lifestyle changes that could reduce their subsequent diabetes risk. Methods We conducted a secondary analysis using data from Estudio Parto...
Article
Background Due to underrepresentation of racial/ethnic minority and low-income groups in clinical studies, there is a call to improve the recruitment and retention of these populations in research. Pilot studies can test recruitment and retention practices for better inclusion of medically underserved children and families in subsequent clinical tr...
Article
Objectives This study evaluated the association between a restricted carbohydrate diet (<45% energy from carbohydrate) and metabolic syndrome stratified by fatty acid classes in a nationally representative sample of U.S adults. Methods Data on food and nutrient intake, and markers of metabolic syndrome, were obtained from 19,078 respondents ≥20 y...
Article
Background: School-supervised asthma therapy improves asthma outcomes for children, yet this strategy is not widely utilized. School nurses play a vital role in this intervention, yet their perspectives on school-supervised asthma therapy have not been thoroughly examined. Objectives: To examine the perspectives of school nurses participating in sc...
Article
Introduction: Poor sleep quality is associated with negative emotions and may modulate emotional eating (EE). However, this has not been studied among US Latinx adults, a group experiencing sleep disparities. Objective: To examine the association between sleep quality and EE in Latinx adults and explore the mediating role of negative emotions....
Article
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Background Implementation science frameworks advise the engagement of multi-level partners (at the patient, provider, and systems level) to adapt and increase the uptake of evidence-based practices (EBPs). However, there is little guidance to ensure that systems-level adaptations reflect the voices of providers who deliver and patients/caregivers w...
Article
Background The association of social isolation or lack of social network ties in older adults is unknown. This knowledge gap is important since the risk of heart failure (HF) and social isolation increase with age. The study examines whether social isolation is associated with incident HF in older women, and examines depressive symptoms as a potent...
Article
Objective: Despite evidence on allostatic load (AL) as a model explaining associations between stress and disease, there is no consensus on its operationalization. This study aimed to contrast various AL constructs and their longitudinal associations with disease and disability. Methods: Baseline and 5-year follow-up data from 738 adults partici...
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Full-text available
Background Reducing sugar-sweetened beverage (SSB) consumption is a promising dietary target for childhood obesity prevention. This paper describes the design and methods of a cluster randomized trial of H 2 GO!, a youth empowerment intervention to prevent childhood obesity through reducing SSB consumption among a low-income, ethnically diverse sam...
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Background: Anxiety and depression symptoms are known to increase cancer symptom burden, yet little is known about the longitudinal integrations of these among Hispanic/Latinx patients. The goal of this study was to explore the trajectory and longitudinal interactions among anxiety and depression, cancer symptom burden, and health-related quality o...
Article
This research tests the independent contribution of social capital and the use of the internet to obtain health information to support maternal-child communication about peer pressure to have sex among Puerto Rican families. A sample of 413 Puerto Rican households in Springfield, MA provides the data to independently test these hypotheses. The resu...
Article
Introduction This study assesses the impact of a culturally modified, motivationally targeted, individually tailored intervention on postpartum weight retention among Hispanic women with abnormal glucose tolerance during pregnancy. Methods Estudio Parto (Project Aiming to Reduce Type twO diabetes) was an RCT conducted in Western Massachusetts (col...
Article
Dysfunctional eating behaviors (DEB: emotional eating (EE), uncontrolled eating (UE) and cognitive restraint (CR)) are prevalent in U.S. Latinos and may influence diet. However, this has not been studied in Puerto Rico (PR). This study documents DEB in PR, and explores associations with diet. Cross-sectional study of adults (n = 92) in Ponce, PR. D...
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Background: Poor adherence to antihypertensive medications is a significant contributor to the racial gap in rates of blood pressure (BP) control among Latino adults, as compared to Black and White adults. While multi-level interventions (e.g., those aiming to influence practice, providers, and patients) have been efficacious in improving medicati...
Article
Background Poor sleep is associated with adverse outcomes among postpartum women. Exercise may improve sleep, but this has not been well examined in the postpartum period. Purpose To examine the impact of a culturally modified, individually tailored lifestyle intervention on sleep outcomes among postpartum Latina women. Methods Estudio PARTO was...
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Full-text available
Obesity is associated with significant comorbidities and financial costs. While behavioral interventions produce clinically meaningful weight loss, weight loss maintenance is challenging. The objective was to improve understanding of the neural and psychological mechanisms modified by mindfulness that may predict clinical outcomes. Individuals who...
Preprint
Obesity is associated with significant comorbidities and financial costs. While behavioral interventions produce clinically meaningful weight loss, weight loss maintenance is challenging. The objective was to improve understanding of the neural and psychological mechanisms modified by mindfulness that may predict clinical outcomes. Individuals who...
Article
Objective To examine the mediating role of emotional eating (EE) in the association between food insecurity (FI) and obesity in Latina women. Design A secondary analysis of a cross-sectional study. Participants Women (n = 297) were recruited from a community health center in Lawrence, MA. Variables measured The 6-item US Department of Agricultur...
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Full-text available
Aims To assess the impact of a culturally modified, motivationally targeted, individually-tailored intervention on postpartum physical activity (PA) and PA self-efficacy among Hispanic women. Methods Estudio PARTO was a randomized controlled trial conducted in Western Massachusetts from 2013–17. Hispanic women who screened positive for gestational...
Article
Ataque de nervios is a Latina/o idiom of distress that may occur as a culturally sanctioned response to acute stressful experiences, particularly relating to grief, threat, family conflict, and a breakdown in social networks. The contextual factors associated with ataque de nervios have received little attention in research. This study examined the...
Article
Background: Home remedies (HRs) are described as foods, herbs, and other household products used to manage chronic conditions. The objective of this study was to examine home remedy (HR) use among Blacks with hypertension and to determine if home remedy use is correlated with blood pressure and medication adherence. Methods: Data for this cross-...
Article
Objectives To examine the mediating role of emotional eating (EE) in the association between food insecurity (FI) and obesity in U.S. Latina women. Methods This study had a cross-sectional design. Participants were Latina women (n = 297) recruited from a community health center serving a large portion of the Latino population in Lawrence, Massachu...
Article
Objectives To document the level of dysfunctional eating behaviors, specifically emotional eating (EE), uncontrolled eating (UE) and cognitive restraint (CR), among adults in Puerto Rico (PR), and explore the association between each behavior and dietary intake (i.e., percentage of calories from fats, saturated fats and servings of fruits and veget...
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Importance: Although racial/ethnic differences in functional outcomes after total knee arthroplasty (TKA) exist, whether such differences are associated with differences in presurgical physical function (PF) has not been thoroughly investigated. Objective: To examine trajectories of PF by race/ethnicity before and after TKA among older women. D...
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Context: Policies (eg, regulations, taxes, and zoning ordinances) can increase opportunities for healthy eating. Community Health Improvement Plans (CHIP) may foster collaboration and local health department (LHD) engagement in policy decision making to improve local food environments. Limited research describes what policies supportive of healthy...
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Objective To examine the association between food insecurity and emotional eating (EE) in US Latinxs and explore the mediating role of perceived stress. Design Cross-sectional analysis. Food insecurity was measured with the six-item US Department of Agriculture Household Food Security Scale; EE with the Three-Factor Eating Questionnaire R18-V2; an...
Article
Background: Puerto Ricans experience a high prevalence of type 2 diabetes. Dietary glycemic load (GL) and allostatic load (AL) have been linked with diabetes. AL, the wear and tear on the body from chronic stress, starts with secretion of primary stress markers from activation of the hypothalamic-pituitary-adrenal (HPA) axis, sympathetic nervous s...
Article
Background Despite numerous interventions targeting medication adherence in patients with uncontrolled hypertension, practice-based trials in Latino patients are scant. Objective To evaluate the effect of a systems-level adherence intervention, delivered by medical assistants (MAs), versus a comparison condition on medication adherence and blood p...
Article
Background. John Henryism is defined as a measure of active coping in response to stressful experiences. John Henryism has been linked with health conditions such as diabetes, prostate cancer, and hypertension, but rarely with health behaviors. Aims. We hypothesized that reporting higher scores on the John Henryism Scale may be associated with poor...
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Full-text available
Background: Efficacious strategies to reduce sugar-sweetened beverage (SSB) consumption among youth are needed. This pilot study assessed the feasibility and preliminary efficacy of a community-based youth empowerment intervention to reduce SSB consumption and obesity risk among a low-income, ethnically diverse sample of youth. Methods: The H2GO...
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Background: Local health departments (LHDs) are increasingly involved in Community Health Improvement Plans (CHIPs), a collaborative planning process that represents an opportunity for prioritizing physical activity. We determined the proportion of LHDs reporting active transportation strategies in CHIPs and associations between LHD characteristic...
Article
This systematic review examined the extent to which lifestyle physical activity interventions that used wearable devices (eg, pedometers, accelerometers) reported on the length of device wear time requested in their protocols, criteria for analytic inclusion of data, and participant compliance with device use protocols. Literature were searches wer...
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Objective: The purpose of this study was to describe the preferences, the use, satisfaction of mental health services (MHS) among a sample of Puerto Rican patients with cancer undergoing oncology treatment. Methods: A convenience sample of 120 patients diagnosed with cancer was recruited. Self-report questionnaires assessed socio-demographic and b...
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Background: Lifestyle interventions regularly rely on study staff to implement the intervention and collect outcomes data directly from study participants. This study describes the experiences of project staff in two randomized controlled trials of a postpartum lifestyle intervention to reduce risk factors for type 2 diabetes in Latinas. Latinas a...
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Background: One third of U.S. children and two thirds of adults are overweight or obese. Interventions to prevent obesity and thus avert threats to public health are needed. This paper describes the design and methods of the Healthy Kids & Families study, which tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle...
Article
Objectives: Poor sleep among postpartum women is associated with adverse maternal outcomes. Physical activity (PA) is associated with better sleep. However, few studies have been conducted among postpartum Hispanic women. The objective of this study was to examine the association between PA and sleep quality and duration among postpartum Hispanic...
Article
Background: Latinos experience disparities in obesity. Although causes of obesity are multifactorial, overeating is a major contributor. Emotional eating (EE) is associated with obesity and with intake of energy-dense foods. However, the relationship between EE and overeating, and the mediating role of energy-dense foods on this relationship, has...
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Objectives To develop and validate a Weight Literacy Scale in English and Spanish for adults. Methods The two-phase study utilized quantitative and qualitative methods. Phase 1 of the study consisted of developing an initial survey (English and Spanish versions) assessing weight literacy based on a review of the literature; conducting semi-structu...
Data
Final 31-item Weight Literacy Scale–English. Note: Items 26 and 27 contain multiple questions; each question is counted as an item. * denotes the correct answer. (DOCX)
Data
Study sample weight literacy score data. (CSV)
Data
Study sample demographics and construct validity data. (CSV)
Article
Objective/background: Poor sleep during pregnancy is common and is associated with pregnancy complications. Physical activity (PA) is associated with better sleep in nonpregnant populations. However, studies among pregnant women are sparse, conflicting, and none have been conducted among Hispanic women, who face a disproportionate burden of poor s...
Article
Objective Evidence suggests discrimination increases the risk of obesity. The biopsychosocial model of racism posits that psychological factors such as depressive symptoms may link experiences of perceived interpersonal discrimination to obesity. This study tested whether self‐reported experiences of everyday discrimination were associated with adi...
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Full-text available
Objective This study examined associations between pregnant women’s report of obstetric provider GWG advice, self-reported adherence to such advice, and GWG. Methods Healthy pregnant women (N = 91) who started obstetric care prior to 17 weeks of gestation completed assessments between 30 and 34 weeks of gestation. These included survey (questions o...
Article
Objectives: To examine the association between sugar-sweetened beverage availability at home and sugar-sweetened beverage consumption, and to evaluate whether this association was consistent across school and school neighborhood sugar-sweetened beverage availability. Study design: Secondary data analyses were performed from the 2014 cross-sectio...
Data
References of Studies that Measured Physical Activity using Subjective Measures (N = 239)1–239.
Data
References of Studies that Measured Physical Activity using Objective Measures (N = 103)1–103.
Data
Summary of the types of physical activity assessment methods.
Article
Full-text available
Valid, reliable, and direct measures of physical activity (PA) are critical to assessing the impact of lifestyle PA interventions. However, little is known about the extent to which objective measures have been used to assess the outcomes of lifestyle PA interventions. This systematic review had two aims: 1) evaluate the extent to which PA is measu...
Article
Background: Food insecurity has been consistently associated with CVD risk factors (i.e., obesity, type 2 diabetes, hypertension and hypercholesterolemia). Consumption of fruits and vegetables may reduce CVD risk factors among food insecure Latinos. Objective: To examine the potential moderating effect of fruit and vegetable intake in the associati...
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Full-text available
Purpose: To examine the relationship of caste and class with perceived discrimination among pregnant women from rural western India. Methods: A cross-sectional survey was administered to 170 pregnant women in rural Gujarat, India, who were enrolled in a longitudinal cohort study. Everyday Discrimination Scale and Experiences of Discrimination quest...
Article
Background: Among adolescents, sugar-sweetened beverages (SSBs) are the primary source of added dietary sugar and constitute 10-15% of their total caloric intake. A range of factors influence adolescent dietary behaviors and food choices. This study aimed to explore adolescents' attitudes and knowledge about SSBs, how they receive messages about SS...
Article
Introduction: Evidence-based healthy eating (HE) policies can increase opportunities to engage in a healthy diet. The adoption of evidence-based policies into practice is limited and no study reports the status of HE policies nationally. Community Health Improvement Plans (CHIPs) strategically address health priorities, steer evidence-based strateg...
Article
Full-text available
Obesity remains a persistent public health and health disparity concern in the United States. Eliminating health disparities, particularly among racial/ethnic minority groups, is a major health priority in the US. The primary aim of this review was to evaluate representation of racial/ethnic sub-group members in behavioral weight loss interventions...
Article
Several studies, such as the Diabetes Prevention Program (DPP), have provided foundational evidence for the efficacy of lifestyle interventions on weight loss and cardiometabolic prevention. However, translating these interventions to real-world settings and engaging at-risk populations has proven difficult. Social media-delivered interventions hav...
Article
African Americans remain underrepresented in health-related research. We examined the association between spirituality using the Self-Rating Spirituality Scale (range 6-24) and self-reported willingness to participate in health-related research studies among African Americans. Covariates included gender, education level, employment status, and prev...
Article
Background: Regular physical activity (PA) lowers the risk of cardiovascular disease (CVD), but few US adults meet PA guidelines. The United States Preventive Services Task Force (USPSTF) recommends primary care providers offer PA counselling for CVD prevention. We examined the association between adherence to PA guidelines and reported provider a...
Article
Full-text available
Background Efforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss i...
Preprint
BACKGROUND Efforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss i...