
Milagros C. RosalUniversity of Massachusetts Chan Medical School | UMMS · Department of Medicine
Milagros C. Rosal
MS, PhD
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263
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Introduction
Additional affiliations
March 1994 - March 2016
Publications
Publications (263)
Background
Cardiovascular health (CVH) in young adulthood is associated with CVD in later life, yet CVH in young adults in the United States falls below ideal levels, with noticeable sex differences. Research on CVH in young adults in Puerto Rico is scarce. This study examined CVH and sex differences in CVH in a large cohort of young adults in Puer...
Residents of Puerto Rico face a high burden of food insecurity (FI), which has been associated with insomnia symptoms (IS). However, this association remains understudied in Puerto Rican young adults, a vulnerable group experiencing an elevated prevalence of FI and poor sleep. We evaluated the association between FI and IS and the mediating role of...
Objective
We aimed to determine the relationship between socioeconomic and psychological factors and overall cardiovascular health (CVH), as defined by the American Heart Association's Life's Essential 8 (LE8), among young adults in Puerto Rico.
Methods
Participants were 2156 young adults, between the ages of 18–29 years, enrolled in the PR-OUTLOO...
Family support plays an important role in promoting resilience and health among transgender and/or nonbinary youth (TNBY), but family members often experience barriers to supporting their TNBY, including minority-adjacent stress stemming from exposure to structural stigma and antitransgender legislation. TNBY and their families need effective famil...
Introduction
Maternal overweight or obesity has been associated with metabolic syndrome through 1 year postpartum, but it remains unknown whether a culturally-modified, motivationally-targeted, and individually-tailored Lifestyle Intervention could improve postpartum cardiometabolic health among Hispanic women with overweight or obesity.
Methods
P...
The Puerto Rico (PR) Young Adults' Stress, Contextual, Behavioral & Cardiometabolic Risk Study (PR-OUTLOOK) is investigating overall and component-specific cardiovascular health (CVH) and cardiovascular disease (CVD) risk factors in a sample of young (age 18-29) Puerto Rican adults in PR (target n=3,000) and examining relationships between individu...
BACKGROUND
The relationship between systolic blood pressure (SBP) and longevity is not fully understood. We aimed to determine which SBP levels in women ≥65 years of age with or without blood pressure medication were associated with the highest probability of surviving to 90 years of age.
METHODS
The study population consisted of 16570 participant...
Background: Recent research has identified associations between optimism and cardiovascular disease endpoints. However, other resilience factors like shift-and-persist (SP; adapting the self to stress while finding purpose in tough times), spirituality, social support, and life satisfaction have been understudied. We assessed associations among the...
Introduction
To evaluate the effect of a culturally-modified, motivationally-targeted, individually-tailored lifestyle intervention on postpartum weight retention among Hispanic women with overweight/obesity.
Materials and methods
Proyecto Mamá was a randomized controlled trial conducted in western Massachusetts (2014–2020). Hispanic women with ov...
While recent research has begun to address the effects of family support on transgender and/or nonbinary youth (TNY), almost no studies have directly examined how cisgender siblings in families with TNY navigate their sibling's gender disclosure and affirmation within both their families and their larger communities. We conducted an exploratory sec...
This study examined concordance of family members’ perspectives of family functioning and mental health across two years in families with transgender and/or nonbinary youth (TNBY). Participants were 89 family members (30 TNBY, age 13–17 years; 44 cisgender caregivers; 15 cisgender siblings, age 14–24 years) from 30 families from the U.S. New Englan...
Objective
Residents of Puerto Rico are disproportionately exposed to social and environmental stressors (e.g., Hurricane María and the 2020 sequence of tremors) known to be associated with psychological distress. Shift-and-persist (SP), or the ability to adapt the self to stressors while preserving focus on the future, has been linked with lower ps...
We explored patterns of COVID-19 vaccination across pediatric visit types using electronic health record data from 7/1/2021 through 7/25/2022 in a pediatric safety-net clinic. We generated frequencies and descriptive statistics for patient demographic and vaccine administration variables. Analyses were stratified into age subgroups of 5-to-11-year-...
Background:
Women with abnormal glucose tolerance during pregnancy are at risk for cardiovascular disease (CVD), with higher rates among Hispanics. However, studies on the impact of lifestyle interventions on postpartum CVD profiles are sparse.
Methods:
This is a secondary analysis of a controlled trial among a subsample of Hispanic women with a...
Background: The association between systolic blood pressure (SBP) and longevity is not fully understood. We aimed to determine survival probabilities to age 90 for various SBP levels among women aged ≥ 65 years with or without BP medication.
Methods: We analyzed blood pressure data from participants in the Women's Health Initiative (n=16,570) who w...
Despite the availability of COVID-19 vaccines for youth since 2021, vaccine hesitancy has resulted in suboptimal uptake. Public health campaigns that empower local youth ambassadors as trusted messengers who share their personal narratives related to getting vaccinated hold promise for promoting COVID-19 vaccination. We used a seven-step approach t...
Background: Emerging evidence supports significant variations in cardiovascular health (CVH), as defined by the American Heart Association (AHA) using “Life’s Simple 7” metrics, among Hispanics in the mainland US by sex and heritage group. Of these, Hispanic men and those of Puerto Rican background are less likely to meet favorable CVH criteria. Ye...
Background: Shift-and-persist (SP), defined as the ability to adapt the self to stressors while preserving focus in the future, is associated with favorable cardiometabolic outcomes. SP may be of great importance to individuals in Puerto Rico (PR) given their disproportionate exposure to social and environmental stressors. However, there is a scarc...
Background: Depressive symptoms are associated with cardiovascular disease (CVD) incidence, morbidity and mortality. Less is known about the association between depressive symptoms and overall cardiovascular health (CVH) of young adults, an age group that commonly experiences depressive symptoms. We examined the association between depressive sympt...
Background
Discrimination has been posited as a contributor of sleep disparities for Latinxs. The strategy used to cope with discrimination may reduce or exacerbate its effects on sleep. This study examined whether different types of discrimination (everyday and major lifetime discrimination) were associated with sleep indices (quality, disturbance...
Socioeconomically disadvantaged children experience a high burden of obesity but few interventions address obesity prevention in this population subgroup. The Healthy Kids & Families study tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Participants were child-parent...
Objective
: Innovative strategies are needed to improve pediatric COVID-19 vaccination rates. We describe the process for developing a clinic-based intervention, CONFIDENCE, to improve pediatric COVID-19 vaccine uptake and present results of our beta-test for feasibility and acceptability.
Methods
: CONFIDENCE included communication training with...
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...
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...
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...
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...
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...
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 Health...
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...
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...
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...
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...
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....
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...
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...
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...
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...
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...
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...
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...
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...
Abstract 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 m...
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...
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...
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...
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...
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...
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...
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-...
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...
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...
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...
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...
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...
Introduction: Hypertension (HTN) continues to be a significant yet modifiable risk factor for cardiovascular disease in the United States, increasingly affecting younger individuals. This study examined rates and correlates of HTN and HTN awareness in a sample of parents of school-age children
Methods: We analyzed baseline data from the Healthy Ki...
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...
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...
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...
Abstract 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...
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...
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 bac...
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...
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...
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...
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...
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...
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...
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)
Study sample weight literacy score data.
(CSV)
Study sample demographics and construct validity data.
(CSV)
Background
Previous published literature has shown that cardiovascular risk factor management programs conducted during physician visits in developed countries result in a decrease in the risk for cardiovascular diseases. The purpose of this study was to determine the feasibility of a physician‐training program for diabetes and cardiovascular risk...
Background
Latinos experience considerable disparities in obesity. Although causes of obesity are multifactorial, overeating is a major contributor. Emotional eating (EE) has been shown to be positively associated with obesity. However, the relationship between EE and overeating among Latinos has not been studied.
Objectives
To examine if EE is as...
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...
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...