Susan M. Schembre

• Doctor of Philosophy
• Professor (Associate) at Georgetown University

BACKGROUND Recent advances in personal biosensing technology support the shift from standardized to personalized health interventions, whereby biological data is used to motivate health behavior change. However, the implementation of interventions using biological feedback as a behavior change technique has not been comprehensively explored. OBJEC...

Objective: Many cancer survivors do not meet recommended levels of exercise, despite the benefits physical activity offers. This study aimed to understand experiences of insufficiently active overweight/obese breast or colorectal cancer survivors, in efforts to (1) examine regular physical activity barriers, and (2) determine perceptions and accep...

Regular physical activity reduces the progression of several cancers and offers physical and mental health benefits for cancer survivors. However, many cancer survivors are not sufficiently active to achieve these health benefits. Possible biological mechanisms through which physical activity could affect cancer progression include reduced systemic...

Valid and reliable measures are needed to identify individuals at risk of dietary restraint, emotional and external eating, and to customize weight loss education for more effective weight management. This study aimed to develop and validate a Chinese version of the Weight-Related Eating Behavior Questionnaire (WREQ-C) for assessing dietary restrai...

Background: Providing biofeedback is one of the behavioral change techniques that shows promising effects in physical activity interventions. However, as a bio-marker that can acutely reflect the immediate biological consequences of physical activity, glucose has been rarely used in physical activity intervention to motivate behavioral change. This...

Human diets in developed countries such as the US have changed dramatically over the past 75 years, leading to increased obesity, inflammation, and cardiometabolic dysfunction. Evidence over the past decade indicates that the interaction of genetic variation with changes in the intake of 18-carbon essential dietary omega-6 (n-6) and omega-3 (n-3) p...

Postmenopausal breast cancer is the most common obesity-related cancer death among women in the U.S. Insulin resistance, which worsens in the setting of obesity, is associated with higher breast cancer incidence and mortality. Maladaptive eating patterns driving insulin resistance represent a key modifiable risk factor for breast cancer. Emerging e...

Weight losses >10% favorably modulate biomarkers of breast cancer risk but are not typically achieved by comprehensive weight loss programs, including the Diabetes Prevention Program (DPP). Combining the DPP with hunger training (HT), an evidence-based self-regulation strategy that uses self-monitored glucose levels to guide meal timing, has potent...

Background Individuals at increased hereditary risk of cancer are an important target for health promotion and cancer prevention interventions. Health-4-Families uses the Multiphase Optimization STrategy (MOST) framework and is designed to pilot digital delivery strategies for a distance-based, 16-week intervention to promote weight management, hea...

Objective To identify dietary self-monitoring implementation strategies in behavioral weight loss interventions. Design We conducted a systematic review of eight databases and examined 59 weight loss intervention studies targeting adults with overweight/obesity that used dietary self-monitoring. Setting NA Participants NA Results We identified...

BACKGROUND Many health conditions can be prevented, managed, or improved through behavioral interventions. Biological feedback, as a component of health behavior change interventions, is of particular interest given recent advances in wearable biosensing technology, digital health apps, and personalized health and wellness. Yet, there is a paucity...

Background: Many health conditions can be prevented, managed, or improved through behavioral interventions. As a component of health behavior change interventions, biological feedback is of particular interest given recent advances in wearable biosensing technology, digital health apps, and personalized health and wellness. Nevertheless, there is...

Continuing to eat even when full leads to excessive calorie consumption and obesity. Thus, understanding brain responses to food cues when satiated has important implications for weight control interventions. We used the late positive potential (LPP, a component of the event-related potentials (ERP) indexing motivational relevance) to determine the...

BACKGROUND Type 2 diabetes mellitus (T2D) can be managed through diet and lifestyle changes. The American Dietetics Association acknowledges that knowing what and when to eat is the most challenging aspect of diabetes management. While current recommendations for self-monitoring of diet and glucose levels aim to improve glycemic control among peopl...

Background Type 2 diabetes mellitus (T2D) can be managed through diet and lifestyle changes. The American Diabetes Association acknowledges that knowing what and when to eat is the most challenging aspect of diabetes management. Although current recommendations for self-monitoring of diet and glucose levels aim to improve glycemic stability among p...

Background: Limited information exists on how the family unit aids or impedes physical activity (PA) engagement within Hispanic populations. This qualitative study explored family-level influences on PA in dyads of adult Hispanic family members (eg, parent-adult child, siblings, spouses). Methods: In-person interviews and brief surveys were cond...

Recent advancements in continuous glucose monitoring (CGM) represent a novel and untapped resource to optimize behavior change interventions for the prevention and treatment of type 2 diabetes and obesity. In this chapter, we provide a brief history about CGM and evidence supporting its use, including nontraditional indications (people with type 2...

Introduction: Women with pathogenic germline gene variants in BRCA1 and/or BRCA2 are at increased risk of developing ovarian and breast cancer. While surgical and pharmacological approaches are effective for risk-reduction, it is unknown whether lifestyle approaches such as healthful dietary habits, weight management, and physical activity may als...

PurposeWeight gain is common among breast cancer patients and may contribute to poorer treatment outcomes. Most programs target breast cancer survivors after the completion of therapy and focus on weight reduction. This study examined the feasibility and preliminary efficacy of an intervention designed to prevent primary weight gain among women rec...

The purpose of the current study was to examine affective response to sweet foods and drinks as a function of children's internalizing symptoms using ecological momentary assessment (EMA). A sample of 192 8-12-year-old children completed a self-report measure of internalizing symptoms and EMA prompts of affect and food intake for eight days, exclud...

Introduction: Regular physical activity (PA) lowers the risk of endometrial, breast, and colorectal cancer. However, nearly half of American adults are not sufficiently active. The physical inactivity rate is even higher among the overweight and obese population, which, in combination with the unfavorable effect of excess body weight, puts this pop...

Our ability to understand and intervene on eating in the absence of hunger (EAH) as it occurs in peoples' natural environments is hindered by biased methods that lack ecological validity. One promising indicator of EAH that does not rely on self-report and is easily assessed in free-living individuals is glucose. Here, we hypothesize that elevated...

Diet has direct and indirect effects on health through inflammation and the gut microbiome. We investigated total dietary inflammatory potential via the literature-derived index (DII ® ) with gut microbiota diversity, composition, and function. In cancer-free patient volunteers initially approached at colonoscopy and healthy volunteers recruited fr...

Background: Regular physical activity (PA) is associated with a lower risk of several types of cancers. However, two-thirds of overweight/obese adults are not sufficiently active; this, in combination with the unfavorable effect of excess body weight, puts them at greater risk for cancer. One reason that these individuals do not engage in enough P...

Lifestyle factors related to energy balance, such as excess body weight, poor diet, and physical inactivity, are associated with risk of sporadic endometrial cancer (EC) and colorectal cancer (CRC). There are limited data on energy balance-related lifestyle factors and EC or CRC risk among individuals with lynch syndrome, who are at extraordinarily...

Purpose: Diet modulates gut microbiome composition and systemic inflammation—both intermediary factors in the development of colorectal neoplasia. We investigated the association of total dietary inflammatory potential, as assessed by the literature-derived dietary inflammatory index (DII®), with gut microbiota diversity and composition, microbial...

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Background: Momentary affect and stress in mothers and their children may be an important predictor of food intake in the natural environment. This study hypothesized that there would be parallel actor and partner effects such that mothers' and children's negative affect (NA), positive affect (PA), and ability to cope with stress would be associat...

Background Few studies have examined the role of maternal stress in relation to their children’s dietary quality and its trajectory over time. Purpose The objective of this longitudinal study was to examine the effect of baseline maternal stress on the change in their 8- to 12-year-old children’s dietary quality over 1 year. Methods Mother–child...

While some individuals can defy the lure of temptation, many others find appetizing food irresistible. The goal of this study was to investigate the neuropsychological mechanisms that increase individuals' vulnerability to cue‐induced eating. Using ERPs, a direct measure of brain activity, we showed that individuals with larger late positive potent...

Background: Research on the clustering of physical activity, sedentary, and dietary intake behaviors in children has relied on retrospective and parent-report measures, which may obscure true associations. The current study combined objectively-measured moderate-to-vigorous intensity physical activity (MVPA) and sedentary time (ST) data from waist-...

Parents exert a strong influence on their children's diet. While authoritative parenting style is linked to healthier weight and dietary outcomes in children, and authoritarian and permissive parenting styles with unhealthy eating, little is known about the mechanisms that mediate these relationships. Feeding styles are often examined in relation t...

BACKGROUND New methods for assessing diet in research are being developed to address the limitations of traditional dietary assessment methods. Mobile device–assisted ecological momentary diet assessment (mEMDA) is a new dietary assessment method that has not yet been optimized and has the potential to minimize recall biases and participant burden...

Background: New methods for assessing diet in research are being developed to address the limitations of traditional dietary assessment methods. Mobile device-assisted ecological momentary diet assessment (mEMDA) is a new dietary assessment method that has not yet been optimized and has the potential to minimize recall biases and participant burde...

BACKGROUND Wearable sensors have been increasingly used in behavioral research for real-time assessment and intervention purposes. The rapid advancement of biomedical technology typically used in clinical settings has made wearable sensors more accessible to a wider population. Yet the acceptability of this technology for nonclinical purposes has n...

Background: Wearable sensors have been increasingly used in behavioral research for real-time assessment and intervention purposes. The rapid advancement of biomedical technology typically used in clinical settings has made wearable sensors more accessible to a wider population. Yet the acceptability of this technology for nonclinical purposes has...

Background: The integration of body-worn sensors with mobile devices presents a tremendous opportunity to improve just-in-time behavioral interventions by enhancing bidirectional communication between investigators and their participants. This approach can be used to deliver supportive feedback at critical moments to optimize the attainment of hea...

Objective: To examine the associations between high-fat/high-sugar foods (HFHS) and fruit and vegetable (FV) consumption and affective states in women. Methods: The researchers used electronic ecological momentary assessment to capture HFHS and FV consumption in the past 2 hours (predictor) and current affective states (outcome) across 1 week am...

Objective To provide preliminary evidence in support of using ecological momentary assessment (EMA), a real-time data capture method involving repeated assessments, to measure dietary intake in children by examining the concordance of children’s dietary reports through EMA and 24 h recall. Design Children completed eight days of EMA surveys, repor...

While some individuals can defy the lure of temptation, many others find appetizing food irresistible. Using event-related potentials, we showed that individuals who find food-related images more motivationally relevant than erotic ones (“sign-trackers”) are more susceptible to cue-induced eating and, in the presence of a palatable food option, eat...

Neurobiological models of addiction posit that drug use can alter reward processes in two ways: (1) by increasing the motivational relevance of drugs and drug-related cues and (2) by reducing the motivational relevance of non-drug-related rewards. Here, we discuss the results from a series of neuroimaging studies in which we assessed the extent to...

1555 Background: Physical activity, diet, and healthy weight may reduce cancer risk in hereditary breast and ovarian cancer (HBOC) and Lynch syndrome (LS) families. Evidence-based programs to help affected families make these behavioral changes are lacking. We evaluated data from a 16-week family-centered lifestyle intervention trial for individual...

Researchers have proposed a variety of behavioral traits that may lead to weight gain and obesity; however, little is known about the neurocognitive mechanisms underlying these weight-related eating behaviors. In this study, we measured activation of reward circuitry during a task requiring response and inhibition to food stimuli. We assessed parti...

Aberrant brain reward responses to food-related cues are an implied characteristic of human obesity; yet, findings are inconsistent. To explain these inconsistencies, we aimed to uncover endophenotypes associated with heterogeneity in attributing incentive salience to food cues in the context of other emotionally salient cues; a phenomenon describe...

Neurobiological models of obesity postulate that obese individuals have difficulty regulating food intake partly because they attribute excessive salience to stimuli signaling food availability. Typically, human studies that investigate the relationship between brain responses to food-related stimuli and obesity present food cues without subsequent...

Background: Weight gain is a common problem after breast cancer diagnosis and treatment, particularly for women who receive chemotherapy. The weight gain has negative effects on quality of life, increases risk for chronic disease, and may increase risk of breast cancer recurrence. This pilot study tested a behavioral weight gain prevention interven...

Lifestyle interventions that promote physical activity and healthy dietary habits may reduce binge eating symptoms and be more feasible and sustainable among ethnic minority women, who are less likely to seek clinical treatment for eating disorders. The purpose of this study was to investigate (1) whether participating in a lifestyle intervention i...

Little is known about the relationship between dietary intake and affective and physical feeling states in children. The current study used Ecological Momentary Assessment (EMA) to examine how usual dietary intake is cross-sectionally associated with both average affective and physical feeling state ratings and rating variability in children. Child...

Examine the association between perceived stress and hunger continuously over a week in free-living individuals. Forty five young adults (70% women, 30% overweight/obese) ages 18 to 24 years (Mean=20.7, SD=1.5), with BMI between 17.4 and 36.3 kg/m(2) (Mean=23.6, SD=4.0) provided between 513-577 concurrent ratings of perceived stress and hunger for...

Background The loss of self-control or inability to resist tempting/rewarding foods, and the development of less healthful eating habits may be explained by three key neural systems: (1) a hyper-functioning striatum system driven by external rewarding cues; (2) a hypo-functioning decision-making and impulse control system; and (3) an altered insula...

Purpose Develop and demonstrate preliminary validation of a brief questionnaire aimed at assessing social cognitive determinants of physical activity (PA) in a college population. Design Quantitative and observational. Setting A midsized northeastern university. Subjects Convenience sample of 827 male and female college students age 18 to 24 yea...

Genetic variants in bitter-taste receptor genes have been hypothesized to negatively impact health outcomes and/or influence dietary intake and, consequently, could increase the risk of colorectal neoplasia. Using a case-control study of 914 colorectal adenoma cases/1188 controls, we explored associations among colorectal adenoma risk, dietary inta...

Eating breakfast is believed to promote a healthy body weight. Yet, few studies have examined the contribution of energy balance-related behavioral factors to this relation in minority youth. We assessed the associations between breakfast consumption and dietary intake, physical activity (PA), and adiposity before and after accounting for energy in...

To explore an independent association between self-reported sleep duration and cause-specific mortality. Data were obtained from the Multiethnic Cohort Study conducted in Los Angeles and Hawaii. Among 61,936 men and 73,749 women with no history of cancer, heart attack or stroke, 19,335 deaths occurred during an average 12.9 year follow-up. Shorter...

Purpose To determine whether Transtheoretical Model (TTM) constructs differ between individuals making successful versus unsuccessful stage transitions for consumption of five or more servings of fruit and vegetables each day and thus provide a useful basis for designing health promotion interventions. Design Longitudinal, observational study. A r...

Objective: To evaluate the motivational effect of the Project WebHealth study procedures and intervention components on weight-related health behavior changes in male and female college students. Design: Process evaluation. Setting: Eight universities in the United States. Participants: Project WebHealth participants (n = 653; 29% men). Mai...

Purpose To identify impact of an online nutrition and physical activity program for college students. Design Randomized, controlled trial using online questionnaires and on-site physical and fitness assessments with measurement intervals of 0 (baseline), 3 (postintervention), and 15 months (follow-up). Setting Online intervention delivered to col...

Dietary supplement use is widespread among adults across races/ethnicities, yet reasons for use can vary across these groups. The Supplement Reporting (SURE) study quantified dietary supplement use and reasons for taking supplements in a multiethnic sample of adults who took at least one supplement. This study explored sociodemographic differences,...

The purpose of this study was to test the associations between cognitive and psychological eating behavior traits and detailed measures of adiposity and body fat distribution using imaging-based methods in a cross-sectional study. Eating behavior traits (compensatory and routine restraint, external eating, and emotional eating) were assessed using...

Emotional eating (EE) is hypothesized to have a negative impact on diet quality and body weight that could affect chronic disease risk. Our aim was to determine if EE was associated with diet quality, physical activity (PA), and coronary heart disease (CHD) risk factors among 261 freshmen at a Northeast university. EE was scored with the Weight Rel...

In accordance with the sociocultural model, race/ethnicity is considered a major influence on factors associated with body image and body dissatisfaction, and eating disorders are often characterized as problems that are primarily limited to young White women from Western cultures. The purpose of this study was to determine whether there are differ...

Non-exercise equations developed from self-reported physical activity can estimate maximal oxygen uptake (VO(2)max) as well as submaximal exercise testing. The International Physical Activity Questionnaire (IPAQ) is the most widely used and validated self-report measure of physical activity. This study aimed to develop and test a VO(2)max estimatio...

This study evaluates the 16-item, four-factor Weight-Related Eating Questionnaire (WREQ), which assesses theory-based aspects of eating behavior, across diverse, nonclinical subgroups. A total of 621 men and women aged 18-81 years (34.3 ± 16.4) with a mean BMI of 25.7 ± 6.1 kg/m(2) (range 15.5-74.1 kg/m(2)) were recruited from general education cla...

There are no standardized methods for monitoring appetite in free-living populations. Fifteen participants tested a computer-automated text-messaging system designed to track hunger ratings over seven days. Participants were sent text-messages (SMS) hourly and instructed to reply during waking hours with their current hunger rating. Of 168 SMS, 0.6...

Weight gain and an increase in overweight and obesity in college students raise serious health concerns. Weight management interventions for college-age men and women might be more effective if they were tailored to subgroups of students with similar behavioral and psychosocial characteristics associated with body weight status. The purpose of this...

Obesity research conducted to date has focused on identifying and educating the public on “what” and “how much” to eat. Despite our efforts, the prevalence of obesity continues to rise. Some of the more promising obesity research is focused on identifying and assessing cognitive and psychological aspects of eating behavior with the intent of unders...

To improve our understanding of excess body weight and risk for diabetes type 2, the study examined the influence of weight change in the Hawaii component, including 78,006 Caucasians, Japanese Americans and Native Hawaiians, of the Multiethnic Cohort Study. Participants aged 58.5±9.2 years completed a questionnaire at cohort entry (Qx1), including...

The aim of this study was to compare standard lipid profile, reported dietary intake, and physical activity in older adults who reported taking or not taking a lipid-lowering medication, namely statins. Cross-sectional study utilizing baseline data collected from a subsample of a larger randomized clinical trial, The Study of Exercise and Nutrition...

Research shows the prevalence of obesity is increasing. The greatest increase occurs between 20 and 29 years of age. Obesity results from a long-term positive energy balance attributable to eating and exercise behaviors. Research shows effective behavior change interventions impact cognitive constructs which explain specific behaviors. Objectives w...

The objective of this study was to develop an improved weight-related eating questionnaire (WREQ) that reflects recent advancements in the assessment and understanding of theory-based eating behaviors. A sequential process of measurement development was used to construct this brief but comprehensive questionnaire. By factor analysis and structural...

The study objectives were to determine if high versus low emotional and situational eaters (High ES vs Low ES) perceive hunger (VAS‐H) differently before and after a test meal and if observed differences correspond with the appetite‐related plasma biomarkers total ghrelin (TG) and insulin (INS). Participants (N=54) were healthy, 18 to 27 year old m...