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1.  Theoretical foundations of the Study of Latino (SOL) Youth: implications for obesity and cardiometabolic risk 
Annals of epidemiology  2013;24(1):10.1016/j.annepidem.2013.10.011.
Purpose
This article describes the conceptual model developed for the Hispanic Community Health Study/Study of Latino Youth, a multisite epidemiologic study of obesity and cardiometabolic risk among U.S. Hispanic/Latino children.
Methods
Public health, psychology, and sociology research were examined for relevant theories and paradigms. This research, in turn, led us to consider several study design features to best represent both risk and protective factors from multiple levels of influence, as well as the identification of culturally relevant scales to capture identified constructs.
Results
The Socio-Ecological Framework, Social Cognitive Theory, family systems theory, and acculturation research informed the specification of our conceptual model. Data are being collected from both children and parents in the household to examine the bidirectional influence of children and their parents, including the potential contribution of intergenerational differences in acculturation as a risk factor. Children and parents are reporting on individual, interpersonal, and perceived organizational and community influences on children's risk for obesity consistent with Socio-Ecological Framework.
Conclusions
Much research has been conducted on obesity, yet conceptual models examining risk and protective factors lack specificity in several areas. Study of Latino Youth is designed to fill a gap in this research and inform future efforts.
doi:10.1016/j.annepidem.2013.10.011
PMCID: PMC3879411  PMID: 24246265
Hispanic/Latino; Children; Obesity; Acculturation; Socio-Ecological Framework; Theory
2.  The association of emotion regulation with lifestyle behaviors in inner-city adolescents 
Eating behaviors  2013;14(4):10.1016/j.eatbeh.2013.07.009.
Purpose
Recent research suggests a role of cognitive self-regulation skills on obesity and lifestyle behaviors. However, very little is known about the role of emotion regulation. This study examined the association of emotion regulation with lifestyle behaviors and examined a mediational model testing effects of emotion regulation through self-efficacy and depressive symptoms.
Methods
A cross-sectional study was conducted with 602 adolescents (mean age 12.7 years) from 4 public schools in the Bronx, NY. The sample was 58% female, predominantly Hispanic (74%) and US born (81%). Emotion regulation was assessed by 3 indicators and defined as a latent variable. Dependent variables included fruit/vegetable intake, snack/junk food intake, frequency of physical activity, and time spent in sedentary behaviors. Structural equation modeling examined the association of emotion regulation with lifestyle behaviors, with self-efficacy and depressive symptoms defined as potential mediators.
Results
The analyses showed that there was a positive association of emotion regulation with higher intake of fruits/vegetable and greater physical activity, which was mediated by self-efficacy. Emotion regulation was related to snack/junk food intake and sedentary behavior, and the structural equation model indicated pathways through an inverse relation to depressive symptoms, but these pathways were only observed in adolescent girls and not boys.
Conclusions
These findings indicate that the ability to regulate emotions among adolescents has a role in weight-related behaviors. Future studies may need to explore the relation of other dimensions of emotion to positive health behaviors and study aspects of emotion regulation that may be more relevant for boys.
doi:10.1016/j.eatbeh.2013.07.009
PMCID: PMC3817414  PMID: 24183148
Adolescents; Lifestyle behaviors; Emotion regulation; Depressive Symptoms; Self-efficacy
3.  Behavioral Self-Regulation and Weight-Related Behaviors in Inner-City Adolescents: A Model of Direct and Indirect Effects 
Childhood obesity (Print)  2011;7(4):306-315.
Background
This study examined the association of two distinct self-regulation constructs, effortful control and dysregulation, with weight-related behaviors in adolescents and tested whether these effects were mediated by self-efficacy variables.
Methods
A school-based survey was conducted with 1771 adolescents from 11 public schools in the Bronx, New York. Self-regulation was assessed by multiple indicators and defined as two latent constructs. Dependent variables included fruit/vegetable intake, intake of snack/junk food, frequency of physical activity, and time spent in sedentary behaviors. Structural equation modeling examined the relation of effortful control and dysregulation to lifestyle behaviors, with self-efficacy variables as possible mediators.
Results
Study results showed that effortful control had a positive indirect effect on fruit and vegetable intake, mediated by self-efficacy, as well as a direct effect. Effortful control also had a positive indirect effect on physical activity, mediated by self-efficacy. Dysregulation had direct effects on intake of junk food/snacks and time spent in sedentary behaviors.
Conclusions
These findings indicate that self-regulation characteristics are related to diet and physical activity and that some of these effects are mediated by self-efficacy. Different effects were noted for the two domains of self-regulation. Prevention researchers should consider including self-regulation processes in programs to improve health behaviors in adolescents.
PMCID: PMC3522174  PMID: 23243551
4.  Health Effects of Low-Carbohydrate Diets: Where Should New Research Go? 
Current diabetes reports  2013;13(2):271-278.
There has been considerable debate about the metabolic effects of restricting carbohydrate intake in weight and diabetes management. However, the American Diabetes Association has noted that weight and metabolic improvements can be achieved with low carbohydrate, low fat (implicitly higher carbohydrate), or a Mediterranean style diet (usually an intermediate level of carbohydrate). Our paper addresses variability in the definition for low or restricted carbohydrate, the effects of carbohydrate restriction on diabetes-related health outcomes, strategies for restricting carbohydrate intake, and potential genetic variability in response to dietary carbohydrate restriction. Issues for future research are also addressed.
doi:10.1007/s11892-012-0357-5
PMCID: PMC3595318  PMID: 23266565
diabetes; diet; nutrition; low carbohydrate; eating patterns; available carbohydrate; genetic variability; Paleolithic diet; nutrition guidelines; insulin resistance; gut hormones; health effects; diabetes; research
5.  Sleep and Cardiometabolic Function in Obese Adolescent Girls with Polycystic Ovary Syndrome 
Sleep medicine  2012;13(10):1307-1312.
Objective
To compare the polysomnography findings and cardiometabolic function among adolescent girls with PCOS and matched female and male controls.
Method
Retrospective chart review of electronic medical records of 28 girls with PCOS (age: 16.8±1.9 yrs, BMI Z-score 2.4±0.4), 28 control females (age: 17.1±1.8, BMI Z-score 2.4±0.3) and 28 control males (age: 16.6±1.6, BMI Z-score 2.5±0.5) in a tertiary care center.
Results
The prevalence of obstructive sleep apnea (OSA) was higher in girls with PCOS compared to control females (16/28 (57%) vs. 4/28(14.3%), p<0.01), however, was comparable to that of the control males (16/28(57%) vs. 21/28(75%), p=0.4). Girls with PCOS had a significantly higher prevalence of insulin resistance compared to control females and control males (20/28 (71.4%) vs. 9/22 (41.0%) (p=0.04) vs. 8/23 (34.8%) (p=0.01). Among girls with PCOS, those with OSA had significantly higher proportions of metabolic syndrome (9/16 (56.3% ) vs. 1/12 (8.3%) p=0.03), higher insulin resistance (13/16 (81.3%) vs. 5/12 (41.6%), p=0.03), elevated daytime systolic blood pressure (128.4±12.8 vs. 115.6±11.4, p<0.01), lower HDL (38.6±8.7 vs. 49±10.9, p=0.01) and elevated triglycerides (149.7±87.7 vs. 93.3±25.8, p=0.03) compared to those without OSA.
Conclusions
We report a higher prevalence of OSA and metabolic dysfunction in a selected group of obese girls with PCOS referred with sleep related complaints compared to BMI matched control girls without PCOS. We also report higher prevalence of cardiometabolic dysfunction in girls with PCOS and OSA compared to girls with PCOS without OSA.
doi:10.1016/j.sleep.2012.07.002
PMCID: PMC3509263  PMID: 22921588
AHI: Apnea hypopnea index; HDL: High density lipoprotein; HOMA-IR: Homeostatic model assessment a measure of Insulin resistance; MetS: Metabolic syndrome; OSA: Obstructive sleep apnea; PCOS: Polycystic ovary syndrome; TG: Triglyceride
6.  Associations of Obesity and Asthma with Functional Exercise Capacity in Urban Minority Adolescents 
Pediatric pulmonology  2012;47(11):1061-1069.
Summary
Purpose
To examine the independent association of asthma and obesity and of their coexistence with functional exercise capacity among urban adolescents.
Methods
One hundred and eighteen Hispanic and African American adolescents including 33 obese asthmatics, 18 normal-weight asthmatics, 38 obese non-asthmatics and 29 normal-weight non-asthmatics underwent anthropometric measures, 6 minute walk test (6MWT) as measure of functional exercise capacity and spirometry as measure of pulmonary function. The 6 minute walk distance (6MWD) was compared between the four study groups. The association of 6MWD with measures of lower airway obstruction, and measures of adiposity was assessed.
Results
The 6MWD was lower among the obese groups with the least distance covered by the obese asthmatic group (p=0.02). In the obese asthmatic group, there was a negative correlation between 6MWD and body mass index (BMI) (r= −0.35, p= 0.03) but no association was noted with percent-predicted Forced Expiratory Volume in the 1st second (FEV1) (r=0.07, p=0.70). Conversely, the 6MWD correlated with FEV1 among normal-weight asthmatics (r=0.45, p=0.04) and normal-weight non-asthmatics (r=0.4, p=0.03) but was not associated with BMI in either of the two groups. After adjusting for age, height, gender and ethnicity, BMI was noted to be a significant predictor (β −2.76, 95% CI −4.77- −0.76, p<0.01)) of the 6MWD among the obese while percent predicted FEV1 (β 1.87, 95%CI 0.28–3.45, p=0.02) was a significant predictor among the normal-weight participants.
Conclusions
Our findings suggest that among urban minority obese asthmatic adolescents, functional exercise capacity was associated with obesity, rather than pulmonary function.
doi:10.1002/ppul.22547
PMCID: PMC3389560  PMID: 22467360
Asthma; Obesity; Functional Exercise Capacity; Adolescents
7.  Considering Options for Attenuating Postmeal Glucose Excursions 
Diabetes Care  2010;33(12):2709-2710.
doi:10.2337/dc10-1653
PMCID: PMC2992216  PMID: 21115773
8.  High Prevalence of Obesity Among Inner-City Adolescent Boys in the Bronx, New York: Forgetting Our Boys 
Preventing Chronic Disease  2010;8(1):A23.
We examined sex differences in overweight and obesity in a sample of 1,619 inner-city adolescents. Participants were enrolled from 11 public schools in the Bronx, New York. The prevalence of overweight and obesity was 21.7% and 22.5%, respectively; prevalence of obesity was significantly higher among adolescent boys than adolescent girls (24.9 vs 20.1%). Childhood obesity is a public health concern in the United States, and the higher prevalence of obesity in adolescent boys requires additional attention.
PMCID: PMC3044034  PMID: 21159235
9.  Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes 
Diabetes Care  2009;32(7):1147-1152.
OBJECTIVE
To compare the effects of a 1-year intervention with a low-carbohydrate and a low-fat diet on weight loss and glycemic control in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS
This study is a randomized clinical trial of 105 overweight adults with type 2 diabetes. Primary outcomes were weight and A1C. Secondary outcomes included blood pressure and lipids. Outcome measures were obtained at 3, 6, and 12 months.
RESULTS
The greatest reduction in weight and A1C occurred within the first 3 months. Weight loss occurred faster in the low-carbohydrate group than in the low-fat group (P = 0.005), but at 1 year a similar 3.4% weight reduction was seen in both dietary groups. There was no significant change in A1C in either group at 1 year. There was no change in blood pressure, but a greater increase in HDL was observed in the low-carbohydrate group (P = 0.002).
CONCLUSIONS
Among patients with type 2 diabetes, after 1 year a low-carbohydrate diet had effects on weight and A1C similar to those seen with a low-fat diet. There was no significant effect on blood pressure, but the low-carbohydrate diet produced a greater increase in HDL cholesterol.
doi:10.2337/dc08-2108
PMCID: PMC2699720  PMID: 19366978
10.  Self-Control Constructs Related to Measures of Dietary Intake and Physical Activity in Adolescents 
Purpose
To test self-regulation concepts in relation to dietary intake and physical activity patterns in adolescence, which we predicted to be influenced by components of a self-control model.
Methods
A survey was conducted with a multiethnic sample of 9th grade public school students in a metropolitan area (N = 539). Confirmatory analysis tested the measurement structure of self-control. Structural equation modeling tested the association of self-control constructs with measures of fruit and vegetable intake, saturated-fat intake, physical activity, and sedentary behavior.
Results
Confirmatory analysis of 14 indicators of self-control showed best fit for a two-factor structure, with latent constructs of good self-control (planfulness) and poor self-control (impulsiveness). Good self-control was related to more fruit and vegetable intake, more participation in sports, and less sedentary behavior. Poor self-control was related to more saturated-fat intake and less vigorous exercise. These effects were independent of gender, ethnicity, and parental education, which themselves had relations to diet and exercise measures. Multiple-group modeling indicated that effects of self-control were comparable across gender and ethnicity subgroups.
Conclusions
Self-control concepts are relevant for patterns of dietary intake and physical activity among adolescents. Attention to self-control processes may be warranted for prevention programs to improve health behaviors in childhood and adolescence.
doi:10.1016/j.jadohealth.2007.06.013
PMCID: PMC2190087  PMID: 18023783
self-control; diet; exercise; adolescents; gender; ethnicity

Results 1-10 (10)