Papers by Uriyoan Colon-Ramos
Author contributions: ACR assisted in data collection, data management, led analyses and developm... more Author contributions: ACR assisted in data collection, data management, led analyses and development of first drafts, contributed significantly to final revisions. UCR conceived study, secured funding, supervised all aspects of study design, data collection, analysis and writing, and led revisions to this manuscript. SDC, RBG contributed to the study design and instruments used for data collection. SDC also led psychosocial analyses and contributed to checking of all data analyses and interpretation of data. RBG led co-design of intervention and contributed to study design, logistics of data collection, and interpretation of results. IR led data collection and contributed to interpretation of results. SS led implementation metrics analyses and contributed to manuscript revisions. RMR, KL, JG, RBG, contributed significantly to revisions and interpretation of results. All authors were involved in revisions of manuscript prior to submission, and reviewed all drafts and final manuscript.
Puerto Ricans in the US experience higher deaths from diabetes and other causes compared to non-H... more Puerto Ricans in the US experience higher deaths from diabetes and other causes compared to non-Hispanic Whites and other Hispanic groups. We compared mortality in Puerto Rico to that of Puerto Ricans in the US as a first step to investigate if similar or worse mortality patterns originate from the sending country (Puerto Rico). Age-adjusted death rates were generated using national vital statistics databases in the US and territories for all-cause and the top ten causes of death among Hispanics in 2009. Mortality ratios in the archipelago of Puerto Rico (APR) were compared to mainland US Puerto Ricans (MPR). Rates for other ethnic/racial groups (Mexican Americans, Cubans, and non-Hispanic Whites, Blacks, American Indians, and Asians) were calculated to provide a context. APR had significantly higher all-cause mortality and death rates for diabetes, nephritis, pneumonia/influenza, and homicide/assault compared to MPR (APR/MPR ratio for all-cause: 1.08, diabetes: 2.04, nephritis: 1.84, pneumonia/influenza: 1.33, homicide/assault: 3.15). Death rates for diabetes and homicide/assault (particularly among men) were higher among APR compared to any other racial/ethnic groups in the US. In contrast, deaths from heart disease, cancer, and chronic liver disease were significantly lower for APR compared to MPR (MPR/ APR ratio 0.72, 0.91, 0.41, respectively). Among APR women, death rates for these causes were also lower compared to any other group in the US. Substantial mortality variability exists between Puerto Ricans in Puerto Rico and those in the US, re-emphasizing the need to study of how socio-environmental determinants of health differ in sending and receiving countries. Explanations for disparate rates include access to and availability of healthcare and unique factors related to the migration experience of this group.
Preventing Chronic Disease, Oct 1, 2008
IntroductionLow-carbohydrate diets (LCDs) have regained popularity in recent years, but public aw... more IntroductionLow-carbohydrate diets (LCDs) have regained popularity in recent years, but public awareness and perceived healthfulness of LCDs have not been explored. We describe population awareness, use, and perceptions of the healthfulness of LCDs and examine differences by sociodemographic and communication variables.MethodsNationally representative data from the Health Information National Trends Survey (HINTS 2005) were analyzed by using multivariate logistic regression to examine independent correlates of awareness, use, and perceptions of the healthfulness of LCDs.ResultsAwareness of LCDs in the United States was high (86.6%). Independent correlates of awareness included being a college graduate, being non-Hispanic white, and having a high body mass index (BMI). Among respondents who were aware of LCDs, approximately 17% had tried LCDs during the last year. Independent correlates of LCD use included being a woman and having a high BMI. One-third of respondents who were aware of LCDs agreed that they are a healthy way to lose weight. Independent correlates of perceived LCD healthfulness included not being a high school graduate and being likely to change behavior in response to new nutrition recommendations.ConclusionThis study is among the first to explore correlates of awareness, use, and perceptions of LCDs in a nationally representative sample. Despite high levels of awareness of LCDs, these diets are not used frequently and are not perceived as being healthy.
Journal of the Academy of Nutrition and Dietetics, 2023
Background:Water is recommended as an alternative for sugar-sweetened beverages (SSB). Low-income... more Background:Water is recommended as an alternative for sugar-sweetened beverages (SSB). Low-income, minority groups in the US continue to exhibit high SSB and low water consumption, and are more likely to exceed 100% fruit juice recommendation.Objective:To test the effects of a home-based intervention designed to replace SSB with tap water and reduce excess juice consumption among parents and their infants/toddlers.Design:Randomized Controlled TrialParticipants:Parents (n=92) of infants/toddlers who participated in 3 Early Head Start (EHS) home-visiting programs that serve predominantly Hispanic, low-income communities 2019–2021.Intervention:The 12-week intervention (Water Up!@Home) simultaneously addressed: a) physical barriers to tap water consumption (via a water filter); b) sociocultural barriers to replacing SSB and juice with water (via a curriculum). Comparison group received a water filter only. Hypothesis: Intervention will lead to a reduction of 6 fl oz /day in SSB and juice consumption.Main outcomes:Parent-reported self and infant/toddler SSB; water (filtered, tap, bottled); 100% fruit juice consumption.Statistical analyses:ANCOVA to compare changes in consumption between experimental groups; t-tests to assess changes within groups.Results:Participants in both groups reported significant reductions in SSB from baseline (parents: intervention [−11.2 fl oz/day, p<0.01]; comparison [−8.0 fl oz/day, p<0.01]; children: intervention [−1.50 fl oz/day, p=0.03]; comparison [−1.56 fl oz/day, p=0.02]), increased water consumption (parents in both groups [+5.6 fl oz/day]; children: intervention [+3.61 fl oz/day, p=0.01], comparison [+2.24 fl oz/day, p=0.05]), mostly from filtered tap water. Differences between groups were not statistically significant. Intervention participants reported significant reductions in 100% fruit juice vs. comparison (parents: −3.6 fl oz/day vs. −1.0 fl oz/day, p<0.01; children: −0.73 fl oz/day vs. +0.48 fl oz/day, p=0.03).Conclusions:The intervention effectively reduced 100% fruit juice consumption. Water security should be examined as a contributor to SSB consumption in this population.
Public Health Nutrition, Feb 19, 2021
Objective: To examine the association between family environment variables (parenting styles, fam... more Objective: To examine the association between family environment variables (parenting styles, family meal atmosphere), gender-based stereotypes and food intake in Latin American adolescents. Design: Structural equation modelling applied to cross-sectional data, 2017. Setting: Urban and rural sites of San José, Costa Rica. Participants: n 813; 13-18 years old. Results: Data suggest direct associations between gender-based stereotypes and intake of fruits and vegetables (FV) (β = 0•20, P < 0•05), unhealthy foods (fast food (FF)) (β = −0•24, P < 0•01) and ultra-processed foods (β = −0•15, P < 0•05) among urban girls; intake of legumes among rural girls (β = 0•16, P < 0•05) and intake of sugar-sweetened beverages (SSB) among rural boys (β = 0•22, P < 0•05). Family meal atmosphere was associated with legume intake (β = 0•19, P <•05) among rural girls. Authoritative parenting style was associated with FV intake (β = 0•23, P < 0•05) among urban boys and FF intake (β = 0•17, P < 0•05) among urban girls. Authoritarian parenting style was associated with FV consumption (β = 0•19, P < 0•05) among rural boys, and with SSB and FF consumption (β = 0•21, P < 0•05; β = 0•14, P < 0•05, respectively) among urban girls. Conclusions: Findings are the first to describe the complex family environment and gender-based stereotypes within the context of a Latin American country. They emphasise the need for culturally relevant measurements to characterise the sociocultural context in which parent-adolescent dyads socialise and influence food consumption.
Nutrients, Feb 24, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Introduction: Healthy food incentive programs at farmers’ markets offer an opportunity to improve... more Introduction: Healthy food incentive programs at farmers’ markets offer an opportunity to improve food access, promote healthy eating, and enhance economic viability of markets. The Produce Plus program offers low-income Washington, DC residents the opportunity to receive one $10 voucher/family/market/week for fruits and vegetable purchases at participating markets. We examined the effect of Produce Plus on participants’ frequency of attendance and use of additional money/benefits at markets. Methods: Program participants were surveyed at participating farmers’ markets across the District between June and September 2015. Survey questions included frequency with which the participants shopped at farmers’ markets and whether they used additional money/benefits beyond the program benefits. Descriptive statistics were used to summarize the data. Results: Of the 288 survey respondents, 58.0% reported having attended a farmers’ market \u3e3 times in the past month, 70.6% reported that they came to the market specifically because of Produce Plus, and 84.8% reported attending farmers’ markets more frequently because of Produce Plus. Only 33.6% of participants reported spending additional money at the market, of which 57.5% used their own money and 35% used SNAP benefits. Among participants reporting attending markets more frequently because of Produce Plus, the majority (59%) reported not spending additional funds at the market. Conclusion: Our findings indicate that healthy food incentive programs are a strategy for increasing attendance at farmers’ markets, but most program participants only spend incentive program benefits at the market
Introduction: The Produce Plus program offered by the District of Columbia (DC) Department of Hea... more Introduction: The Produce Plus program offered by the District of Columbia (DC) Department of Health provides $10 per family/market/week to participants of federal financial and nutrition assistance programs to spend on fresh fruit and vegetables (F&V) at farmers’ markets. The objective of this study was to determine whether F&V intake among Produce Plus participants differs from that of the average DC population. Methods: Using a cross-sectional survey, program participants were interviewed at markets across DC between June and September 2015. Questions included the Behavioral Risk Factor Surveillance System (BRFSS) F&V module which assesses F&V intake over the previous month. Participants’ F&V intake was compared to 2013 DC BRFSS F&V data. Results: A total of 288 Produce Plus participants were surveyed; results are presented here as median (interquartile range). Compared to 2013 DC BRFSS data for individuals reporting annual household incomes of \u3c$35,000, Produce Plus participants reported higher fruit (2.0(1.0-3.0) vs. 1.0(0.4-2.0) times/day) and vegetable (2.0(1.3-3.5) vs. 1.4(0.8-2.3) times/day) intake compared to BRFSS respondents with similar household incomes. Produce Plus participants reported higher fruit intake as the season progressed and they were more likely to have previously received program benefits (June: 1.4(1.0-2.4) vs. August/September: 2.0(1.0-3.0) times/day). Vegetable intake stayed constant throughout the season (June: 2.1(1.5-3.2) vs. August/September: 2.1(1.3-3.8) times/day). Discussion: Participants in the Produce Plus program reported higher F&V intake compared to DC BRFSS respondents with similar incomes, but still below recommended levels. A prospective study is planned to more fully assess whether the Produce Plus program increases participants’ F&V intake
Appetite, Feb 1, 2016
An estimated 78% of Hispanics in the United States (US) are overweight or obese. Household food i... more An estimated 78% of Hispanics in the United States (US) are overweight or obese. Household food insecurity, a condition of limited or uncertain access to adequate food, has been associated with obesity rates among Hispanic adults in the US. However, the Hispanic group is multi-ethnic and therefore associations between obesity and food insecurity may not be constant across Hispanic country of origin subgroups. This study sought to determine if the association between obesity and food insecurity among Hispanics is modified by Hispanic ancestry across low-income (200% of poverty level) adults living in California. Data are from the cross-sectional 2011e12 California Health Interview Survey (n ¼ 5498). Rates of overweight or obesity (BMI ! 25), Calfresh receipt (California's Supplemental Nutrition Assistance Program), and acculturation were examined for differences across subgroups. Weighted multiple logistic regressions examined if household food insecurity was significantly associated with overweight or obesity and modified by country of origin after controlling for age, education, marital status, country of birth (US vs. outside of US), language spoken at home, and Calfresh receipt (P < .05). Significant differences across subgroups existed for prevalence of overweight or obesity, food security, Calfresh receipt, country of birth, and language spoken at home. Results from the adjusted logistic regression models found that food insecurity was significantly associated with overweight or obesity among Mexican-American women (b (SE) ¼ 0.22 (0.09), p ¼ .014), but not Mexican-American men or Non-Mexican groups, suggesting Hispanic subgroups behave differently in their association between food insecurity and obesity. By highlighting these factors, we can promote targeted obesity prevention interventions, which may contribute to more effective behavior change and reduced chronic disease risk in this population.
Public Health Nutrition, Aug 25, 2020
Objective: To elucidate mechanisms across family function, home environment and eating behaviours... more Objective: To elucidate mechanisms across family function, home environment and eating behaviours within sociocultural context among Hispanic youth. Design: Two models tested via path analysis (youth fruit and vegetable (FV) consumption; empty energy consumption) using data from the Study of Latino Youth (2011-2013).
Journal of Nutrition Education and Behavior, Feb 1, 2022
Objective: Food insecurity risk increases among disaster-struck individuals. The authors employed... more Objective: Food insecurity risk increases among disaster-struck individuals. The authors employed the social determinants of health framework to (1) describe the characteristics and food-seeking behaviors of individuals coping with the coronavirus disease 2019 pandemic and (2) evaluate the relationship between these factors and food insecurity risk. Design: A cross-sectional Qualtrics survey was administered May 14−June 8, 2020. Participants: Adults living in New York were recruited online (n = 410). Main Outcome Measure: Food insecurity risk. Analysis: Logistic regression analyses were conducted using a model-building approach. Results: A total of 38.5% of the sample was considered food insecure after the coronavirus disease 2019 outbreak. The final model revealed that not knowing where to find help to acquire food, reporting that more food assistance program benefits would be helpful, being an essential worker, having general anxiety, and being a college student were risk factors for food insecurity regardless of demographic characteristics. Conclusions and Implications: With more individuals experiencing food insecurity for the first time, there is a need for enhanced outreach and support. The findings complement emerging research on food insecurity risk during and after the pandemic and can help to inform food assistance programs and policies.
Disaster Medicine and Public Health Preparedness, Jun 10, 2021
Objective: The aim of this study was to describe the results of food environment assessments comp... more Objective: The aim of this study was to describe the results of food environment assessments completed after Hurricane Florence in North Carolina (2018) and Hurricane María in Puerto Rico (2017), and provide recommendations for assessing disaster food environments. Methods: Adapted structured observation protocols were used to conduct rapid assessments of the availability, price, and quality of specific foods in retail markets. Results: In both settings, unhealthful food items (soda, chips, fruit-flavored drinks) and milk were widely available and at lower prices than domestic averages. The adapted instrument in Puerto Rico allowed for documentation of greater availability of canned items compared with fresh or frozen foods. In both settings, researchers noted the inability of the instrument to document items that are important to assess postdisaster: ready-to-heat and ready-to-eat foods; food preparation facilities and supplies; hygiene supplies; and empty shelf-space. Conclusions: The instruments, despite their limitations, were able to capture food availability issues in postdisaster environments. Future instrument adaptation is necessary to capture availability of all major food groups, healthful and unhealthful options, shelf-stable, ready-to-eat, and ready-to-heat foods versus other formats (fresh, frozen), and cooking and hygiene supplies.
Obesity Reviews, May 4, 2021
Childhood obesity is a major public health challenge across Latin America and the United States. ... more Childhood obesity is a major public health challenge across Latin America and the United States. Addressing childhood obesity depends on valid, reliable, and culturally sensitive measurements. Such progress within and between countries of the Americas could be enhanced through better measurement across different age groups, different countries, and in sending and receiving communities. Additionally, better and more comparable measurements could accelerate cross-border collaboration and learning. Here, we present (1) frameworks that influenced our perspectives on childhood obesity and measurement needs across the Americas; (2) a summary of resources and guidance available concerning measurement and adaptation of measures for childhood obesity research; and (3) three major areas that present challenges and opportunities for measurement advances related to childhood obesity, including parental behavior, acculturation, and the potential to incorporate ethnographic methods to identify critical factors related to economics and globalization. Progress to reduce childhood obesity across the Americas could be accelerated by further transnational collaboration aimed at improving measurement for better surveillance, intervention development and evaluation, implementation research, and evaluation of natural experiments. Additionally, there is a need to improve training related to measurement and for improving access to valid and reliable measures in Spanish and other languages common in the Americas.
Current developments in nutrition, Jul 1, 2021
Indigenous food sovereignty (IFS) represents a community-led movement with potential to reduce he... more Indigenous food sovereignty (IFS) represents a community-led movement with potential to reduce health inequities, but no scoping review of the impact of taking an IFS approach on intervention research has been conducted. This review sought to: 1) describe intervention studies that employ IFS principles, and 2) describe the impact of studies using IFS principles on food access, eating patterns, diet quality, physical activity, and health. Through a literature review, 4 IFS principles were identified: 1) community ownership, 2) inclusion of traditional food knowledge, 3) inclusion and promotion of cultural foods, and 4) environmental/intervention sustainability. Twenty intervention studies published between January 1, 2000 and February 5, 2020 were included. Most of the studies that scored high in IFS principles saw a positive impact on diet. This review found evidence supporting the value of IFS principles in the development, implementation, and evaluation of health interventions for Indigenous communities.
Current Developments in Nutrition
Nutrients
Sugar-sweetened beverages (SSBs) are implicated in weight gain and adverse cardiometabolic heath.... more Sugar-sweetened beverages (SSBs) are implicated in weight gain and adverse cardiometabolic heath. Social networks of stakeholders involved in providing potable water and sugar-sweetened beverages (SSBs) in high schools in Costa Rica were studied using social analysis network. In public and private schools, the interactions between the stakeholders in charge of providing beverages are fragmented and their role in preventing the availability of SSBs is weak. School canteen owners ultimately decide what beverages are available at school, which may cause students to choose beverages that increase the risk of overweight/obesity. It is therefore urgently necessary to improve the capacity for two-way interactions between the stakeholders to enhance their roles in the provision of beverages. Hence, it is essential to reinforce the stakeholders’ leadership, and set up innovative ways to exert it in order to develop a shared vision of the types of drinks that should be available in the school...
Food and Nutrition Bulletin
Background: School feeding programs (SFPs) can play a crucial role in the emergency food and nutr... more Background: School feeding programs (SFPs) can play a crucial role in the emergency food and nutrition response, but there is a dearth of information on how SFPs operate during emergencies. Design and Methods: A rapid comparative assessment of 11 SFPs throughout Latin America and the Caribbean during the COVID-19 pandemic. Data from (1) systematic document search and (2) surveys with key informants (n = 23) about barriers/facilitators to modifications were systematically analyzed using a multiple case study approach. Results: During the pandemic, all SFPs continued (although continuation plans varied from a few days in Chile to > 1 month in Puerto Rico) via food kits, food vouchers, and/or grab n’ go meals. The SFP implementation was highly dependent on the programs’ autonomy and financial support, which impacted their logistics to acquire and distribute foods during the pandemic. The types of foods offered in some SFPs suggest that established nutritional guidelines were not alw...
Nutrients
Consumption of added sugars, especially from sugar-sweetened beverages (SSBs), has been associate... more Consumption of added sugars, especially from sugar-sweetened beverages (SSBs), has been associated with several negative health outcomes during adolescence. This study aimed to identify dietary intake and food sources of added sugars in the home, school, and neighborhood environments of Costa Rican adolescents. Dietary intake of added sugars was determined using 3-day food records in a cross-sectional study of 818 adolescents aged 12 to 19 and enrolled in rural and urban schools in the province of San José. On average, 90% of adolescents consumed more than 10% of their total energy intake from added sugars. Furthermore, 74.0% of added sugars were provided at home, 17.4% at school, and 8.6% in the neighborhood. Added sugars were primarily provided by frescos (29.4%), fruit-flavored still drinks (22.9%), and sugar-sweetened carbonated beverages (12.3%), for a total contribution of 64.6%. Our findings suggest that Costa Rican adolescents have a plethora of added sugar sources in all fo...
Public Health Nutrition
Objective:This study sought to explain results of the Water Up!@Home randomised controlled trial ... more Objective:This study sought to explain results of the Water Up!@Home randomised controlled trial where low-income parents were randomised to receive an educational intervention +a low-cost water filter pitcher or only the filter. Parents in both groups had reported statistically significant reductions in sugar-sweetened beverages (SSB) and increases in water intake post-intervention.Design:Qualitative explanatory in-depth interviews analysed thematically and deductively.Setting:Washington, DC metropolitan area, USA.Participants:Low-income Latino parents of infants/toddlers who had participated in the Water Up! @Home randomised controlled trial.Results:The filter-stimulated water consumption in both groups by (1) increasing parents’ perception of water safety; (2) acting as a cue to action to drink water; (3) improving the flavour of water (which was linked to perceptions of safety) and (4) increasing the perception that this option was more economical than purchasing bottled water. ...
International Journal of Environmental Research and Public Health
In the United States, low-income, underserved rural and urban settings experience poor access to ... more In the United States, low-income, underserved rural and urban settings experience poor access to healthy, affordable food. Introducing new food outlets in these locations has shown mixed results for improving healthy food consumption. The Healthy Community Stores Case Study Project (HCSCSP) explored an alternative strategy: supporting mission-driven, locally owned, healthy community food stores to improve healthy food access. The HCSCSP used a multiple case study approach, and conducted a cross-case analysis of seven urban healthy food stores across the United States. The main purpose of this commentary paper is to summarize the main practice strategies for stores as well as future directions for researchers and policy-makers based on results from the prior cross-case analyses. We organize these strategies using key concepts from the Retail Food Environment and Customer Interaction Model. Several key strategies for store success are presented including the use of non-traditional bus...
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Papers by Uriyoan Colon-Ramos