Pilot Projects 2022 Funding Year

Rachyl Pines, PhD

Email: rpines@sbch.org

Community-Based Nutrition-Lifestyle Therapy for Pregnant Latina Women With Diabetes

Community-Based Nutrition-Lifestyle Therapy for Pregnant Latina Women With Diabetes

Socioeconomically disadvantaged (SED) pregnant Latina women are disproportionately burdened by type 2 diabetes (T2D). This proposal will develop and test a culturally tailored, dietary-lifestyle behavioral intervention that supports the increased consumption of plant-based foods and is implemented through community health workers (CHWs) to prevent excessive gestational weight gain and improve glycemic control in pregnant Latina women with T2D. This study will take advantage of our existing strong relationships with the local Latino community, CHWs, Santa Barbara County Public Health, which includes eight multidisciplinary healthcare clinics with sliding fee programs, and Rooted Santa Barbara, a community plant-based lifestyle organization. Cultural sensitivity means focusing on delivering health information based on norms, values, beliefs, environmental factors, the historical context that is unique to a racial/ethnic population. For our program to be culturally sensitive, it will include delivery of the program by CHWs primarily in the Spanish language with English as needed and incorporate culturally relevant eating and physical activity recommendations. The project specifically aims to 1) develop the dietary-lifestyle behavioral intervention that encourages a plant-forward diet for pregnant Latina women with T2D to prevent excessive weight gain in pregnancy and improve glycemic control; done in collaboration with CHWs and participants by conducting focus groups to incorporate feedback on the program; 2) conduct a randomized controlled trial with 30 pregnant Latina women with T2D to evaluate the efficacy of the dietary-lifestyle behavioral intervention to prevent excessive gestational weight gain and improve glycemic control; and 3) evaluate the acceptance and delivery of the nutrition-behavior lifestyle program in CHWs and participants. If successful, this study will establish the efficacy of a culturally sensitive program delivered by CHWs incorporating plant-forward diets for pregnant Latina women with T2D for preventing gestational weight gain and improving glycemic control.


Christopher Anderson, PhD, MSPH

Email: christophera@phfewic.org

Infant Feeding Practices and Disparities in Early Childhood Diet and Weight Status among Latino WIC Participants

What infants are fed, including the type of infant formula, contributes to growth patterns and child health. This study will use Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) administrative data to assess the type of infant formula received each month from birth to age 1, child growth from birth to age 4 years, and residential address to determine food environment exposure for WIC-participating children in Los Angeles County. Surveys collected from WIC participants will be matched to administrative data to provide cross-sectional information on child diet with the association of infant formula. We will assess the association of infant formula consumption with child diet and growth, and we will determine if and how the neighborhood food environment contributes to this relantionship. Finally, we will evaluate the contribution of different infant formula exposures to dietary and growth outcomes between Latino and Non-Latino WIC participating children. Given the elevated risk of obesity among children in low-income households and the broad reach of WIC, understanding how components of the WIC program (including the infant formula provided) contribute to child health is critical to maximizing the positive public health impact of the WIC program.

Alaina Vidmar, MD

Email: avidmar@chla.usc.edu

Impact Of Meal Timing On Glycemic Profile in Latino Adolescents with Obesity

One of five teenagers in the United States are living with obesity. We currently treat obesity by recommending that youth change the type of food they eat, the quantity of food they eat, and increase their daily exercise. Unfortunately, although these skills are very important to lead a healthy life, they often do not result in weight loss for many teenagers. For many adults, limiting the hours of the day in which they eat helps them lose weight, control their diabetes, high blood pressure and high cholesterol. It seems that the time of day in which they eat changes whether this approach results in weight loss and improved health. Several studies have suggested that eating early in the day may be the best approach to improve health. However, many teenagers prefer to not eat breakfast or lunch and are most hungry later in the day. Either way, recommending that teenagers should start eating early in the morning may not be something they are interested in and therefore hard for them to follow consistently. To better understand this, we will recruit 30 teenagers living with obesity without diabetes, to be a part of a 14-day study. In this study, teenagers living with obesity but without diabetes will wear a continuous glucose monitor daily for 14 days and come to our clinic three days, at different times, to eat a meal. We will track what happens to their blood sugar, other hormones and proteins in response to eating at different times of day to prevent them from developing diabetes.

Jeremy Landeo-Gutierrez, MD, MPH

Email: jlandeogutierrez@health.ucsd.edu

Disparities in Obstructive Sleep Apnea in Latino Children

Obstructive sleep apnea (OSA) is estimated to occur in ~3-5% of children in the United States, and can cause significant negative health outcomes and impact behavioral and neurocognitive outcomes. Children from ethnic minorities suffer a disproportional burden of OSA with greater severity at time of diagnosis as well as experience delayed treatment. Despite this, there is limited information on the impact of OSA specifically among Latino children. Although untreated OSA has been linked to excessive daytime sleepiness (EDS), there is insufficient data evaluating mechanisms that could explain this association. We hypothesize that Latino adolescents are overrepresented among those suffering from OSA and EDS at the time of diagnosis and that lower brain oxygenation measures analyzed by near-infrared spectroscopy (NIRS) during diagnostic polysomnography (PSG) explains their enhanced susceptibility to EDS when compared to non-Latino adolescents.

Aim 1. We will retrospectively identify the epidemiologic and clinical characteristics associated with OSA and EDS in Latino and non-Latino adolescents who underwent a sleep study at Rady Children’s Hospital between January and December 2021.

Aim 2. We will determine the differential effects of OSA in Latino and non-Latino adolescents presenting with and without EDS, using NIRS to analyze cerebral oxygenation in the sleep laboratory.

This study will provide key epidemiological and clinical information to understand the determinants of health disparities in OSA among Latino adolescents suffering effects that impair their daytime functioning. Moreover, the successful completion of this study will provide insight into the possible mechanism that may explain the link between OSA and EDS.

Leah Yieh, MD, MPH

Email: lyieh@chla.usc.edu

The Impact of Social Determinants of Health on Outcomes and Resource Utilization for Very Low Birthweight Latino Infants in Los Angeles

Very low birthweight (VLBW) infants (less than 1500 grams) are at higher risk for mortality, developmental delays and increased healthcare use after discharge compared to healthy infants. Neighborhood level factors such as exposure to segregation, safe housing, clean air and access to healthy food, can influence the health outcomes of children. Prior studies in Los Angeles County show that infant mortality is higher among Mexican-origin women living in higher-density immigrant neighborhoods. In addition, VLBW infants born to Latino mothers are less likely to receive developmental therapies after discharge from the hospital. Therefore, it is important to understand the primary drivers of adverse health outcomes in this population to inform clinical decision-making and opportunities for intervention. To address this gap, we will examine the relationship between maternal demographics, infant-level risk factors, and the Child Opportunity Index, a composite measure of positive and negative attributes of neighborhood conditions, and their association with outcomes (mortality, developmental delays) as well as healthcare use (hospitalizations, emergency room visits, outpatient therapies). Data will be obtained from the California Perinatal Quality Care Collaborative, California Office of Statewide Health Planning and Development, California Vital Statistics, and statewide High-Risk Infant Follow Up clinics. We will use a multifaceted approach to highlight disparities in the geographic distribution of VLBW Latino infants in Los Angeles County in relation to opportunity gaps between neighborhoods that have not been well studied in association with post-discharge outcomes. The findings of our study will identify high-risk communities, disparities in neighborhood resources, and potentially modifiable drivers of health inequities.

Abigail Horn, PhD

Email: abigail.horn@usc.edu

Analyzing Digital Menu Data to Characterize Nutritional Quality of Food Environments in Latino Neighborhoods within Southern California

Latino families are disproportionately affected by diet-related diseases including obesity and type 2 diabetes. Food environments—the physical spaces in which people access and consume food—have the potential to profoundly impact diet and related diseases, and it is well-established that low-income neighborhoods and communities of color have poorer quality environments. However, recent initiatives to improve diet by improving food environments have demonstrated little success. They are hampered by a limited understanding of how environments affect eating behavior – partially due to the limited characterization of their fine-grained nutritional features. Food environments are often classified by the presence or absence of broad outlet categories (e.g., grocery, fast-food), masking the diversity of nutritional quality across individual outlet offerings. This project will leverage novel data streams (NDS) including digital menus, point of interest databases (e.g. Yelp), nutrition application data and techniques from machine learning, to develop a tool for characterizing the nutritional quality of restaurants in a continuous score that will be deployable at scale across diverse neighborhoods. The tool will be developed with the guidance of experts in dietary assessment, and applied to deliver insights into disparities in access to nutritious foods in Latino neighborhoods in the City of Los Angeles (LA). The tool will be then shared with stakeholders through a data science portal. Partners in public health, including the LA County Department of Public Health’s Nutrition and Physical Activity Program, will be involved in designing what to showcase in the portal, as well as brainstorming the translational use cases for the tool, such as as identifying restaurants to include in the Restaurant Meal Program, which gives people at high risk for chronic hunger the option to use CalFresh benefits to buy prepared meals at approved restaurant vendors.