Elena Carbone
University of Massachusetts Amherst, Nutrition, Faculty Member
Depression affects 8% of adults in America and is one of the leading causes of disability in Western countries. The dietary inflammatory index (DII) has previously been reported to be associated with inflammation and depression. However,... more
Depression affects 8% of adults in America and is one of the leading causes of disability in Western countries. The dietary inflammatory index (DII) has previously been reported to be associated with inflammation and depression. However, no study to date has looked at the potential mediating effect of inflammation on the association of DII and depression. We hypothesized that the association of DII and depression would be both statistically and clinically mediated substantially by inflammation. We assessed these associations using the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2005-2010 database. Our analysis included 10,022 participants aged 20 years and older. Inflammation was assessed with C-reactive protein (CRP) levels. Diet was measured using two 24 hour dietary recalls. Depression was assessed using the 9-item Patient Health Questionnaire (PHQ-9), which has a score range of 0 to 27, with the higher score showing more severe depressive symptoms. Comparing the highest to lowest DII quartiles, the mean score difference for depression was 0.47 units (95% CI 0.24-0.70, P-trend <.001) in the multivariable adjusted model. In the sex-stratified models, the results remained significant only among females, with the mean score difference of 0.72 (95% CI 0.34-1.10, P-trend <.001). CRP mediated 3.6% of the association between DII and depression in the total population in the fully adjusted model, which was statistically significant (P-trend <.001) but not clinically significant. No mediation association was found in the sex-stratified models. Further studies are needed to assess the associations with various inflammatory biomarkers in larger and more diverse populations.
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Research Interests: Literacy, Health Literacy, Diet, Community Health, Medicine, and 15 moreLearning Style, Learning, Feasibility Study, Kinesthetic learning, Humans, Feasibility Studies, Interactive Learning, Feeling, Learning Activities, Aged, Middle Aged, Community Health and Preventive Medicine, Educational Status, Health knowledge, and Hispanic American
Research Interests: Biochemistry, Education, Health Promotion, Gerontology, Focus Groups, and 15 moreFormative Assessment, Health Education, Consumer Behavior, Humans, Diabetes mellitus, Intervention, Focus Group, Exercise, Massachusetts, Incidence, Community Health and Preventive Medicine, Educational Status, Low Income, Medical and Health Sciences, and Latin Americans
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The aim of this cross-sectional study was to examine the associations between underestimation of weight and sociodemographic, health, and dietary factors among adults living in a rural community in Puerto Rico. For data collection, a... more
The aim of this cross-sectional study was to examine the associations between underestimation of weight and sociodemographic, health, and dietary factors among adults living in a rural community in Puerto Rico. For data collection, a researcher-designed questionnaire was distributed to each household in the area. A multivariable logistic regression was conducted for data analysis. Results revealed that the prevalence of overweight and obesity was 34.4% and 38.7%, respectively. A total of 53.4% of the participants underestimated their weight, most of whom were either overweight or obese. Weight underestimation was associated with being male, age ≥35 years, living below the poverty level estimate, perceiving diet quality as excellent/very good, and consuming fast food ≥1 times/week. In conclusion, overweight/obesity rates were high in this sample, and underestimation of weight was common among people with higher body mass index levels. Future public health interventions targeting obes...
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Over one-third of adolescents are overweight or obese. Food literacy (FL), the ability to plan and manage, select, prepare, and eat healthy foods, is a contemporary concept that provides a mechanism to understand the relationship between... more
Over one-third of adolescents are overweight or obese. Food literacy (FL), the ability to plan and manage, select, prepare, and eat healthy foods, is a contemporary concept that provides a mechanism to understand the relationship between food-related knowledge and skills and dietary intake. Innovative interventions which focus on the core concepts of FL and include generationally appropriate technology have the potential to provide positive impact on the dietary habits of adolescents. This systematic review followed PRISMA guidelines and employed the Downs and Black criteria for rating studies. Titles and abstracts of 545 articles were collected and reviewed from 13 electronic databases. Studies were selected if they were peer-reviewed, included adolescents 12-19 years-old, incorporated concepts related to FL, and employed technology as part of the intervention. Eight studies, six randomized controlled trials (RCT) and two interventions without controls were included. Seven of the i...
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Maternal periodontal disease is associated with adverse perinatal outcomes. Anxiety and depression adversely impact oral health in nonpregnant women; however, this association has not been evaluated during pregnancy, a time characterized... more
Maternal periodontal disease is associated with adverse perinatal outcomes. Anxiety and depression adversely impact oral health in nonpregnant women; however, this association has not been evaluated during pregnancy, a time characterized by higher rates of anxiety and depression. Therefore, we examined the association between these factors and oral disease and oral healthcare utilization among 402 pregnant respondents to the 2010 Behavioral Risk Factor Surveillance System. Self-reported lifetime diagnoses of anxiety, depression, and current depression were assessed. Oral health outcomes included self-reported tooth loss and dental visits in the past year. One-fifth (21.2 percent) of respondents reported a tooth loss and 32.5 percent reported nonuse of oral health services. The prevalence of lifetime diagnosed anxiety and depression was 13.6 percent and 11.3 percent, respectively, whereas 10.6 percent reported current depression. After adjusting for risk factors, pregnant women with diagnosed anxiety had increased odds of one or more tooth loss [odds ratio (OR) = 3.30; 95 percent confidence interval (CI): 1.01-10.77] compared with those without the disorder. Similarly, after adjusting for socioeconomic factors, women with anxiety had increased odds of nonuse of oral health services (OR = 2.67; 95 percent CI: 1.03-6.90); however, this was no longer significant after adjusting for health behaviors and body mass index. We observed no significant association with depression. In this population-based sample, we found a two- to threefold increased odds of tooth loss and nonuse of oral health services among pregnant women with a lifetime diagnosis of anxiety. To our knowledge, this is the first study to examine these associations among pregnant women.
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This study designed and piloted an interactive measure to assess learning preferences of Latinos in the United States with diabetes and limited literacy. The measure utilized interactive learning activities to represent four learning... more
This study designed and piloted an interactive measure to assess learning preferences of Latinos in the United States with diabetes and limited literacy. The measure utilized interactive learning activities to represent four learning styles: visual (seeing), kinesthetic (doing), affective (feeling/sensing), and cognitive (thinking), targeting four diabetes self-management behaviors: choosing healthy foods; understanding portion sizes; distinguishing foods to eat often/sometimes/rarely; and limiting fat. Quantitative data were collected using the Spanish Short Test of Functional Health Literacy in Adults (S-TOFHLA). Individual, structured cognitive interview questions asked participants to identify learning activities that most reflected their own experience with diabetes. Participant observations provided additional qualitative data. Ten Spanish-speaking adults with type 2 diabetes and limited literacy participated in two randomly selected target behaviors and identified easiest and most difficult to understand learning activities. S-TOFHLA scores ranged from 0 to 21 points (mean 7.0) and identified eight participants with inadequate and two with marginal health literacy. Easiest to understand tasks were kinesthetic, most difficult to understand tasks were cognitive. This is one of the first known studies of its kind and offers insight for measuring learning styles of Latinos with diabetes and low health literacy.
Research Interests: Health Literacy, Diet, Community Health, Preventive medicine, Choice and preference (Learning), and 17 moreLearning Style, Learning, Feasibility Study, Patient education, Humans, United States, Feasibility Studies, Interactive Learning, Learning Activities, Participant Observation, Aged, Middle Aged, Qualitative Data, Study design, Educational Status, Type 2 Diabetes Mellitus, and Health knowledge
Adolescent overweight and obesity are ongoing public health concerns, and innovative weight loss interventions are needed to reach this age group. The objective of this systematic review was to assess and synthesize the literature on... more
Adolescent overweight and obesity are ongoing public health concerns, and innovative weight loss interventions are needed to reach this age group. The objective of this systematic review was to assess and synthesize the literature on adolescent weight loss programs that utilize cell phones as an intervention component to reduce weight, as measured by body mass index or body mass index z-score. A systematic review of the literature, consistent with PRISMA guidelines, was undertaken using 11 databases. Studies of weight loss interventions published in peer-reviewed journals in English during the last 10 years were eligible for inclusion if they examined an adolescent population, used validated measures for pre- and post-test weight, identified weight loss as a primary or secondary outcome, and specified use of cell phones to deliver a component of the program. While within-group weight loss results were noted, no significant between-group differences were found across the majority of ...
... doc-tors and patients together can develop an individual screen-ing plan that meets the physical and psychological needs of the patient until further research is available to clarify the question of who should be offered widespread... more
... doc-tors and patients together can develop an individual screen-ing plan that meets the physical and psychological needs of the patient until further research is available to clarify the question of who should be offered widespread prostate cancer screening. 10 Albertsen PC ...
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Skin cancer is a significant and increasing public health problem. Improvement in sun protection practices among children holds great promise for prevention, and parents and caregivers play important roles. Health promotion programs are... more
Skin cancer is a significant and increasing public health problem. Improvement in sun protection practices among children holds great promise for prevention, and parents and caregivers play important roles. Health promotion programs are most likely to succeed when based on a systematic planning process including an understanding of current practices, beliefs, social norms and environments. This article describes formative research used to help develop the SunSmart skin cancer prevention program in Hawaii. Group discussions and interviews were conducted with 216 children in grades 1, 2 and 3, 15 parents, and 27 recreation staff. Children's discussion groups took place in intact classrooms. A combination of quantitative and qualitative methods was used. Multiple raters and an iterative process were used to analyze data from survey forms, observer impressions and audio tapes, and to draw the main conclusions. Sun protection practices in all groups were inconsistent, though general ...
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To assess student retention, readiness, support and outcomes among students completing the Professional Practice Program in Nutrition (PPPN). Qualitative evaluation using semistructured, in-depth interviews conducted with PPPN graduates.... more
To assess student retention, readiness, support and outcomes among students completing the Professional Practice Program in Nutrition (PPPN). Qualitative evaluation using semistructured, in-depth interviews conducted with PPPN graduates. Course grades, grade point averages, and comprehensive exam results compared 10 PPPN students from 2 cohorts and 72 residential students from 3 cohorts. The Professional Practice Program in Nutrition was a 3-year, pilot public health nutrition master&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s (MPH) degree curriculum using distance education (DE) strategies. Ethnograph was used to assist with qualitative data analysis. Fisher exact test was used to compare quantitative outcomes. Qualitative findings revealed that PPPN students were highly motivated, sought out the DE MPH and initially had great support from family and employers; however, support from employers waned over time. Although several challenges to continued enrollment confronted PPPN students, those who completed the MPH all advanced in the workplace. Course grades and grade point averages were similar between the 2 groups. Students in the PPPN were more likely than residential students to retake the comprehensive exam. The findings indicate that DE strategies were suitable to deliver an MPH curriculum in nutrition. The majority of PPPN graduates experienced job advancement and demonstrated leadership development.
Research Interests: Program Evaluation, Education, Distance Education, Nutrition, Graduate Education, and 15 moreSocial Support, Qualitative Research, Public Health, Curriculum, Students, Humans, Student retention, Case Study, United States, Professional Practice, Educational Status, Nutritional Sciences, Professional Competence, Student Dropouts, and Cohort Studies
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Research Interests: Education, Distance Education, Science Education, Accreditation, Curriculum, and 13 moreMotivation, Students, Humans, Web based instruction, Computer Assisted Instruction, College Students, Systematic review, Nutrition Education, Research Needs, Nutritional Sciences, Theoretical Model, Internet, and Education Continuing
Research Interests: Cultural Studies, Health Promotion, Decision Making, Community-Based Mental Health Services, Cultural Competency, and 11 moreHealth Education, Health Disparities, Community Health, Puerto Rico, Information Processing, Literature Review, Humans, Social Representation, Surface Structure, Public health systems and services research, and Curriculum and Pedagogy
Hispanics are twice as likely as non-Hispanic Whites to have diabetes and are also at higher risk for diabetes-related complications and poorer outcomes. The prevalence of diabetes is inversely related to educational status. Low literacy... more
Hispanics are twice as likely as non-Hispanic Whites to have diabetes and are also at higher risk for diabetes-related complications and poorer outcomes. The prevalence of diabetes is inversely related to educational status. Low literacy is common, especially among older Hispanics. Little literature exists on formative research to create diabetes education materials for this audience. Two focus groups assessed views and preferences for diabetes education of low-literate, low-income, non-English-speaking urban Caribbean and Central American Hispanics with diabetes, as well as utility of materials developed specifically for this population, as part of the preliminary work for a pilot study of a diabetes intervention. Implications for practitioners and researchers are discussed.
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Depression affects 8% of adults in America and is one of the leading causes of disability in Western countries. The dietary inflammatory index (DII) has previously been reported to be associated with inflammation and depression. However,... more
Depression affects 8% of adults in America and is one of the leading causes of disability in Western countries. The dietary inflammatory index (DII) has previously been reported to be associated with inflammation and depression. However, no study to date has looked at the potential mediating effect of inflammation on the association of DII and depression. We hypothesized that the association of DII and depression would be both statistically and clinically mediated substantially by inflammation. We assessed these associations using the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2005-2010 database. Our analysis included 10,022 participants aged 20 years and older. Inflammation was assessed with C-reactive protein (CRP) levels. Diet was measured using two 24 hour dietary recalls. Depression was assessed using the 9-item Patient Health Questionnaire (PHQ-9), which has a score range of 0 to 27, with the higher score showing more severe depressive symptoms. Comparing the highest to lowest DII quartiles, the mean score difference for depression was 0.47 units (95% CI 0.24-0.70, P-trend <.001) in the multivariable adjusted model. In the sex-stratified models, the results remained significant only among females, with the mean score difference of 0.72 (95% CI 0.34-1.10, P-trend <.001). CRP mediated 3.6% of the association between DII and depression in the total population in the fully adjusted model, which was statistically significant (P-trend <.001) but not clinically significant. No mediation association was found in the sex-stratified models. Further studies are needed to assess the associations with various inflammatory biomarkers in larger and more diverse populations.
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Objectives Lifetime prevalence of depression in America is 5% among men and 10% among women, with slightly higher rates among premenopausal women. Diet and inflammation are associated with depression. We assessed the mediating role... more
Objectives Lifetime prevalence of depression in America is 5% among men and 10% among women, with slightly higher rates among premenopausal women. Diet and inflammation are associated with depression. We assessed the mediating role (indirect effect) of inflammation on the association of DII and depression (total effect). Methods We used observations from 3 cycles of the NHANES database (N = 10,022). Diet was measured using 24-hour dietary recalls. We used DII to assess inflammatory potential of diet and categorized it into quartiles (Q1, Q2, Q3, Q4). Continuous and major depression were defined using the Patient Health Questionnaire (PHQ-9). Systemic inflammation was measured by C-reactive protein (CRP) levels. Our multivariable model was adjusted for age, sex, race, BMI, waist circumference, smoking, diabetes, marital status, education, socioeconomic status, and physical activity. We used structural equation modeling to assess the mediation effect of CRP. Results When comparing Q4 ...
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Background Disturbances in glucose metabolism during pregnancy are associated with negative sequalae for both mother and infant. The association between smoking and abnormal glucose tolerance (AGT) remains controversial. Therefore, the... more
Background Disturbances in glucose metabolism during pregnancy are associated with negative sequalae for both mother and infant. The association between smoking and abnormal glucose tolerance (AGT) remains controversial. Therefore, the aim of this study was to examine the relationship between smoking prior to and during pregnancy and risk of AGT. Methods We utilized data from a prospective cohort of 1,006 Hispanic (predominantly Puerto Rican) prenatal care patients in Western Massachusetts. Women reported pre- and early pregnancy smoking at recruitment (mean = 15 weeks) and mid pregnancy smoking at a second interview (mean = 28 weeks). AGT was defined as > 135 mg/dL on the routine 1-hour glucose tolerance test (1-hr OGTT). We used multivariable regression to assess the effect of pre, early, and mid-pregnancy smoking on risk of AGT and screening plasma glucose value from the 1-hr OGTT. Results In age-adjusted models, women who smoked > 0-9 cigarettes/day in pre-pregnancy had an...
Objectives Lifetime prevalence of depression in America is 5% among men and 10% among women, with slightly higher rates among premenopausal women. Diet and inflammation are associated with depression. We assessed the mediating role... more
Objectives Lifetime prevalence of depression in America is 5% among men and 10% among women, with slightly higher rates among premenopausal women. Diet and inflammation are associated with depression. We assessed the mediating role (indirect effect) of inflammation on the association of DII and depression (total effect). Methods We used observations from 3 cycles of the NHANES database (N = 10,022). Diet was measured using 24-hour dietary recalls. We used DII to assess inflammatory potential of diet and categorized it into quartiles (Q1, Q2, Q3, Q4). Continuous and major depression were defined using the Patient Health Questionnaire (PHQ-9). Systemic inflammation was measured by C-reactive protein (CRP) levels. Our multivariable model was adjusted for age, sex, race, BMI, waist circumference, smoking, diabetes, marital status, education, socioeconomic status, and physical activity. We used structural equation modeling to assess the mediation effect of CRP. Results When comparing Q4 ...