- Director, Center for Elimination of Border Health Disparities
- Professor, Public Health
- Professor, Medicine
Dr. Marrero has a strong interest in improving prevention and care of chronic disease for people who experience health disparities. His main interests in this context are diabetes, mental health, and cancer. He is currently working on programs to implement diabetes prevention among women and their children of hispanic desent who have elevated risk for developing type 2 diabetes.
- Ph.D. Social Ecology
- University of California, Irvine, Irvine, California, United States
- M.A. Social Ecology
- University of California, Irvine, Irvine, California, United States
- B.A. Social Ecology
- University of California, Irvine, Irvine, California, United States
- UA, Tucson, Arizona (2017 - Ongoing)
- UA, Tucson, Arizona (2016 - Ongoing)
- UA, Tucson, Arizona (2016 - Ongoing)
- Indiana University School of Medicine (2004 - 2016)
- Indiana University School of Medicine (2004 - 2016)
- Indiana University School of Medicine (2003 - 2016)
- Indiana University School of Medicine (2003 - 2004)
- Indiana University at Indianapolis (1986 - 1993)
- University of Southern California, Los Angeles, California (1984)
- University of Southern California School of Medicine (1982 - 1984)
- University of California, Irvine School of Medicine (1980 - 1984)
- Trainex International (1980 - 1981)
- University of California, Irvine, Medical School, Department of Pediatrics (1980 - 1981)
- UC Irvine Celebration of Graduate Success.
- University of California, Irvine, Spring 2016
1.Improving diabetes prevention and care for populations with health disparities.2. improving mental health care for populations with health disparities3. the impact of pesticide and other farm chemicals on diabetes
DissertationHPS 920 (Spring 2021)
DissertationHPS 920 (Spring 2020)
Evaluat Public Hlth LiteratureHPS 609 (Fall 2019)
Evaluat Public Hlth LiteratureHPS 609 (Fall 2018)
- McCaffery, J. M., Jablonski, K. A., Franks, P. W., Delahanty, L. M., Aroda, V., Marrero, D., Hamman, R. F., Horton, E. S., Dagogo-Jack, S., Wylie-Rosett, J., Barrett-Connor, E., Kitabchi, A., Knowler, W. C., Wing, R. R., Florez, J. C., & , D. P. (2020). Replication of the Association of BDNF and MC4R Variants With Dietary Intake in the Diabetes Prevention Program. Psychosomatic medicine, 79(2), 224-233.More infoGenomewide association studies (GWAS) have identified consistent associations with obesity, with a number of studies implicating eating behavior as a primary mechanism. Few studies have replicated genetic associations with dietary intake. This study evaluates the association between obesity susceptibility loci and dietary intake.
- Pihlaskari, A. K., Anderson, B. J., Eshtehardi, S. S., McKinney, B. M., Marrero, D. G., Thompson, D., & Hilliard, M. E. (2020). Diabetes disclosure strategies in adolescents and young adult with type 1 diabetes. Patient education and counseling, 103(1), 208-213.More infoAdolescence and young adulthood have social and developmental challenges that can impact type 1 diabetes (T1D) management. New relationships (e.g. friends, schoolmates, dating partners, teachers, employers) introduce opportunities for disclosure of T1D status. Characterizing how adolescents and young adults (AYAs) disclose having T1D to others may help inform clinical strategies to help AYAs ensure their safety by obtaining social support.
- Rivers, P., Hingle, M., Ruiz-Braun, G., Blew, R., Mockbee, J., & Marrero, D. (2020). Adapting a Family-Focused Diabetes Prevention Program for a Federally Qualified Health Center: A Qualitative Report. The Diabetes educator, 145721719897587.More infoThe purpose of the study was to explore the needs of high-risk Latinx/Hispanic women with a history of gestational diabetes who were patients at a Federally Qualified Health Center (FQHC) in anticipation of a future family-based program.
- Thornton, P. L., Kumanyika, S. K., Gregg, E. W., Araneta, M. R., Baskin, M. L., Chin, M. H., Crespo, C. J., de Groot, M., Garcia, D. O., Haire-Joshu, D., Heisler, M., Hill-Briggs, F., Ladapo, J. A., Lindberg, N. M., Manson, S. M., Marrero, D. G., Peek, M. E., Shields, A. E., Tate, D. F., & Mangione, C. M. (2020). New research directions on disparities in obesity and type 2 diabetes. Annals of the New York Academy of Sciences, 1461(1), 5-24.More infoObesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.
- de Groot, M., Marrero, D., Mele, L., Doyle, T., Schwartz, F., Mather, K. J., Goldberg, R., Price, D. W., Ma, Y., Knowler, W. C., & , D. P. (2020). Depressive Symptoms, Antidepressant Medication Use, and Inflammatory Markers in the Diabetes Prevention Program. Psychosomatic medicine, 80(2), 167-173.More infoAntidepressant medication use (ADM) has been shown to predict diabetes. This article assessed the role of inflammatory markers in this relationship within the Diabetes Prevention Program (DPP).
- Algotar, A., Hsu, C. H., Sherry Chow, H. H., Dougherty, S., Babiker, H. M., Marrero, D., Abraham, I., Kumar, R., Ligibel, J., Courneya, K. S., & Thomson, C. (2019). Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP): Protocol for a Feasibility and Exploratory Efficacy Study in Men on Androgen Deprivation Therapy. JMIR research protocols, 8(2), e12579.More infoAndrogen deprivation therapy (ADT) for prostate cancer is associated with adverse cardiometabolic effects such as reduced libido, hot flashes, metabolic syndrome, diabetes, myocardial infarction, and stroke. This reduces quality of life and potentially increases mortality. Several large clinical trials have demonstrated improvements in cardiometabolic risk with comprehensive multimodality lifestyle modification. However, there is a lack of data for such interventions in men on ADT for prostate cancer, and existing studies have used non-standardized interventions or lacked data on metabolic risk factors.
- Hilliard, M. E., Minard, C. G., Marrero, D. G., de Wit, M., Thompson, D., DuBose, S. N., Verdejo, A., Monzavi, R., Wadwa, R. P., Jaser, S. S., & Anderson, B. J. (2019). Assessing Health-Related Quality of Life in Children and Adolescents with Diabetes: Development and Psychometrics of the Type 1 Diabetes and Life (T1DAL) Measures. Journal of pediatric psychology.More infoTo develop and validate new measures of diabetes-specific health-related quality of life (HRQOL) for people with type 1 diabetes (T1D) that are brief, developmentally appropriate, and usable in clinical research and care. Here we report on the phases of developing and validating the self-report Type 1 Diabetes and Life (T1DAL) measures for children (age 8-11) and adolescents (age 12-17).
- Marrero, D. G., Hilliard, M. E., Maahs, D. M., McAuliffe-Fogarty, A. H., & Hunter, C. M. (2019). Using patient reported outcomes in diabetes research and practice: Recommendations from a national workshop. Diabetes research and clinical practice, 153, 23-29.More infoThe National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the American Diabetes Association (ADA) Co-Sponsored the workshop, Using Patient Reported Outcomes in Diabetes Research and Practice. The goal of the workshop was to identify PRO research priorities for those living with type 1 or type 2 diabetes, discuss considerations for use of disease specific versus generic measures, as well as outline research priorities to meet key end-user needs for assessing PROs for diabetes researchers, clinicians/hospital systems, patients/caregivers, and regulators. Here, we summarize the conclusions and recommendations from the workshop.
- Ruiz-Brown, G., Mockbee, J., Blew, R., Rivers, P., Marrero, D., & Hingle, M. D. (2019). Adapting a Family-Focused Diabetes Prevention Program for Federally Qualified Health Center: A Qualitative Report.. The Diabetes Educator.
- Tan, T. W., Shih, C. D., Concha-Moore, K. C., Diri, M. M., Hu, B., Marrero, D., Zhou, W., & Armstrong, D. G. (2019). Disparities in outcomes of patients admitted with diabetic foot infections. PloS one, 14(2), e0211481.More infoThe purpose of this study was to evaluate the disparities in the outcomes of White, African American (AA) and non-AA minority (Hispanics and Native Americans (NA)), patients admitted in the hospitals with diabetic foot infections (DFIs).
- Algotar, A., Hsu, C., Abraham, I. L., Marrero, D., Thomson, C. A., & Chow, H. (2019). Comprehensive lifestyle improvement program for prostate cancer (CLIPP): Protocol for a feasibility and exploratory efficacy study in men on androgen deprivation therapy. Journal of Medical Internet Research.
- Hannon, T. S., Saha, C. K., Carroll, A. E., Palmer, K. N., O'Kelly Phillips, E., & Marrero, D. G. (2018). The ENCOURAGE healthy families study: A comparative effectiveness trial to reduce risk for type 2 diabetes in mothers and children. Pediatric diabetes.More infoTrials in adults have demonstrated that interventions targeting lifestyle are effective in preventing or delaying type 2 diabetes (T2D). To address this need in youth, we developed ENCOURAGE Healthy Families (ENCOURAGE), based on the US Diabetes Prevention Program (DPP).
- Puckrein, G. A., Hirsch, I. B., Parkin, C. G., Taylor, B. T., Xu, L., & Marrero, D. G. (2018). Impact of the 2013 National Rollout of CMS Competitive Bidding Program: The Disruption Continues. Diabetes care, 41(5), 949-955.More infoUse of glucose monitoring is essential to the safety of individuals with insulin-treated diabetes. In 2011, the Centers for Medicare & Medicaid Services (CMS) implemented the Medicare Competitive Bidding Program (CBP) in nine test markets. This resulted in a substantial disruption of beneficiary access to self-monitoring of blood glucose (SMBG) supplies and significant increases in the percentage of beneficiaries with either reduced or no acquisition of supplies. These reductions were significantly associated with increased mortality, hospitalizations, and costs. The CBP was implemented nationally in July 2013. We evaluated the impact of this rollout to determine if the adverse outcomes seen in 2011 persisted.
- Dixon, B. E., Jabour, A. M., Phillips, E. O., & Marrero, D. G. (2017). An informatics approach to medication adherence assessment and improvement using clinical, billing, and patient-entered data. Journal of the American Medical Informatics Association : JAMIA, 21(3), 517-21.More infoThe aim of this study was to describe an integrated informatics approach to aggregating and displaying clinically relevant data that can identify problems with medication adherence and facilitate patient-provider communication about strategies to improve medication use. We developed a clinical dashboard within an electronic health record (EHR) system that uses data from three sources: the medical record, pharmacy claims, and a personal health record. The data are integrated to inform clinician-patient discussions about medication adherence. Whereas prior research on assessing patterns of medication adherence focused on a single approach using the EHR, pharmacy data, or patient-entered data, we present an approach that integrates multiple electronic data sources increasingly found in practice. Medication adherence is a complex challenge that requires patient and provider team input, necessitating an integrated approach using advanced EHR, clinical decision support, and patient-controlled technologies. Future research should focus on integrated strategies to provide patients and providers with the right combination of informatics tools to help them adequately address the challenge of adherence to complex medication therapies.
- Miller, C. K., Weinhold, K., Marrero, D. G., Nagaraja, H. N., & Focht, B. C. (2017). A Translational Worksite Diabetes Prevention Trial Improves Psychosocial Status, Dietary Intake, and Step Counts among Employees with Prediabetes: A Randomized Controlled Trial. Preventive medicine reports, 2, 118-126.More infoFew worksite trials have examined the impact of diabetes prevention interventions on psychological and behavioral outcomes. Thus, the impact of a worksite lifestyle intervention on psychosocial outcomes, food group intake, and step counts for physical activity (PA) was evaluated.
- Osborn, C. Y., van Ginkel, J. R., Marrero, D. G., Rodbard, D., Huddleston, B., & Dachis, J. (2017). One Drop | Mobile on iPhone and Apple Watch: An Evaluation of HbA1c Improvement Associated With Tracking Self-Care. JMIR mHealth and uHealth, 5(11), e179.More infoThe One Drop | Mobile app supports manual and passive (via HealthKit and One Drop's glucose meter) tracking of self-care and glycated hemoglobin A (HbA).
- Osborn, C. Y., van Ginkel, J. R., Rodbard, D., Heyman, M., Marrero, D. G., Huddleston, B., & Dachis, J. (2017). One Drop | Mobile: An Evaluation of Hemoglobin A1c Improvement Linked to App Engagement. JMIR diabetes, 2(2), e21.More infoThree recent reviews evaluated 19 studies testing the hemoglobin A1c (HbA1c) benefit of 16 diabetes apps, including 5 publicly available apps. Most studies relied on small samples and did not link app engagement with outcomes.
- Ratanawongsa, N., Crosson, J. C., Schillinger, D., Karter, A. J., Saha, C. K., & Marrero, D. G. (2017). Getting under the skin of clinical inertia in insulin initiation: the Translating Research Into Action for Diabetes (TRIAD) Insulin Starts Project. The Diabetes educator, 38(1), 94-100.More infoThe purpose of this cross-sectional study is to explore primary care providers' (PCPs) perceptions about barriers to initiating insulin among patients. Studies suggest that many patients with poorly controlled type 2 diabetes do not receive insulin initiation by PCPs.
- Dixon, B. E., Alzeer, A. H., Phillips, E. O., & Marrero, D. G. (2016). Integration of Provider, Pharmacy, and Patient-Reported Data to Improve Medication Adherence for Type 2 Diabetes: A Controlled Before-After Pilot Study. JMIR medical informatics, 4(1), e4.More infoPatients with diabetes often have poor adherence to using medications as prescribed. The reasons why, however, are not well understood. Furthermore, most health care delivery processes do not routinely assess medication adherence or the factors that contribute to poor adherence.
- Hays, L. M., Hoen, H. M., Slaven, J. E., Finch, E. A., Marrero, D. G., Saha, C., & Ackermann, R. T. (2016). Effects of a Community-based Lifestyle Intervention on Change in Physical Activity Among Economically Disadvantaged Adults With Prediabetes. American journal of health education, 47(5), 266-278.
- Johnson, S. B., & Marrero, D. (2016). Innovations in healthcare delivery and policy: Implications for the role of the psychologist in preventing and treating diabetes. The American psychologist, 71(7), 628-637.More infoAlthough the biomedical model has dominated U.S. health care for more than a century, it has failed to adequately address current U.S. health care challenges, including the treatment and prevention of chronic disease; the epidemic rise in diabetes is one important example. In response, newer models of health care have been developed that address patients' mental and physical health concerns by multidisciplinary care teams that place the patient and family in the center of shared decision making. These new models of care offer many important opportunities for psychologists to play a larger role in the prevention and treatment of diabetes. However, for psychology's role to be fully realized, both external and internal challenges must be addressed. This will require psychologists to become more interdisciplinary, more familiar with the larger health care culture, more willing to expand their skill sets, and more collaborative with other health disciplines both from a patient-care and a larger advocacy perspective. (PsycINFO Database Record
- Marrero, D. G. (2016). Diabetes Care and Research: What Should Be the Next Frontier?. Diabetes spectrum : a publication of the American Diabetes Association, 29(1), 54-7.More infoThis article is adapted from the address of the American Diabetes Association (ADA) President, Health Care and Education, given in June 2015 at the Association's 75th Scientific Sessions in Boston, Mass. A webcast of this speech is available for viewing at the ADA website (http://professional.diabetes.org/webcasts).
- Marrero, D. G. (2016). Evaluation of a Technology to Support a Translational Diabetes Prevention Intervention. Diabetes care, 39(8), 1307-8.
- Marrero, D. G., Palmer, K. N., Phillips, E. O., Miller-Kovach, K., Foster, G. D., & Saha, C. K. (2016). Comparison of Commercial and Self-Initiated Weight Loss Programs in People With Prediabetes: A Randomized Control Trial. American journal of public health, 106(5), 949-56.More infoTo determine if a widely available weight-management program (Weight Watchers) could achieve sufficient weight loss in persons with prediabetes compared with a Diabetes Prevention Program-based individual counseling program supported by National Diabetes Education Program materials.
- Powers, M. A., & Marrero, D. G. (2016). Response to Comment on Powers et al. Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care 2015;38:1372-1382. Diabetes care, 39(1), e17.
- Puckrein, G. A., Nunlee-Bland, G., Zangeneh, F., Davidson, J. A., Vigersky, R. A., Xu, L., Parkin, C. G., & Marrero, D. G. (2016). Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis. Diabetes care, 39(4), 563-71.More infoIn 2011, the Centers for Medicare & Medicaid Services (CMS) launched the Competitive Bidding Program (CBP) in nine markets for diabetes supplies. The intent was to lower costs to consumers. Medicare claims data (2009-2012) were used to confirm the CMS report (2012) that there were no disruptions in acquisition caused by CBP and no changes in health outcomes.
- Wessel, J., & Marrero, D. (2016). Do Genes Determine Our Health? Implications for Designing Lifestyle Interventions and Drug Trials. Circulation. Cardiovascular genetics, 9(1), 2-3.
- Ackermann, R. T., Liss, D. T., Finch, E. A., Schmidt, K. K., Hays, L. M., Marrero, D. G., & Saha, C. (2015). A Randomized Comparative Effectiveness Trial for Preventing Type 2 Diabetes. American journal of public health, 105(11), 2328-34.More infoWe evaluated the weight loss effectiveness of a YMCA model for the Diabetes Prevention Program (DPP) lifestyle intervention.
- Hannon, T. S., Carroll, A. E., Palmer, K. N., Saha, C., Childers, W. K., & Marrero, D. G. (2015). Rationale and design of a comparative effectiveness trial to prevent type 2 diabetes in mothers and children: the ENCOURAGE healthy families study. Contemporary clinical trials, 40, 105-11.More infoThe number of youth with type 2 diabetes (T2D) is expected to quadruple over 4 decades. Gestational diabetes mellitus (GDM) is also increasing and is linked with development of T2D in women, and greater risk for T2D in adolescents exposed to GDM. Despite the increasing prevalence of T2D, approaches to prevent diabetes in high-risk youth and families are rare. To address this, we are conducting the Encourage Health Families Study (ENCOURAGE). This is a randomized trial evaluating the comparative effectiveness and costs of an adaptation of the Diabetes Prevention Program (DPP) directed at mothers who had GDM or prediabetes and their children. The intervention is a group-based lifestyle program which we developed and implemented in partnership with the YMCA. We are comparing the ENCOURAGE intervention targeted to 1) mothers who have had GDM or prediabetes, and 2) mothers who have had GDM or prediabetes along with their school-aged children. This manuscript provides 1) the rationale for a targeted approach to preventing T2D and the interventions, 2) description of the translation of the DPP curriculum, and 3) the study design and methodology. The primary aims are to determine if participation leads to 1) weight loss in high-risk mothers, and 2) youth having healthier weights and lifestyle habits. We will also evaluate costs associated with each approach. These data are essential to build a translation model of T2D prevention that is both realistic and feasible to address this growing problem in both youth and adults.
- Liu, G. C., Hannon, T., Qi, R., Downs, S. M., & Marrero, D. G. (2015). The obesity epidemic in children: Latino children are disproportionately affected at younger ages. International journal of pediatrics & adolescent medicine, 2(1), 12-18.More infoNational surveillance clearly illustrates that U.S. children are becoming increasingly overweight. However, the timing of the onset of childhood overweight has not been well-described.
- Marrero, D. G., Ma, Y., de Groot, M., Horton, E. S., Price, D. W., Barrett-Connor, E., Carnethon, M. R., Knowler, W. C., & , D. P. (2015). Depressive symptoms, antidepressant medication use, and new onset of diabetes in participants of the diabetes prevention program and the diabetes prevention program outcomes study. Psychosomatic medicine, 77(3), 303-10.More infoTo assess in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study whether diagnosis of diabetes predicted elevated depressive symptoms (DS) or use of antidepressant medicine (ADM) following diagnosis; whether diabetes status or duration had significant effect on DS or ADM use; and to determine the associations between A1C, fasting plasma glucose (FPG), normalization of FPG, and DS or ADM use after diagnosis.
- Weinhold, K. R., Miller, C. K., Marrero, D. G., Nagaraja, H. N., Focht, B. C., & Gascon, G. M. (2015). A Randomized Controlled Trial Translating the Diabetes Prevention Program to a University Worksite, Ohio, 2012-2014. Preventing chronic disease, 12, E210.More infoWorking adults spend much time at the workplace, an ideal setting for wellness programs targeting weight loss and disease prevention. Few randomized trials have evaluated the efficacy of worksite diabetes prevention programs. This study evaluated the efficacy of a worksite lifestyle intervention on metabolic and behavioral risk factors compared with usual care.
- , A. D., Lorber, D., Anderson, J., Arent, S., Cox, D. J., Frier, B. M., Greene, M. A., Griffin, J., Gross, G., Hathaway, K., Hirsch, I., Kohrman, D. B., Marrero, D. G., Songer, T. J., & Yatvin, A. L. (2014). Diabetes and driving. Diabetes care, 37 Suppl 1, S97-103.
- Ackermann, R. T., Finch, E. A., Schmidt, K. K., Hoen, H. M., Hays, L. M., Marrero, D. G., & Saha, C. (2014). Rationale, design, and baseline characteristics of a community-based comparative effectiveness trial to prevent type 2 diabetes in economically disadvantaged adults: the RAPID Study. Contemporary clinical trials, 37(1), 1-9.More infoReaching Out and Preventing Increases in Diabetes (RAPID) is a community-based randomized trial evaluating the comparative costs and effectiveness of a group-based adaption of the DPP lifestyle intervention developed and implemented in partnership with the YMCA. RAPID enrolled adult primary care patients, with BMI 24 kg/m(2) or higher and abnormal glucose metabolism (HbA1c 5.7-6.9% or fasting plasma glucose 100-125 mg/dL). 509 participants were enrolled and randomized to one of two groups: standard clinical advice plus free-of-charge access to a group-based adaption of the DPP offered by the Y, versus standard clinical advice alone. Key outcomes for future analysis will include differences in body weight and other cardiovascular risk factors over a 24-month intervention period. At baseline, RAPID participants had a mean (SD) age of 51 ± 12.1 years, weight of 225.1 ± 56.2 lbs, and BMI of 36.9 ± 8.6 kg/m(2). 70.7% were women, 57.2% were African American, 35.4% were non-Hispanic White, and 3.2% were Hispanic. Mean HbA1c was 6.05 ± 0.34%. Additionally, 55.4% of participants had a baseline systolic blood pressure of ≥130 mmHg, 33.1% had a total blood cholesterol exceeding 200mg/dL, and 74% reported a household income of
- Hays, L. M., Finch, E. A., Saha, C., Marrero, D. G., & Ackermann, R. T. (2014). Effect of self-efficacy on weight loss: a psychosocial analysis of a community-based adaptation of the diabetes prevention program lifestyle intervention. Diabetes spectrum : a publication of the American Diabetes Association, 27(4), 270-5.More infoObjective. Weight loss is the most effective approach to reducing diabetes risk. It is a research priority to identify factors that may enhance weight loss success, particularly among those at risk for diabetes. This analysis explored the relationships between self-efficacy, weight loss, and dietary fat intake among adults at risk for developing type 2 diabetes. Methods. This pilot, site-randomized trial was designed to compare group-based Diabetes Prevention Program lifestyle intervention delivery by YMCA staff to brief counseling alone (control) in 92 adults at risk for diabetes (BMI ≥ 24 kg/m(2), ≥ 2 diabetes risk factors, and a random capillary blood glucose of 110-199 mg/dl). Self-efficacy was measured using the Weight Efficacy Lifestyle questionnaire. Data were collected at baseline, 6 months, and 12 months. A paired t test was used to determine within-group changes in self-efficacy and weight at 6 and 12 months. Using a fitted model, we estimated how much of an increase in self-efficacy was related to a 5% weight reduction at 6 and 12 months. Results. Self-efficacy was associated with a 5% reduction in baseline weight at 6 and 12 months but was not related to fat intake. Conclusion. These findings suggest that it is important to assess the level of self-efficacy when counseling adults at high risk for diabetes about weight loss. Certain aspects of self-efficacy seem to play a greater role, depending on the stage of weight loss.
- Kunapareddy, C. J., Nyandiko, W., Inui, T., Ayaya, S., Marrero, D. G., & Vreeman, R. (2014). A qualitative assessment of barriers to antiretroviral therapy adherence among adolescents in western Kenya. Journal of HIV/AIDS & social services, 13(4), 383-401.More infoAntiretroviral therapy (ART) requires nearly perfect adherence to be effective. This study aims to identify key factors identified by HIV-infected adolescents on ART as contributing to medication adherence in western Kenya. Using a qualitative study design, three adolescent focus groups discussions were conducted at an urban and rural clinic site in western Kenya. The study population included HIV-infected adolescents receiving ART through the USAID-AMPATH HIV care system. A trained facilitator conducted groups in Kiswahili using a semi-structured interview guide probing multiple aspects of experience of taking medicines. Transcribed focus group dialogues were analyzed using constant comparison, progressive coding, and triangulation. The adolescents described a context of negative societal beliefs about HIV, necessitating a lifestyle of secrecy and minimizing the information shared about HIV or ART. Assessing and addressing adolescents' fears and behaviors regarding medication secrecy and disclosure may enable more accurate monitoring of adherence and development of intervention strategies.
- , A. D., Lorber, D., Anderson, J., Arent, S., Cox, D. J., Frier, B. M., Greene, M. A., Griffin, J. W., Gross, G., Hathaway, K., Kohrman, D. B., Marrero, D. G., Songer, T. J., & Yatvin, A. L. (2013). Diabetes and driving. Diabetes care, 36 Suppl 1, S80-5.
- Dixon, B. E., Jabour, A. M., Phillips, E. O., & Marrero, D. G. (2013). Improving medication adherence for chronic disease using integrated e-technologies. Studies in health technology and informatics, 192, 929.More infoDiabetes mellitus (DM) is a chronic disease affecting more than 285 people worldwide and the fourth leading cause of death. Increasing evidence suggests that many DM patients have poor adherence with prescribed medication therapies, impacting clinical outcomes. Patients' barriers to medication adherence and the extent to which barriers contribute to poor outcomes, however, are not routinely assessed. We designed a dashboard for an electronic health record system to integrate DM disease and medication data, including patient-reported barriers to adherence. Processes to support routine capture of data from patients are also being explored. The dashboard is being evaluated at multiple ambulatory clinics to examine whether integrated electronic tools can support patient-centered decision-making processes involving complex medication regimens for DM and other chronic diseases.
- Hill, J. O., Galloway, J. M., Goley, A., Marrero, D. G., Minners, R., Montgomery, B., Peterson, G. E., Ratner, R. E., Sanchez, E., & Aroda, V. R. (2013). Scientific statement: Socioecological determinants of prediabetes and type 2 diabetes. Diabetes care, 36(8), 2430-9.
- Marrero, D. G., Ard, J., Delamater, A. M., Peragallo-Dittko, V., Mayer-Davis, E. J., Nwankwo, R., & Fisher, E. B. (2013). Twenty-first century behavioral medicine: a context for empowering clinicians and patients with diabetes: a consensus report. Diabetes care, 36(2), 463-70.
- Marrero, D. G., Hardwick, E. J., Staten, L. K., Savaiano, D. A., Odell, J. D., Comer, K. F., & Saha, C. (2013). Promotion and tenure for community-engaged research: an examination of promotion and tenure support for community-engaged research at three universities collaborating through a Clinical and Translational Science Award. Clinical and translational science, 6(3), 204-8.More infoCommunity-engaged health research, an approach to research which includes the participation of communities, promotes the translation of research to address and improve social determinants of health. As a way to encourage community-engaged research, the National Institutes of Health required applicants to the Clinical and Translational Science Award (CTSA) to include a community engagement component. Although grant-funding may support an increase in community-engaged research, faculties also respond to the rewards and demands of university promotion and tenure standards. This paper measures faculty perception of how three institutions funded by a CTSA support community-engaged research in the promotion and tenure process.
- , A. D., Lorber, D., Anderson, J., Arent, S., J, D., Frier, B. M., Greene, M. A., Griffin, J. W., Gross, G., Hathaway, K., Hirsch, I., Kohrman, D. B., Marrero, D. G., Songer, T. J., & Yatvin, A. L. (2012). Diabetes and driving. Diabetes care, 35 Suppl 1, S81-6.
- Florez, H., Pan, Q., Ackermann, R. T., Marrero, D. G., Barrett-Connor, E., Delahanty, L., Kriska, A., Saudek, C. D., Goldberg, R. B., Rubin, R. R., & , D. P. (2012). Impact of lifestyle intervention and metformin on health-related quality of life: the diabetes prevention program randomized trial. Journal of general internal medicine, 27(12), 1594-601.More infoAdults at high risk for diabetes may have reduced health-related quality of life (HRQoL).
- McEwen, L. N., Karter, A. J., Waitzfelder, B. E., Crosson, J. C., Marrero, D. G., Mangione, C. M., & Herman, W. H. (2012). Predictors of mortality over 8 years in type 2 diabetic patients: Translating Research Into Action for Diabetes (TRIAD). Diabetes care, 35(6), 1301-9.More infoTo examine demographic, socioeconomic, and biological risk factors for all-cause, cardiovascular, and noncardiovascular mortality in patients with type 2 diabetes over 8 years and to construct mortality prediction equations.
- Zhu, V. J., Tu, W., Marrero, D. G., Rosenman, M. B., & Overhage, J. M. (2011). Race and medication adherence and glycemic control: findings from an operational health information exchange. AMIA ... Annual Symposium proceedings. AMIA Symposium, 2011, 1649-57.More infoThe Central Indiana Beacon Community leads efforts for improving adherence to oral hypoglycemic agents (OHA) to achieve improvements in glycemic control for patients with type 2 diabetes. In this study, we explored how OHA adherence affected hemoglobin A1C (HbA1c) level in different racial groups. OHA adherence was measured by 6-month proportion of days covered (PDC). Of 3,976 eligible subjects, 12,874 pairs of 6-month PDC and HbA1c levels were formed between 2002 and 2008. The average HbA1c levels were 7.4% for African-Americans and 6.5% for Whites. The average 6-month PDCs were 40% for African-Americans and 50% for Whites. In mixed effect generalized linear regression analyses, OHA adherence was inversely correlated with HbA1c level for both African-Americans (-0.80, p
- Marrero, D. (2016, April). Diabetes in Minorities Communities – Present & Past. 2016 National Minority Quality Forum Leadership Summit on Health Disparities and the Congressional Black Caucus Spring Health Braintrust 13th Annual leadership Summit.. Washington DC.
- Marrero, D. (2016, November). Comunication afectiva para la consejeria efectiva en Diabetes. 70 Reunion Annual De Salud Publica..
- Marrero, D. (2016, august). Review of Quality of Life Instruments in Diabetes. Diabetes Outcome Measures Beyond Hemoglobin A1c Workshop. Food and Drug Administration, Center for Drug Evaluation and Research.. Silver Springs Maryland.: Food and Drug Administration, Center for Drug Evaluation and Research..
- Marrero, D. (2016, march). Integrating Patient Data to Improve Medication Adherence. HIMSS 16. Las Vegas: HIMSS 16.
- Marrero, D. (2016, november). cas del Comportamiento de la Diabetes.. 70 Reunion Annual De Salud Publica..
- Thomson, C. A., Courneya, K. S., Ligibel, J., Kumar, R., Babiker, H. M., Dougherty, S., Marrero, D., Babiker, H. M., Abraham, I. L., Chow, H., Hsu, C., & Algotar, A. (2019, Spring). Comprehensive lifestyle improvement program for prostate cancer (CLIPP): A feasibility study in men with prostate cancer on ADT.. ASCO Genitourinary Cancers Symposium.
- Thomson, C. A., Smith, T., Hsu, C., Dougherty, S. T., Babiker, H. M., Chow, H., Marrero, D., & Algotar, A. (2018, Fall). Abstract: Comprehensive lifestyle improvement program for prostate cancer (CLIPP) Survivors. UACC Scientific Retreat. Tucson, AZ.