Epidemiology & Public Health
737 W. Lombard Street, 163
Education and Training
1996-2000 B.S. Biology
Loyola College in Maryland, Baltimore MD
Concentration in Cell and Molecular Biology
2002-2008 Ph.D. Human Nutrition
Johns Hopkins Bloomberg School of Public Health, Baltimore MD
Department of International Health
Dissertation Advisor: Margarita Treuth, PhD
Thesis Title: Familial Determinants of Overweight and Physical Activity Behavior Change Among Urban African American Adolescents
I am a nutritional epidemiologist with additional training in assessment of physical activity. My research focuses on programs and policies to promote health and prevent obesity among pediatric populations.
My research falls into 5 main categories:
Pediatric Obesity Prevention Intervention Studies: I began my career focusing on obesity prevention via individual-level behavior change strategies. I was fortunate to work on the Challenge! trial for my dissertation research (advisor: M. Treuth), a home- and community-based health promotion/obesity prevention study targeting low-income, urban, African American adolescents. This trial demonstrated the efficacy of this intervention in preventing obesity. I then served as co-investigator on both the Toddler Obesity Prevention Study (TOPS) and an extension of Challenge! (Challenge! in Schools).
School Wellness Policy Implementation:Written Local Wellness Policies (LWPs) are mandated in school system by the federal government, however implementation of these policies takes place to a large extent on the school-level. I work with the Maryland State Department of Education and the Maryland Department of Health and Mental Hygiene ("Maryland School Wellness Partneship: www.marylandschoolwellness.org) on the Maryland Wellness Policies and Practices Project (MWPPP) and Wellness Champions for Change (WCC). The MWPPP focuses on LWP implementation in schools and school systems through the administration of biennial surveys with directed system-level feedback and technical assistance. WCC was a pilot study of an intervention to train teachers to be wellness champions, stemming from evidence collected via the MWPPP. We are currenlty expanding WCC (including added student-level evaluations) through a 5-year, $5 million USDA grant. I also co-chair the National CDC NOPREN/PAPRN+ School Wellness Working Group.
Environmental Influences on Health Promoting Behaviors of Children: Through my BIRCWH K12 Career Development Award I gained skills in GIS mapping and examined the association between access to food and physical activity locations and dietary consumption/ physical activity behaviors of adolescent girls (two manuscripts under review, both presented at scientific meetings). I also recently completed an R03 grant to analyze data collected via Ecological Momentary Assessment (EMA, real time data collection using smart phones) regarding the home environment in association with diet and physical activity behaviors of toddlers.
Physical Activity Assessment via continuous wear ankle accelerometry: validation and threshold development: I received independent funding twice to conduct accelerometer validation studies, one study focused on adolescent girls and one on toddler aged children. After validating Actical ankle accelerometry versus gold standard methods, I was then able to develop sensitive and specific thresholds for time spent in sedentary, light, and Moderate-Vigorous Physical activity. This method and these thresholds have then been applied in large obesity prevention trials, demonstrating the feasibility of ankle accelerometry and providing continued evidence of a need for pediatric physical activity promotion efforts.
Measures development for obesity/nutrition-related constructs: On multiple occasions, when a measure has been needed in a research study, but a validated tool was not available, I have initiated a measures development study. This has lead to the significant contribution of measures for screening for food insecurity, assessing parental satisfaction with toddler body size, and toddler feeding.
pediatric obesity prevention, school wellness, local wellness policies, child care wellness, community health promotion, nutritional epidemiology, physical activity promotion, healthy eating
Complete List of Published Work in MyBibliography: http://www.ncbi.nlm.nih.gov/sites/myncbi/collections/bibliography/48738942/
1. Hager ER, Quigg AM, Black MM, Coleman SM, Heeren T, Rose-Jacobs R, Cook JT, Ettinger De Cuba SA, Casey PH, Chilton M, Cutts DB, Meyers AF, Frank DA, Children’s HealthWatch Research Group. Development and Validity of a Brief 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics. 2010 Jul;126(1):e26-32.
***In 2015, the American Academy of Pediatrics released a policy statement calling for this tool be used to screen families for food insecurity in clinical settings (Promoting Food Security for All Children. Pediatrics 2015;136;e1431; published online October 23, 2015)
***Dr. Hager was interviewed by and quoted in a New York Times article titled " Pediatricians Are Asked to Join Fight Against Childhood Hunger", written in reference to the AAP statement, October 23, 2015.
2. Hager ER, Candelaria M, Latta LW, Hurley KM, Wang Y, Caulfield LE, Black MM. Maternal Perceptions of Toddler Body Size: Accuracy and Satisfaction differ by Toddler Weight Status. Archives of Pediatric and Adolescent Medicine. 2012 May;166(5):417-22.
*** Included in the issue of this journal: Published Commentary “Respecting Cultural Values of Toddler Weight Perception While Discouraging Parental Overfeeding” by Eliana M. Perrin, MD, MPH and “Advice for Patients: Healthy Eating and Body Size for Toddlers” by Megan A. Moreno, MD, MSEd, MPH,
***Over 50 media citations, including television, radio, and internet coverage
3. Hager ER, Treuth MS, Gormely C, Epps L, Snitker S. Black MM. Ankle Accelerometry for assessing physical activity among adolescent girls: threshold determination, validity, reliability and feasibility. Research Quarterly in Exercise and Sport. 2015 Dec;86(4):397-405.
4. Hager ER, Tilton N, Wang Y, Kapur N, Arbaiza R, Merry B, Black M. The Home Environment and Toddler Physical Activity: an Ecological Momentary Assessment Study. Pediatric Obesity. 2015 Dec 23. doi: 10.1111/ijpo.12098. [Epub ahead of print]
5. Hager ER and Turner L. Successes of the Healthy Hunger-Free Kids Act. JAMA Pediatrics 2016 Jan 4;170(1). 1111/ijpo.12098. [Epub ahead of print]
***Over 100 print/internet media citations including Time, CNN, etc.
6. Hager ER, Calamaro, Bentley LM, Hurley KM, Wang Y, Black MM. Nighttime Sleep Duration and Sleep Behaviors among Toddlers from Low-Income Families: Associations with Obesogenic Behaviors and Obesity and the Role of Parenting. Childhood Obesity. 2016 Jul 22. [Epub ahead of print].
7. Hager ER, Gormely C, Latta LW, Treuth MS, Caulfield LE, Black MM. Toddler Physical Activity Study: Laboratory and Community Studies to Evaluate Accelerometer Validity and Correlates. BMC Public Health 2016 Sep 6;16:936.
8. Hager ER, Cockerham A, O'Reilly N, Harrington D, Harding J, Hurley KM, Black MM. Food Swamps and Food Deserts in Baltimore City, MD: Associations with Dietary Behaviors among Urban Adolescent Girls. Public Health Nutrition. 2016 Sep 22:1-10. [Epub ahead of print]
9. Hager ER, Rubio DS, Eidel GS, Penniston ES, Lopes M, Saksvig BI, Fox R, Black MM. School-level implementation of local wellness policies, Maryland 2012-2013: Role of school systems, school health councils, and health disparities using a systems perspective. Journal of School Health. 2016 Oct;86(10):742-50.
USDA AFRI Childhood Obesity Grant
Hager (PI )
"Approaches to Enhancing Wellness Policy Implementation in Schools to Promote Healthy Behaviors and Prevent Obesity"
The goal is to create health-promoting school environments through wellness policy implementation in schools by offering training and technical assistance to teacher and student wellness champions and providing technical assistance for wellness policy implementation.
“Maryland Childcare Healthy Kids Initiative: Expanded Family Model”
The goal is to conduct a randomized trial of a health promotion intervention targeting childcare centers, pre-school students, and families to prevent obesity.
MOU with State Department of Health
“Maryland Wellness Policies and Practices Project”
Partnership with State Department of Health and State Department of Education to evaluate the quality of written Local Wellness Policies (LWPs) in school systems and the LWP implementation in schools/systems through the administration of biennial surveys with directed system-level feedback and technical assistance.
Role: Recipient/ Project Lead
CDC Special Interest Program, PAPRN
“Workplace Policies Promoting Physical Activity”
To utilize a multiple case study approach to explore the types of policies that businesses in the State Department of Health program “Healthiest Maryland Businesses” are using to promote physical activity generally, and walking in particular.
Community Health Resources Commission
"Healthiest Maryland Schools"
Through this demonstration project, we are delivering evidence-based obesity prevention curricula to elementary schools in Baltimore City. The interventions are being delivered by an inter-professional team of students from 6 schools (nursing, medicine, public health, dental, social work, and pharmacy).