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:
School/Child Care Wellness Policy Implementation: Written Local Wellness Policies (LWPs) are mandated in school systems by the federal government, however implementation of these policies takes place to a large extent on the school-level. I began partnering with the Maryland State Departments of Education and Health on the Maryland Wellness Policies and Practices Project (MWPPP) in 2012. MWPPP focuses on LWP implementation in schools and school systems through the administration of biennial surveys with directed system-level feedback and technical assistance. This base project and partnership has led to additional ongoing funded studies, included Wellness Champions for Change (USDA Team Nutrition and USDA AFRI) and Project SELECT (USDA Team Nutrition). In addition to these research studies, I co-chair a CDC working group on School Wellness and chair the Maryland State School Health Council.
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). My current research examines LWP implementation as a strategy for obesity prevention.
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. I also received an NICHD 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. I am currently examining the home and community environment as potential moderators of the uptake of school-based interventions
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. I currently serve as co-investigator on three funded NIH R01 grants where I oversee accelerometry data collection.
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: https://www.ncbi.nlm.nih.gov/sites/myncbi/1Jg163CSEPUAh/bibliography/48738942/public/?sort=date&direction=ascending
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 NA, Wang Y, Kapur NC, Arbaiza R, Merry BC, Black MM. The home environment and toddler physical activity: an ecological momentary assessment study. Pediatric Obesity. 2017 Feb;12(1):1-9.
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 Oct; 12(5): 396-400.
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. 2017 Oct;20(14):2598-2607
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.
10. Schuler BR, Saksvig BI, Nduka J, Farabaugh S, Jaspers L, Black MM, Hager ER. Understanding Disparities in Barriers and Enablers to Implementing School Wellness Policies. Health Promotion and Practice 2018 Jan 1:1524839917752109.
11. Campbell KL, Babiarz A, Wang Y, Tilton NA, Black MM, Hager ER. Factors in the Home Environment Associated with Toddler Diet: An Ecological Momentary Assessment Study. Public Health Nutrition 2018 Jul;21(10):1855-186
12. Hager E, Song HJ, Lane HG, Guo H, Jaspers L, Lopes MA. Pilot-testing an intervention to enhance wellness policy implementation in schools: Wellness Champions for Change. In press, Journal of Nutrition Education and Behavior 2018 Sep;50(8):765-775
13. Lane HG, Driessen R, Campbell K, Deitch R, Turner L, Parker E, Hager ER. Development and of the PEA-PODS (Perceptions of the Environment and Patterns of Diet at School) survey for students. Preventing Chronic Disease 2018 Jun 28;15:E88
14. Bussell K, Francis L, Armstrong B, Kilby S, Black MM, Hager ER. Examining Nutrition and Physical Activity Policies and Practices in Maryland's Child Care Centers. Child Obes. 2018 Aug/Sep;14(6):403-411
15. Lane HG, Deitch R, Wang Y, Black MM, Dunton G, Aldoory L, Turner L, Parker EA, Ezell P, Henley SC, Saksvig B, Song HJ, Hager ER. “Wellness Champions for Change,” a multi-level intervention to improve school-level implementation of local wellness policies: study protocol for a cluster randomized trial. Contemporary Clinical Trials. 2018 Dec;75:29-3
16. McIlree C, Lane HG, Wang Y, Hager ER. Wellness Committee Status and Local Wellness Policy Implementation Over Time. American Journal of Preventive Medicine. 2019 Mar;56(3):e75-e83.