Elena Flowers, PhD, RN

Associate Professor, Physiological Nursing
Committee Members

My program of research focuses on precision medicine and risk for type 2 diabetes in high risk racial groups. Specifically, I am studying the utility of epigenetic biomarkers for risk detection and prediction of response to risk-reduction interventions. Current studies include investigation of microRNA expression in individuals who are insulin resistant, and prediction of response to both pharmacologic and non-pharmacologic interventions.


MicroRNAs Associated with Metformin Treatment in the Diabetes Prevention Program.

Research square

Lewis KA, Stroebel B, Zhang L, Aouizerat B, Mattis A, Flowers E

Multi-Tiered Assessment of Gene Expression Provides Evidence for Mechanisms That Underlie Risk for Type 2 Diabetes.

Diabetes, metabolic syndrome and obesity : targets and therapy

Asam K, Lewis KA, Kober K, Gong X, Kanaya AM, Aouizerat BE, Flowers E

MicroRNA Biomarkers Target Genes and Pathways Associated with Type 2 Diabetes.

Diabetes research and clinical practice

Kariuki D, Aouizerat BE, Asam K, Kanaya AM, Zhang L, Florez JC, Flowers E

MicroRNAs Associated with Incident Diabetes in the Diabetes Prevention Program.

The Journal of clinical endocrinology and metabolism

Flowers E, Aouizerat BE, Kanaya AM, Florez JC, Gong X, Zhang L

Review of databases for experimentally validated human microRNA-mRNA interactions.

Database : the journal of biological databases and curation

Kariuki D, Asam K, Aouizerat BE, Lewis KA, Florez JC, Flowers E

Behavioral Analytics for Myopic Agents.

European journal of operational research

Mintz Y, Aswani A, Kaminsky P, Flowers E, Fukuoka Y

Systematic review of transcriptome and microRNAome associations with gestational diabetes mellitus.

Frontiers in endocrinology

Lewis KA, Chang L, Cheung J, Aouizerat BE, Jelliffe-Pawlowski LL, McLemore MR, Piening B, Rand L, Ryckman KK, Flowers E

Healthcare Mistreatment, State-Level Policy Protections, and Healthcare Avoidance Among Gender Minority People.

Sexuality research & social policy : journal of NSRC : SR & SP

Clark KD, Luong S, Lunn MR, Flowers E, Bahalkeh E, Lubensky ME, Capriotti MR, Obedin-Maliver J, Flentje A

The Role of Racial and Ethnic Factors in MicroRNA Expression and Risk for Type 2 Diabetes.

Frontiers in genetics

Flowers E, Kanaya AM, Zhang L, Aouizerat BE

Risk of early birth by body mass index in a propensity score-matched sample: A retrospective cohort study.

BJOG : an international journal of obstetrics and gynaecology

Baer RJ, Chambers BD, Coleman-Phox K, Flowers E, Fuchs JD, Oltman SP, Scott KA, Ryckman KK, Rand L, Jelliffe-Pawlowski LL

Serine, N-acetylaspartate differentiate adolescents with juvenile idiopathic arthritis compared with healthy controls: a metabolomics cross-sectional study.

Pediatric rheumatology online journal

Lewis KA, Osier N, Carrasco R, Chiou J, Carter P, Garcia A, Flowers E, Gennatas ED, Nguyen C, Rana A, Brown SA, Tiziani S

Consideration of social determinants of health in preterm birth risk and resiliency scoring.

American journal of obstetrics and gynecology

Rebecca J. Baer, April Bell, Bridgette Blebu, Kimberly Coleman-Phox, Jean Costello, Elena Flowers, Kayla Karvonen, Miriam Kuppermann, Safyer McKenzie-Sampson, Monica McLemore, Scott P. Oltman, Aric Prather, Nicole Santos, Karen Scott, Brianne Taylor, Larry Rand, Laura Jelliffe-Pawlowski

Circulating MicroRNAs predict glycemic improvement and response to a behavioral intervention.

Biomarker research

Flowers E, Allen IE, Kanaya AM, Aouizerat BE

The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California.

Lancet Regional Health. Americas

Karasek D, Baer RJ, McLemore MR, Bell AJ, Blebu BE, Casey JA, Coleman-Phox K, Costello JM, Felder JN, Flowers E, Fuchs JD, Gomez AM, Karvonen K, Kuppermann M, Liang L, McKenzie-Sampson S, McCulloch CE, Oltman SP, Pantell MS, Piao X, Prather AA, Schmidt RJ, Scott KA, Spellen S, Stookey JD, Tesfalul M, Rand L, Jelliffe-Pawlowski LL

77-OR: Circulating MicroRNAs Predict Glycemic Improvement and Response to a Behavioral Intervention.



Socioeconomic status, diabetes, and gestation length in Native American and White women.

Health psychology : official journal of the Division of Health Psychology, American Psychological Association

Ross KM, Oltman S, Baer R, Altman M, Flowers E, Feuer S, Gomez AM, Jelliffe-Pawlowski L

Circulating microRNAs associated with prediabetes and geographic location in Latinos.

International journal of diabetes in developing countries

Flowers E, Ramírez-Mares JD, Velazquez-Villafaña M, Rangel-Salazar R, Sucher A, Kanaya AM, Aouizerat BE, Lazo de la Vega Monroy ML

Pregnancy after bariatric surgery in women with rheumatic diseases and association with adverse birth outcomes.

Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Singh N, Baer RJ, Swaminathan M, Saurabh S, Sparks JA, Bandoli G, Flowers E, Jelliffe-Pawlowski LL, Ryckman KK

Nonstationary Bandits with Habituation and Recovery Dynamics.

Operations Research

Yonatan Mintz, Anil Aswani, Philip Kaminsky, Elena Flowers, Yoshimi Fukuoka

Direct-to-consumer genomic testing: Are nurses prepared?


Flowers E, Leutwyler H, Shim JK

Alterations in Patterns of Gene Expression and Perturbed Pathways in the Gut-Brain Axis Are Associated With Chemotherapy-Induced Nausea.

Journal of pain and symptom management

Singh KP, Dhruva A, Flowers E, Paul SM, Hammer MJ, Wright F, Cartwright F, Conley YP, Melisko M, Levine JD, Miaskowski C, Kober KM

855: Risk of adverse birth outcome among Black women with post-traumatic stress disorder.

American journal of obstetrics and gynecology

Brittany D. Chambers, Rebecca J. Baer, Gretchen Bandoli, Jennifer Felder, Sky K. Feuer, Elena Flowers, Linda Franck, Anu Manchikanti Gomez, Deborah Karasek, Nichole L. Nidey, Scott P. Oltman, Elizabeth Rogers, Karen Scott, Larry Rand, Kelli K. Ryckman, Laura L. Jelliffe-Pawlowski

Socioeconomic Status, Preeclampsia Risk and Gestational Length in Black and White Women.

Journal of racial and ethnic health disparities

Ross KM, Dunkel Schetter C, McLemore MR, Chambers BD, Paynter RA, Baer R, Feuer SK, Flowers E, Karasek D, Pantell M, Prather AA, Ryckman K, Jelliffe-Pawlowski L

2428-PUB: Circulating microRNAs Are Associated with Latino Ancestry but Not Prediabetes.



2429-PUB: Circulating microRNAs Are Associated with Glycemic Variability over a 12-Month Period.



Body Composition and Diabetes Risk in South Asians: Findings From the MASALA and MESA Studies.

Diabetes care

Flowers E, Lin F, Kandula NR, Allison M, Carr JJ, Ding J, Shah R, Liu K, Herrington D, Kanaya AM

Abstract # 2036 Recent stimulant use and leukocyte gene expression in methamphetamine users with treated HIV infection.

Brain Behavior and Immunity

A.W. Carrico, A. Flentje, K. Kober, S. Lee, P. Hunt, E.D. Riley, S. Shoptaw, E. Flowers, S.E. Dilworth, S. Pahwa, B.E. Aouizerat

A Pilot Study Using a Multistaged Integrated Analysis of Gene Expression and Methylation to Evaluate Mechanisms for Evening Fatigue in Women Who Received Chemotherapy for Breast Cancer.

Biological research for nursing

Flowers E, Flentje A, Levine J, Olshen A, Hammer M, Paul S, Conley Y, Miaskowski C, Kober KM

695: Recurrence of early preterm, late preterm, and early term birth by race/ethnicity and insurance status.

American journal of obstetrics and gynecology

Deborah Karasek, Rebecca J. Baer, James G. Anderson, Jennet Arcara, Rachel Berkowitz, Brittany D. Chambers, Sky Feuer, Elena Flowers, Jonathan Fuchs, Anu Manchikanti Gomez, Rita Hamad, Miriam Kuppermann, Tania Pacheco-Werner, Matt Pantell, Scott P. Oltman, Larry Rand, Kelli K. Ryckman, Laura Jelliffe-Pawlwski

Second trimester inflammatory and metabolic markers in women delivering preterm with and without preeclampsia.

Journal of perinatology : official journal of the California Perinatal Association

Ross KM, Baer RJ, Ryckman K, Feuer SK, Bandoli G, Chambers C, Flowers E, Liang L, Oltman S, Dunkel Schetter C, Jelliffe-Pawlowski L

Behavioral Modeling in Weight Loss Interventions.

European journal of operational research

Aswani A, Kaminsky P, Mintz Y, Flowers E, Fukuoka Y

Risk Factors Associated With Chemotherapy-Induced Nausea in the Week Before the Next Cycle and Impact of Nausea on Quality of Life Outcomes.

Journal of pain and symptom management

Singh KP, Kober KM, Dhruva AA, Flowers E, Paul SM, Hammer MJ, Cartwright F, Wright F, Conley YP, Levine JD, Miaskowski C

Mechanisms and Measurement of Changes in Gene Expression.

Biological research for nursing

Singh KP, Miaskowski C, Dhruva AA, Flowers E, Kober KM

Recent stimulant use and leukocyte gene expression in methamphetamine users with treated HIV infection.

Brain, behavior, and immunity

Carrico AW, Flentje A, Kober K, Lee S, Hunt P, Riley ED, Shoptaw S, Flowers E, Dilworth SE, Pahwa S, Aouizerat BE

Minority stress and leukocyte gene expression in sexual minority men living with treated HIV infection.

Brain, behavior, and immunity

Flentje A, Kober KM, Carrico AW, Neilands TB, Flowers E, Heck NC, Aouizerat BE

Personalizing Mobile Fitness Apps using Reinforcement Learning.

CEUR workshop proceedings

Zhou M, Mintz Y, Fukuoka Y, Goldberg K, Flowers E, Kaminsky P, Castillejo A, Aswani A

Evaluating Machine Learning-Based Automated Personalized Daily Step Goals Delivered Through a Mobile Phone App: Randomized Controlled Trial.

JMIR mHealth and uHealth

Zhou M, Fukuoka Y, Mintz Y, Goldberg K, Kaminsky P, Flowers E, Aswani A

A review of the literature on the relationships between genetic polymorphisms and chemotherapy-induced nausea and vomiting.

Critical reviews in oncology/hematology

Singh KP, Dhruva AA, Flowers E, Kober KM, Miaskowski C

Preliminary evidence supports circulating microRNAs as prognostic biomarkers for type 2 diabetes.

Obesity science & practice

Flowers E, Kanaya AM, Fukuoka Y, Allen IE, Cooper B, Aouizerat BE

Serum BDNF Is Positively Associated With Negative Symptoms in Older Adults With Schizophrenia.

Biological research for nursing

Binford SS, Hubbard EM, Flowers E, Miller BL, Leutwyler H

Differential expression of genes and differentially perturbed pathways associated with very high evening fatigue in oncology patients receiving chemotherapy.

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

Flowers E, Miaskowski C, Conley Y, Hammer MJ, Levine J, Mastick J, Paul S, Wright F, Kober K

Circulating micrornas associated with glycemic impairment and progression in Asian Indians.

Biomarker research

Flowers E, Gadgil M, Aouizerat BE, Kanaya AM

Circulating microRNA-320a and microRNA-486 predict thiazolidinedione response: Moving towards precision health for diabetes prevention.

Metabolism: clinical and experimental

Flowers E, Aouizerat BE, Abbasi F, Lamendola C, Grove KM, Fukuoka Y, Reaven GM

Abstract P300: Circulating MicroRNAs Associated with Glycemic Impairment and Progression in Asian Indians.


Elena Flowers, Bradley E Aouizerat, Meghana Gadgil, Alka M Kanaya

MicroRNAs associated with exercise and diet: a systematic review.

Physiological genomics

Flowers E, Won GY, Fukuoka Y

The relationship of lipoprotein(a), C-reactive protein and homocysteine with metabolic syndrome in South Asians.

Journal of Indian College of Cardiology

Megha Prasad, Elena Flowers, Monica Divakaruni, César Molina, Ashish Mathur, Themistocles L. Assimes, Bradley E. Aouizerat, Anita Sathe, Donna Malhotra, Mintu P. Turakhia

Hyperglycemia is associated with corrected QT prolongation and mortality in acutely ill patients.

The Journal of cardiovascular nursing

Pickham D, Flowers E, Drew BJ


Journal of the American College of Cardiology

Megha Prasad, Elena Flowers, Ashish Mathur, Cesar Molina, Mintu Turakhia

MicroRNA associated with dyslipidemia and coronary disease in humans.

Physiological genomics

Flowers E, Aouizerat BE

Adiposity and cardiovascular risk clustering in South Asians.

Metabolic syndrome and related disorders

Flowers E, Molina C, Mathur A, Reaven GM

MicroRNA associated with atherogenic dyslipidemia in South Asian men.

International journal of cardiology

Flowers E, Singh K, Molina C, Mathur A, Aouizerat BE

A culturally specific health coaching program targeting cardiovascular disease risk in South Asians: rationale, design, and baseline data.

Ethnicity & disease

Sathe A, Flowers E, Mathur A, Garcia DM, Kotrys J, Gandhi R, Molina C, Mathur A

MicroRNA regulation of lipid metabolism.

Metabolism: clinical and experimental

Flowers E, Froelicher ES, Aouizerat BE

Abstract P199: Mean Lipoprotein Levels and Composition in South Asian-Americans Compared to the US Population.


Elena Flowers, Cesar Molina, Ashish Mathur, Bradley Aouizerat, Mintu Turakhia

Gene-environment interactions in cardiovascular disease.

European Journal of Cardiovascular Nursing

Flowers E, Froelicher ES, Aouizerat BE

Measurement of MicroRNA: a regulator of gene expression.

Biological research for nursing

Flowers E, Froelicher ES, Aouizerat BE

Prevalence of metabolic syndrome in South Asians residing in the United States.

Metabolic syndrome and related disorders

Flowers E, Molina C, Mathur A, Prasad M, Abrams L, Sathe A, Malhotra D, Basra R, Malgesini N, Ratnam G, Aouizerat BE, Turakhia MP


Journal of the American College of Cardiology

Monica S. Divakaruni, Elena Flowers, Cesar Molina, Ashish Mathur, Megha Prasad, Leslie Abrams, Anita Sathe, Donna Malhotra, Ruby Basra, Gayatri Ratnam, Bradley E. Aouizerat, Mintu P. Turakhia