IMPH Research in Health Behavior and Health Education

Addressing Health Literacy and Numeracy to Prevent Childhood Obesity 
Cognitive-Behavioral Based Physical Therapy: Improving Surgical Spine Outcomes 
Cultural Effects on Stress, Coping, and Symptom Expression 
Expanded Testing, Linkage, and Treatment for HIV Prevention Among MSM in China 
Facilitating Anemia Treatment Risk Communication for Patients with Kidney Disease 
Health Literacy, Hospital Discharge, and Cardiovascular Outcomes 
Leveraging Patient Portals to Improve Medication Adherence in Type 2 Diabetes 
Modifiable Risk Factors for Fatal Prostate Cancer: A Prospective Study in Asia 
Multi-Component HIV Intervention Packages for Chinese MSM 
A New Instrument to Comprehensively Assess Sedentary Behaviors 
Public-Private Partnership Addressing Literacy-Numeracy to Improve Diabetes Care 
Tailoring Healthy Eating and Physical Activity for African American Men 
Using Social Learning to Improve Adolescent Diabetes Adherence Problem Solving

Addressing Health Literacy and Numeracy to Prevent Childhood Obesity

In 2003, Surgeon General Richard Carmona stated that low health literacy was "one of the largest contributors to our nation's epidemic of overweight and obesity." This assertion is supported by recent studies which have found that low health literacy or numeracy is associated with poorer caregiver breastfeeding knowledge, incorrect mixing of infant formula, difficulty understanding food labels and portion sizes, and higher Body Mass Index (BMI) in adults and children. Of particular concern is the impact of the obesity epidemic on our youngest children. Over 26% of preschool children are now overweight (BMIe85%) or obese (BMIe95%) (based on 2007 HHS/CDC Expert Panel definitions). Rates of obesity in preschool children have doubled over the past decade, with the highest increases among low income and minority children-- the same communities most affected by low health literacy. To date, clinical efforts to prevent or treat childhood obesity have had limited efficacy. Efforts need to start early, because children who are overweight by age two are five times as likely to become overweight adolescents, and subsequently at higher risk for obesity-related complications including early-onset Type-2 Diabetes and cardiovascular disease. No published clinical studies have rigorously addressed obesity prevention prior to age 2 with a specific low-literacy and numeracy focus. Addressing caregiver health literacy in early childhood is an innovative strategy to promote healthy nutrition and activity among these families and prevent unhealthy weight gain across the child's life, which would have great public health significance by preventing both child and adult chronic illness. The proposed study is a multi-site randomized, controlled trial to assess the efficacy of a low- literacy/numeracy-oriented intervention designed to promote healthy family lifestyles and to prevent early childhood obesity. The intervention will be delivered through pediatric resident physicians in primary care settings in under-resourced communities. Four academic medical centers will be randomized: Vanderbilt University, the University of Miami, the University of North Carolina at Chapel Hill, and New York University. Two centers will receive the intervention, while the other two centers will receive an active control. At each site, a cohort of 250 English- or Spanish-speaking caregiver-child dyads will be enrolled and followed from the child's 4-6 month well-child visit through the 24-month well-child visit. The intervention will include a low- literacy-oriented toolkit for pediatric residents to use with families and clear health communication training for the pediatric residents. At control sites, pediatric residents will provide "usual care" with respect to lifestyle counseling, but they will also receive an injury-prevention education program to act as an attention control. The primary hypotheses are that the intervention will improve family dietary and physical activity behaviors and that it will reduce the rate of childhood overweight (BMIe85%) at age 24 months. Project Narrative In 2003, Surgeon General Richard Carmona suggested that low health literacy is "one of the largest contributors to our nation's epidemic of overweight and obesity." Over 26% of preschool children are now overweight or obese, and children who are overweight by age 24 months are five times as likely as non- overweight children to become overweight adolescents. The aim of the study is to assess the efficacy of a low- literacy/numeracy-oriented intervention aimed at teaching pediatric resident physicians to promote healthy family lifestyles and prevent overweight among young children (age 0-2) and their families in under-resourced communities. Read more.

Funding Source: NIH/NICHD
PI: Russell Rothman

Cognitive-Behavioral Based Physical Therapy: Improving Surgical Spine Outcomes

Despite surgical advances, up to 40% of patients continue to have chronic pain and functional disability after lumbar spine surgery. Our own data demonstrate that high fear of movement is a risk factor for increased pain and disability in this patient population. Cognitive-behavioral therapy (CBT) and physical therapy (PT) interventions targeting fear of movement have proven effective for decreasing persistent pain and functional disability in patients with chronic low back pain. However, the efficacy of a combined CBT and PT approach has not been well demonstrated in a surgical spine population. Therefore, we propose to conduct a two-group randomized controlled trial (RCT) to gather preliminary evidence on the efficacy of a brief cognitive-behavioral based PT (CBPT) intervention in patients at-risk for poor outcomes following lumbar spine surgery for degenerative conditions. We hypothesize that incorporating cognitive and behavioral strategies into postoperative standard of care PT will improve self-reported pain and disability and observed physical function, through reductions in fear of movement and pain catastrophizing (i.e., tendency to magnify pain sensations). This pilot study plans to recruit 80 patients with high postoperative fear of movement or pain catastrophizing. These eligible at-risk patients will be randomized to one of the two groups: (1) standard PT treatment + CBPT or (2) standard PT treatment + weekly phone calls to control for attention. The CBPT program consists of 2 in- person and 4 telephone sessions and is based on well-accepted and effective CBT strategies. These strategies focus on relaxation, problem-solving training, cognitive restructuring, and behavioral self- management. Primary outcomes include self-reported pain and disability as measured by the Brief Pain Inventory and the Oswestry Disability Index. Secondary outcomes consist of observed physical function as measured by performance-based tests of gait speed, balance, repeated chair stands, and mobility (Short Physical Performance Battery, Timed Up and Go). Outcome data will be collected at baseline (6 weeks after surgery), after treatment (3 months after surgery), and at 6 months following surgery. The proposed two-group RCT will provide estimates of effect sizes and sample sizes associated with the CBPT intervention and data on feasible recruitment and retention goals and the mechanisms through which the CBPT intervention affects long-term outcomes. This informative pilot data will guide a multi-center, three-group clinical trial to furter validate the CBPT intervention. Our long-term objective is to broaden the availability of effective CBT strategies by expanding the implementation from traditional providers, psychologists, to a group of providers, physical therapists, who routinely interact with a large population of patients with musculoskeletal pain. The proposed study addresses the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) research priority of exploring behavioral therapy and exercise to improve the outcome of musculoskeletal diseases. Read more.

Funding Source: NIH/NIAMS
PI: Kristin Archer

Cultural Effects on Stress, Coping, and Symptom Expression

Despite the fact that psychology and related fields generally have conceptualized themselves as science of universal human behavior, for the most part they have developed as Euro-American science of Euro-American behavior. Failure to consider more fully potential effects of cultural differences on human behavior and emotion has had a number of consequences, the foremost of which probably is that the field has reached conclusions about constructs being related as main effects when in fact they may be related via more complex interactive relations involving cultural processes. The overall purpose of the proposed project is to increase our understanding of how culture and cultural variation are related to human behavioral and emotional functioning, with a particular focus on what might be called the "stress - coping - symptom manifestation" system, with the ultimate goal of generating data that are useful for modifying or developing culturally informed psychosocial interventions. In the proposed project, cross-sectional questionnaire data will be obtained from 1000 Vietnamese and 1000 Vietnamese-American adolescents. Longitudinal interview data will be obtained from subsets of 500 of each of these groups, at three time points spaced three months apart. Data will focus on (a) stressful life events, (b) coping styles and strategies, (c) mental health symptoms, and (d) distal cultural as well as more proximal variables (e.g., collectivism vs. individualism; stigma associated with symptoms, respectively). Analyses will (a) determine the extent to which Vietnamese and Vietnamese-American adolescents differ cross-sectionally in regards to the life events they find stressful, the types of strategies that the adolescents use to cope with these stressful events, and the symptom manifestations (such as affective problems; somatization, conduct problems, etc.) that may occur when these coping attempts are not successful; (b) determine the extent to which cross-sectional group differences are related to cultural variables; (c) model longitudinal relations between life events, coping strategies, and symptom manifestations and determine the extent to which these relations are influenced by the cultural variables; (b) compare models the Vietnamese and Vietnamese-American adolescents to determine whether these relations differ across cultural groups and if they do, whether these differences are mediated by the cultural variables. Finally, results will be reviewed to identify potential factors relevant for developing culturally-informed interventions for Vietnamese- American, and ultimately Asian-American, adolescents. Read more.

Funding Source: NIH/NIMH
PI: Bahr Weiss

Expanded Testing, Linkage, and Treatment for HIV Prevention Among MSM in China

The success of global HIV control efforts for men who have sex with men (MSM) will depend on how effective and sustainable the interventions are, but also how efficiently the intervention programs are implemented. A testable hypothesis is that a package of prevention interventions may have a substantial impact even if single approaches are less impressive. We further hypothesize that combination interventions will be even more sustainable than isolated interventions, due to improved community support of a popular package of services. One package of HIV-specific interventions has been termed "test-and-linkage-to-care" (TLC). The theory behind TLC is that the increase in the proportion of HIV-infected persons who know their status, are bridged to HIV combination antiretroviral therapy (cART)-based care, and who adhere to cART will reduce the amount of virus circulating in a community. TLC integrated with risk reduction intervention and formulated at the individual-level can facilitate one's engagement and commitment in care, reducing infectiousness to others at the same time that personal health is enhanced and restored. TLC seeks to reduce "community viral load," reducing the risk to uninfected persons by reducing the infectiousness of HIV-infected individuals. Our goal in this one-year clinical trial planning (R34) grant is to prepare for a community-level randomized clinical trial (RCT) to test the efficacy of our multicomponent TLC intervention package to reduce HIV incidence among MSM in China. By collaborating with Chinese CDC networks and local MSM community based organizations, we will develop all documents required for initiation of an RCT, complete all local, federal, and international human subjects and regulatory approvals necessary for implementation of the trial, and identify clinical trial sites and establish community advisory boards for a clinical trial. At the end of the study, we will have a RCT protocol ready for testing two research hypotheses: (1) MSM in communities receiving 24 months of TLC intervention will achieve a reduction in HIV incidence relative to MSM in standard prevention communities; and (2) TLC intervention will improve secondary and intermediary indicators of treatment success and risk reduction, compared to the standard prevention approaches. PUBLIC HEALTH RELEVANCE: Our study proposal represents an innovative adaptation of an integration of biomedical and behavioral methods of HIV prevention whose promise is supported by epidemiological data, but has never been tested in a clinical trial design in China. This grant will prepare a clinical trial in which men who have sex with men (MSM) in China who are unaware of their status will be tested and those HIV-infected MSM will benefit from prolonged life by available cART. The patient-centered prevention will be able to target the unrecognized individuals with HIV infections or at high risk of contracting HIV such that the further transmission can be prevented effectively. Read more.

Funding Source: NIH/NIAID
PI: Sten Vermund

Facilitating Anemia Treatment Risk Communication for Patients with Kidney Disease

Patient education is a priority and desired by both patients and providers in the care of chronic kidney disease (CKD). Yet, even in the setting of frequent interactions with health care providers, patients often report low knowledge of chronic diseases, such as diabetes, heart disease, and kidney disease. This suggests ineffective communication between patients and providers. Recently, the potential risks of erythropoiesis stimulating agents (ESAs) have been described and the FDA has mandated ensuring patients are informed participants in this treatment as part of a Risk Evaluation and Mitigation Strategy (REMS). Risk information remains a complex concept for many patients. In patients with kidney disease and receiving ESAs anemia knowledge is often poor. One explanation may be that there are few resources available to providers to promote effective discussions about this complex care issue. The objectives of this application are to: (1) characterize the current practice, preferences, and barrier to counseling about anemia management in kidney disease among a national sample of nephrologists; and (2) to develop and examine the feasibility of an efficient tool to facilitate provider-patient communication to improve patient anemia knowledge and treatment satisfaction. These objectives are in concert with the parent K23 application's goal to determine barriers to efficient and effective health communication for patients with kidney disease. This application furthers the overall goal of the parent award by extending this important area of investigation from end-stage renal disease (ESRD) to a component of care relevant to patients with advanced chronic kidney disease not receiving dialysis. The proposed educational intervention will be designed specifically to permit transplantation to a variety of care settings - including those with vulnerable patient populations, such as those with low health literacy. Additionally, in accordance with the goals of the proposal, this study will further expand the experience and expertise of the P.I. in large national survey design, administration and analyses. This will further advance the pathway of the P.I. to establishing an independent research career. Read more.

Funding Source: NIH/NIDDK
PI: Kerri Cavanaugh

Health Literacy, Hospital Discharge, and Cardiovascular Outcomes

The period following hospital discharge is a vulnerable time for patients in which poorly coordinated care and medication mismanagement are common. Suboptimal care in the peri-discharge period contributes to preventable adverse events, hospital readmission, and higher mortality, particularly in high-risk conditions such as acute coronary syndromes (ACS). Low health literacy is a prevalent risk factor for poor processes and outcomes of care, but little research has been conducted on the role of health literacy in this high-risk setting. The goal of this research is to examine how health literacy and other patient characteristics affect the quality of hospital discharge and related outcomes after hospitalization. We will test a conceptual framework that includes patient-, provider-, and system-related factors as potential mediators and moderators of these relationships. The Specific Aims are to: 1) Determine the association of health literacy with the quality of hospital discharge, including the impact on communication, preparedness for discharge, and subsequent medication management. 2) Examine the effect of health literacy and hospital discharge quality on functional status, health- related quality of life, and unplanned health care utilization 30 and 90 days after hospital discharge. 3) Examine the effect of health literacy and hospital discharge quality on mortality after hospitalization. We will perform a prospective cohort study of 3,000 adults hospitalized for ACS and discharged to home. Data collection and analyses will be grounded in a conceptual framework that relates health literacy to processes and outcomes of care. During hospitalization, we will administer a robust set of validated sociodemographic, educational, cognitive, psychological, cultural, and behavioral measures. For Aim 1, we will interview patients by telephone 2-3 days after discharge to assess the quality of hospital discharge, including measures of patient-provider communication and preparedness for discharge. For Aim 2, we will review medical records and interview patients by telephone 30 and 90 days after discharge to assess changes in functional status, health-related quality of life, and unplanned health care utilization, including Emergency Department visits and rehospitalization. For Aim 3, we will ascertain mortality using the Social Security Administration Death Master File, following patients for up to 3.5 years after enrollment. We will use multivariable path analyses and survival analyses to model the direct and indirect relationships among health literacy, other measured factors, potential mediators or moderators, and each outcome of interest. This interdisciplinary research will greatly enhance our understanding of how health literacy affects hospital discharge processes and outcomes after hospitalization. Findings will enable us to better design interventions to improve services for patients with low health literacy, as well as other high-risk groups. Knowledge gained from this study may also help improve cardiovascular outcomes and reduce literacy-related health disparities. Read more.

Funding Source: NIH/NHLBI
PI: Sunil Kripalani

Leveraging Patient Portals to Improve Medication Adherence in Type 2 Diabetes

For patients with diabetes, glucose lowering agents (GLA) improve glycemic control (HbA1c), and prevent disease-related complications, and premature death. Patient adherence to prescribed regimens is necessary to reap these benefits, and studies suggest adherence is poor, ranging from 36% to 85% adherence to oral GLAs; however, fewer patients using insulin report poor adherence. Existing technologies (e.g., cell phones, Internet reminders, patient web portals) could be leveraged to provide medication adherence reminders and support to patients with diabetes and, in turn, improve clinical outcomes. This proposal describes a career development plan that will prepare the principal investigator (PI) for success as an independent investigator who can leverage various technologies to design and evaluate diabetes self-care interventions. The proposal describes a research strategy in which the PI will use Vanderbilt's patient web portal (PWP) to deliver a theory-based GLA adherence promotion intervention. As a social/health psychologist with training in health behavior change, the PI will acquire complementary, new skills for developing and using technology through this K01. The PI's immediate goal is to use a PWP to deliver an Information-Motivation-Behavioral skills (IMB) focused GLA adherence intervention to patients with diabetes. To meet this goal, the PI has proposed a career development plan that integrates advanced didactic course work, participation in local and national meetings/seminars/workshops/conferences, a mentored research experience, and active involvement in an extremely supportive research environment. This environment includes an NIDDK funded Diabetes Research and Training Center (DRTC), nationally known Department of Biomedical Informatics, state-of-the-art patient PWP, NIH funded CTSA, Center for Health Services Research (CHSR), and Program on Effective Health Communication (EHC). The research specific aims are to: (1) conduct elicitation research with diabetes patients and providers to identify barriers to using a PWP and other technologies for diabetes and medication management; (2) design a GLA adherence intervention delivered via an existing PWP, test for usability with diabetes patients, and refine the intervention prior to evaluation; and (3) perform a randomized controlled trial to test the effect of the intervention on multiple measures of adherence and HbA1c at 3- and 6-months. In addition, the PI will test whether the intervention enhances critical determinants of adherence behavior based on the IMB model, and whether changes in IMB elements map onto improvements in adherence and HbA1c across time. Lastly, the PI will test potential moderators of the effect of the IMB elements on adherence. Leveraging technology in the proposed research will augment the PI's existing training in the design and evaluation of behavior change interventions. Most importantly, it will accelerate her career as a successful independent investigator well equipped to design and evaluate cutting-edge, theoretically grounded interventions with broad application to both the field of diabetes behavioral research and clinical care. Read more.

Funding Source: NIH/NIDDK
PI: Chandra Osborn

Modifiable Risk Factors for Fatal Prostate Cancer: A Prospective Study in Asia

Our overarching goal is to identify modifiable risk factors for fatal prostate cancer. Prostate cancer remains the second leading cause of cancer-death in the United States (U.S.), but known demographic and genetic risk factors have limited value in delaying progression. Further investigation in U.S. populations is problematic because widespread and selective prostate-specific antigen (PSA) testing is so strongly associated with the stage at diagnosis that any association between a risk factor and PSA testing could easily overwhelm a modest by important etiologic association. To remove this known detection bias, we propose a prospective investigation to determine the association between obesity, tobacco, and alcohol use with fatal prostate cancer using data from the Asian Cohort Consortium (ACC). Asian nations rarely perform PSA tests, and most prostate cancer patients in Asia are diagnosed with advanced or metastatic disease. The ACC is a unique resource that has harmonized data across 15 prospective cohort studies and includes over 450,000 men with approximately 3.5 million person-years follow-up. Prostate cancer is far less common in Asia than the U.S., and a prospective study would only be possible with such a consortium. Using a nested case- control design, each of the 507 recorded prostate cancer deaths to date will be individually matched to 10 controls by age (1 year) and cohort. Multivariable conditional logistic regression will be used to investigate associations between BMI, tobacco, and alcohol use with fatal prostate cancer. This project provides an exceptional opportunity to provide the first systematic prospective investigation of modifiable factors for fatal prostate cancer, while minimizing detection bias from selective PSA testing and subsequent treatment. Our results may form the basis for recommendations to prevent prostate cancer mortality in Asia, and more generally, in populations that are not routinely PSA-tested. Furthermore, results may also form the basis for adjuvant care recommendations among men diagnosed with localized disease by at risk for progression to an advanced stage and for death. Read more.

Funding Source: NIH/NCI
PI: Jay Fowke

Multi-Component HIV Intervention Packages for Chinese MSM

There is no proven effective prevention intervention specifically for men who have sex with men (MSM) population. Bundling partial measures and optimize combinations of interventions may have a substantial impact on HIV seroincidence. The goal of this study is to develop and pilot test a package of Test and Link-to-Care (TLC)-based interventions for preparation of future community-level randomized clinical trial. The specific aims are: (1) To conduct a systematic review of the literature and mathematical modeling to guide the selection of HIV prevention interventions for MSM in China; (2) To conduct a pilot study to evaluate the feasibility, acceptability and initial efficacy of a multi-component TLC intervention packages among MSM in China; and (3) To refine and finalize menu-driven HIV prevention packages and design a multi-site randomized clinical trial in 12 Chinese cities to evaluate its impact on HIV seroincidence among Chinese MSM. As a team of an expert network of American and Chinese researchers and community members with rich knowledge in the subject domains and substantial experience in China, we will develop a culturally competent and potentially effective intervention packages for Chinese MSM at the end of this project. The rapid rise of HIV epidemic among Chinese MSM and the comprehensive disease prevention networks in China provide unique environment for conducting a large scale community-based clinical trial. PUBLIC HEALTH RELEVANCE: These sustainable intervention packages, if proven feasible and effective, will be adopted in future research and public health programs for preventing new HIV infections and improving the lives of HIV-infected MSM. This MP3 grant is to develop and pilot test a multi-components prevention intervention package of Test and Link-to-Care (TLC) strategy to reduce HIV transmission by engaging expanded HIV testing with prompt initiation of risk reduction intervention and optimal antiretroviral treatment among a HIV high risk but largely ignored population-men who have sex with men (MSM) in China. These sustainable intervention packages, if proven feasible and effective, will be adopted in future research and public health programs for preventing new HIV infections and improving the lives of HIV-infected MSM in China and other parts of the world. Read more.

Funding Source: NIH/NIAID
PI: Sten Vermund

A New Instrument to Comprehensively Assess Sedentary Behaviors

The purpose of this study is to develop a new, robust, and validated questionnaire to measure sedentary behaviors in adolescents and adults.  We are sedentary for the majority of our waking hours (e.g., reclining, sitting still) and time spent in these behaviors have been independently associated with reduced energy expenditure, weight gain, and chronic disease.  This project is designed to provide the first validated instruments that can be easily administered in large population-based studies to comprehensively assess sedentary behaviors in terms of their context (or domain), setting, purpose, type, and amount. sedentary behaviors across all age ranges. Read more.

Funding Source: NIH/NINR
PI: Jay Fowke

Public-Private Partnership Addressing Literacy-Numeracy to Improve Diabetes Care

Despite strong evidence about the optimal treatment of diabetes, care often remains suboptimal. One recent examination of a national sample of diabetes patients found that less than 10% of patients surveyed were in optimal blood sugar, blood pressure and cholesterol control. One recently discovered barrier to optimal diabetes care is poor health literacy. Poor health literacy affects over 90 million Americans. Our research group was one of the first to demonstrate that low health literacy was independently associated with worse diabetes knowledge, self-management, and glycemic control (A1C). Numeracy (math skills) is an understudied component of literacy that is essential for many tasks in diabetes including glucose monitoring, assessing carbohydrate intake, and medication adjustment. Recently, our group demonstrated that poor numeracy is common in adults with diabetes and significantly associated with worse diabetes self-management, self- efficacy, and A1C. Addressing literacy and numeracy represent an exciting opportunity to improve diabetes care, because these are potentially modifiable risk factors. We recently performed four trials at academic medical centers that suggest that addressing literacy and numeracy can improve diabetes control. The aim of the proposed study is to perform a cluster-randomized trial to assess the efficacy of a low- literacy/numeracy-oriented intervention to improve diabetes care in under-resourced communities in Tennessee. The state of Tennessee now has a higher prevalence of diabetes then any other state in the nation. The study will occur in Tennessee Department of Health "safety net" primary care clinics in middle Tennessee. These primary care clinics provide diabetes care for a predominantly uninsured population at high risk for poor diabetes related health. The study represents a novel partnership between the Tennessee Department of Health and the Vanderbilt Diabetes Research and Training Center to improve care for a vulnerable population of diabetes patients. Ten State Health Department Clinics located in medically underserved areas will be randomized, and a total of 400 diabetes patients will be enrolled. Health Care Providers at the 5 control sites will receive standard diabetes education and the use of educational materials from the National Diabetes Education Program. Health Care Providers at intervention sites will receive training in clear health communication skills, and a Diabetes literacy and numeracy sensitive Educational Toolkit to use in partnership with their diabetes patients. Primary outcomes will include A1C, Blood Pressure, Cholesterol, Weight, Self-Management, and Self-Efficacy at 1 year. Patients will be followed for 2 years to assess sustainability. A cost-effectiveness analysis will be performed. The products of this study (health communication skills training modules and educational materials) will be disseminated via public access on the Internet. If successful, the proposed model will be disseminated across the State and will be a model for other Health Departments and clinics across the nation. Read more.

Funding Source: NIH/NIDDK
PI: Russell Rothman

Tailoring Healthy Eating and Physical Activity for African American Men

Despite increased attention to minority health needs, African American men have higher rates of developing and dying from many diseases associated with unhealthy eating and physical inactivity when compared to white men, white women and African American women. Unfortunately, much of what we know about African American health, including strategies considering culture when targeting healthy eating and physical activity, is based predominately on programs conducted with African American women. This is a significant limitation because well documented, gender-specific differences in dietary health and physical activity highlight the relevance of gender as a determinant of health behavior. Thus, if we are to adequately address the health needs of African American men, both culture and gender must be considered when developing and implementing strategies to increase their healthy eating and physical activity. The aim of this proposal is to develop and test gendered, culturally and contextually relevant messages that will be used in a future, web- based tailored intervention to increase healthy eating and physical activity in African American men. A tailored intervention - that is, an intervention customized to the unique preferences, interests and contexts of individual African American men - may be more engaging than an intervention targeted to African American men as a population group in part, because it may be deemed more personally relevant. In addition, by addressing multiple health behaviors - healthy eating and physical activity - this study reflects the fact that most U.S. adults engage in 2 or more unhealthy behaviors, which puts them at the greatest risks for chronic disease, disability, and premature death. Addressing multiple behavior changes increases the real-world applicability of this research and enhances the chances to uncover common mechanisms of health behavior and unique mechanisms for health behavior change. Our proposed study includes 3 phases: (1) formative research to refine our understanding of gendered, cultural and environmental determinants of healthy eating and physical activity; (2) develop tailored health messages to promote healthy eating and physical activity for African American men; and (3) test and refine the messages to yield a bank of messages for use in future, tailored health promotion interventions to promote healthy eating and physical activity for African American men. Upon completion, we will be well positioned to implement an R01 for a randomized controlled trial to test the efficacy of the tailored messages in a web-based intervention to improve African American men's healthy eating and physical activity. Read more.

Funding Source: NIH/NIDDK
PI: Derek M. GriffitIh

Using Social Learning to Improve Adolescent Diabetes Adherence Problem Solving

Adolescents with type 1 diabetes (T1D) are at high risk for poor adherence and glycemic control. Some of the most prevalent barriers to adherence in adolescents are psychosocial in nature, such as stress, stigma, time pressures, social situations, and communication with peers and parents. Diabetes research and professional organizations support the development of problem solving skills to resolve barriers to adolescent adherence. In order to address the needs of adolescents with T1D, parents, and clinics, we created an Internet adherence problem solving intervention, named YourWay. Initial results indicated moderate impact on adherence but variable engagement with the intervention. Based on our preliminary studies, we propose substantially advancing our intervention through three new design features: 1) a mobile data collection system using ecological momentary assessment (EMA) to populate the intervention with behavioral adherence data and multimedia content and improve awareness of adherence barriers, 2) a new homepage that integrates EMA data, BG values, and adolescent-generated multimedia content into personal adherence stories, and 3) social learning activities with peers focused on adherence problem solving. These enhanced features will provide more objective and more engaging data to guide and motivate adherence problem solving and provide intrinsically motivated social interactions with peers about adherence. Our aims include 1) establishing current behaviors and beliefs regarding adolescent use of health information technology for diabetes, and specifically those related to sharing personal health information with peers, 2) focused iterative design cycles for each of these features to identify the most engaging and acceptable interface and adherence data sharing activities, and 3) a pilot randomized trial to assess the impact of the intervention on glycemic control (A1C). There are currently no resources for this population that integrate social interactions with peers with skill building activities to improve adherence. The proposed Internet intervention will innovatively combine these features into a personal story format. The intervention has a high potential for engaging adolescents in adherence problem solving, improving adherence, and reducing the serious medical consequences related to poor glycemic control. Read more.

Funding Source: NIH/NIDDK
PI: Shelagh Mulvaney