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Early Afternoon Seminars – April 7, 2010 – 12:00 – 2:45 pm

Seminar #01: Advances in Longitudinal Data Analysis: Longitudinal Mixture Modeling
Katie Witkiewitz, PhD, Washington State University, Vancouver, WA.

Summary: Over the past decade methodology has been developed that provides the opportunity to identify variability in behavioral patterns within and between individuals as a function of time and covariates. This seminar will provide a broad overview and hands-on introduction to recent developments in longitudinal data analysis, focusing specifically on longitudinal mixture modeling approaches. Latent growth curve models have been increasingly used to model inter- and intraindividual change across time, however in the specification of the latent growth model it is assumed that the latent variables represent an underlying continuous growth pattern, in other words the latent variables are assumed to be continuous and normally distributed. However this assumption might not always be appropriate, particularly when change over time differs across individuals or is discontinuous. To deal with this possibility longitudinal mixture modeling takes advantage of categorical latent variables or a combination of categorical and continuous latent variables to characterize population heterogeneity and discontinuity in change over time. For example, latent growth mixture models combine the latent growth curve with a categorical latent variable, where the latent categorical variable is used to identify discrete subgroups of individuals who follow a similar pattern of change over time. Each individual has their own unique growth curve and the heterogeneity in growth curves across individuals is summarized by a finite number of growth trajectory classes. This seminar will introduce several types of longitudinal mixture modeling approaches using real-world examples from longitudinal alcohol and smoking datasets. The goal of these analyses will be to learn how these different approaches can be used to understand behavior over time, as well as the advantages, disadvantages and limitations of each approach. A hands-on demonstration of the Mplus statistical software syntax necessary to construct and analyze these models will also be described.

Seminar #02: How to Catalyze Learning in the Online Environment
Brian Knudson, MA, NogginLabs, Inc., Chicago, IL.

Summary: New cutting edge technologies are increasingly driving classroom-based learning and office-based intervention into the online environment. Seminar speakers drawn from academia and industry will demonstrate how practices grounded in theories of learning and motivation can catalyze the adult online learning process. The first speaker, a social psychologist, will describe the relevance of self-determination theory (SDT) to e-learning. He will review evidence that the activation of autonomous forms of motivation facilitates deep processing and conceptual understanding, in virtual as well as natural environments. The next speaker is the founder and CEO of a custom e-learning firm at the forefront of research and technology dedicated to e-learning. He will use award-winning products produced by his firm to show how human learning theory can be applied to create exceptionally powerful learning tools. Principles to be demonstrated include cognitive apprenticeship, four-component instructional design, and the development of goal-based scenarios. The final speaker will describe lessons learned in the process of creating two sets of online learning modules: one to foster research to practice translation, and the other to support the formation of successful of scientific teams. A portion of time will be devoted to discussing challenging on-line instructional and interventional cases brought forward by the audience. In addition to providing expert consultation, this exercise will provide a selection of active illustrations that apply theories of learning and motivation to an electronic context.

Seminar #04: Understanding Patient Preferences for Prevention and Treatment
Sara J. Knight, PhD, San Francisco VA Medical Center and the University of California San Francisco, San Francisco, CA.

Summary: Understanding patient preferences for prevention and treatment is critical in the prediction of patient involvement in health behavior and medical care. While preferences can be evaluated with ratings, rankings, utilities elicitation, and conjoint analysis, few of these methods have been developed to meet rigorous psychometric standards. In this seminar, we will discuss theories of patient preferences and methods for preference measurement, focusing especially on building instruments that have strong psychometric qualities. We will provide an overview of current conceptual models from behavioral science and health economics and we will demonstrate measurement methods including standard gamble, time trade-off, conjoint analysis, best worst scaling, and importance ratings. Using hands-on exercises, we will demonstrate how qualitative data can be used to generate the health state descriptions and choice alternative attributes that form the foundation of a preference measure. Finally, we will present a framework for evaluating the validity and reliability of preference measures. Examples from research on geriatric medicine, cancer treatment, and palliative care will provide concrete illustrations. Using a small group format, participants will have an opportunity to practice preference assessment and to discuss the best strategies for measuring patient preferences in their own research and clinical applications.

Seminar #05: Evaluating Meta Analyses: A Critical Consumers' Guide
James C. Coyne, PhD, University of Pennsylvania, Philadelphia, PA.

Summary: This workshop will present basic principles for evaluating the credibility of the conclusions of a meta-analysis. Increasingly, researchers and evidence-oriented clinicians and policy makers are urged to rely on the results of meta-analyses for decision-making. Yet, recent criticisms of meta-analyses that have appeared in Annals of Behavioral Medicine, Health Psychology, and even JAMA demonstrate that meta-analysis is hardly a straightforward, objective procedure, but one for which there is considerable room for subjective and arbitrary judgment. Further, a meta-analysis depends on the quality of the studies on which it draws and how their limitations are accommodated. Overall, it is quite possible for two meta-analyses to differ greatly in their results and recommendations because of differences in search strategies, selection criteria, and choices made as to how to deal with the methodological limitations of the available trials. Thus, meta analyses can fall short, either because their failure to observe basic principles for how they should be conducted and reported, or because of how decisions that were made as to how to deal with the available trials. The latter decisions require a familiarity with the interventions being studied and the clinical context in which they will be implemented, or, as the presenters have termed it, a clinical connoisseurship. This workshop is most appropriate for consumers of meta-analyses having to make clinical or policy decisions, those who might be contemplating doing a critical re-analysis of a published meta-analysis, and those who are conducting a meta-analysis of their own in which they avoid likely problems and pitfalls. Discussion will center not only on how to do a meta-analysis, but also on how to publish one with adequate transparency. It will present a guide to some necessary summary statistics and their interpretation. Participants will be able to appreciate when results of a meta-analysis "ain't necessarily so". Both primary presenters have published primary meta-analyses as well as critiques of published meta-analyses.

Seminar #06: Clinical Seminar in Behavioral Activation Treatment for Depression With a Co-Morbid Health Condition
Sherry Pagoto, PhD, University of Massachusetts Medical School, Worcester, MA.

Summary: Depression is co-morbid with many health conditions, including type 2 diabetes, HIV/AIDS, CVD, obesity, smoking, and substance abuse. Depression is associated with treatment nonadherence, poor self-care, and unhealthy lifestyle behaviors. Brief Behavioral Activation Treatment for Depression (BATD) is an evidence-based therapy for depression that is uniquely suited for use in medical settings, given its straightforward, time efficient nature, and ease of application to co-morbid health conditions. BATD is based on reinforcement theory and specifically targets contextual factors that affect behavior using principles of the matching law. Matching law suggests that depression persists because reinforcement for healthy behavior is low, and/or depressed behavior produces a relatively high rate of reinforcement. BATD is designed to increase exposure to positive consequences of healthy behavior, thereby increasing the likelihood of such behavior and reducing the likelihood of future depressed behavior. In addition to depression, BATD has been applied successfully to health conditions such as obesity, type 2 diabetes, HIV/AIDS, anxiety disorders, cancer, smoking, and substance abuse. The purpose of this clinical seminar is for participants to learn how to administer BATD in the context of a co-morbid health condition for the purpose of reducing depressive symptomatology as well as increasing healthy behaviors (e.g., healthy diet, physical activity, and medical adherence) and decreasing unhealthy behaviors (e.g., smoking, overeating, alcohol use). In this seminar, we will teach the basic principles of BATD, briefly review the efficacy literature, provide session-by-session instructions, and outline strategies for adapting BATD for application to a wide variety of medical conditions with practical recommendations on addressing barriers, including treatment resistance and integration into other treatments. Participants will receive a treatment manual and reference list. All skill levels are welcome.

Late Afternoon Seminars – April 7, 2010 – 3:15 – 6:00 pm

Seminar #07: Translation Research: Design and Methodology Considerations
Christine Hunter, PhD, National Institute of Diabetes & Digestive & Kidney Diseases, Arlington, VA.

Summary: Although basic science and efficacy research play a critical role in scientific advancement, improved public health is not always realized because of challenges related to translation from bench to beside and bedside to community. Analogous to the search for biological mechanisms as targets for drugs, basic behavioral and social science research requires translation into novel clinical approaches. Once efficacy of a new approach is established, later phase translation research is then needed to address generalizability, adoption, implementation, cost, and sustainability. Promoting high quality translation research is an important step towards bridging the gap between science and practice. For many investigators trained in traditional randomized controlled trial design and methodology, moving into translation research requires a new skill set that includes an appreciation of the strengths and limitations of various types of translation research. Early phase translation often requires transdiciplinary teams to conduct formative and pilot research. Moving from established efficacy research into effectiveness trials requires research designs that balance internal and external validity and researchers that understand the unique issues related to selecting a sample, considering comparison condition options, and approach to causal inference. This seminar is designed to provide a beginner to intermediate level overview of factors to consider when approaching translation research. The specific topics covered in the seminar include an overview of the continuum of translational research and discussion of research opportunities including designs and methodologies that are useful for the different phases of translation. The seminar format will include instruction and active discussion between speakers and attendees.

Seminar #08: Emergent Views of Digital Divide: The Role of Computer and Internet Use on Social Capital
Behjat A. Sharif, PhD, CHES, California State University at Los Angeles, Irvine, CA.

Summary: This presentation discusses social capital as a strong indicator of health. Data is presented to supports the impact of social capital on health at the individual and community levels. Significant findings are highlighted such as the index of collective efficacy (social cohesion and social control). It is significantly inversely associated with reports of neighborhood violence. About two standard deviation elevations in collective efficacy associate with 39.7% reduction in homicide rate. About 26% reduction in individual risk of being drinking is reported in campuses with higher than average levels of social capital. The World Bank's data also support increasing interest to invest in social capital as a strategy to improve population health and development.

In a study of relationship between Internet use and social capital, the strength of the relationship between Internet use and different facets of social capital is explored. This includes examination of civic engagement, interpersonal trust and contentment. Internet use is found to be positively related to civic engagement(r =. 07, p<. 001) and interpersonal trust (r =. 04, p<. 05) while it is not related to contentment (r =. 00, ns). Unlike overall Internet use, specific types of Internet usage have significant and systematic correlation with the production of social capital. Further analysis suggest that social capital is related to Internet use among Generation X, while it is tied to television use among Baby Boomers and newspaper use among the members of Civic Generation. More stringent analyses indicate influential factors such as demographic and contextual variables including traditional media use consistent with previous studies.

It is essential to bolster levels of social capital by promoting healthy relationships among the individuals and a greater sense of care in the community. This presentation discusses current issues related to social capital and makes policy suggestions for improving public health.

Seminar #09: Tobacco Cessation Quitlines: A Platform for Behavior Change Research
Jessie Saul, PhD, North American Quitline Consortium , Phoenix, AZ.

Summary: Tobacco cessation quitlines are an evidence-based, population-wide smoking cessation service. Currently, all U.S. states and territories and Canadian provinces provide quitline services. Demand is high: in the first 8 months of 2009, over 2.2 million calls were routed through the national 1-800-QUIT-NOW number to U.S. quitlines. The vast majority of quitlines in both countries also ask a standard set of intake and follow-up questions which serves as a basis for discussion of process and outcomes across the quitline community of practice.

The current quitline infrastructure could provide a unique model for addressing multiple behavior change issues. Because of their population-wide access, large call volume, reach to diverse populations, and ability to modify existing protocols to address emerging issues with relative ease, quitlines could provide a platform from which a number of key behavioral health issues can be explored within real world settings.

Equally important, quitlines can serve as mechanisms for translating research to practice and vice versa. Research findings can be readily shared within the quitline community of practice using established communication mechanisms, facilitating uptake of innovations by practitioners. In addition, by leveraging the existing links between quitlines and health care providers, community-based organizations, and other partners, lessons learned from practice can be transformed into new research questions.

Participants will review the existing quitline infrastructure and tools for conducting quitline-related research. Examples of how these data have been used to inform policy and practice will be shared. Participants will also discuss opportunities for using quitlines to engage in new collaborative research to advance the science of both tobacco cessation and other behavioral health interventions.

Seminar #11: Eliminating Health Disparities through Medical Education: A Hands-On Workshop for Building and Enhancing Your Curriculum
Jeffrey Ring, PhD, White Memorial Medical Center, Los Angeles, CA.

Summary: The session will begin with a review of how and why students and practicing health care providers must receive training in the awareness, knowledge and skills aspects of culturally responsive medicine, particularly as connected to the goal of elimination of health care disparities. Next, the presenter will describe and demonstrate a number of creative experiential learning activities in awareness, knowledge and skills development components of culturally responsive care. Participants will receive ample curricular materials to empower their own confident and creative teaching in the area of culturally responsive care.

Seminar #13: Contemporary Social Conflict Theory: Implications for Health
Michael R. Van Slyck, PhD, Virginia Commonwealth University, Richmond, VA.

Summary: Research documents the impact of social environments on health related communication and behavior, and actual health. One aspect of the environment, its area of scientific investigation and professional application, with clear implications for health issues, has received less attention than is warranted: Interpersonal conflict as described by Contemporary Social Conflict Theory (CSCT), which is not well known or understood. Its implications for health issues are underestimated or ignored.

Conventional views equate conflict with behavior (arguing/fighting), view it as "bad," and advocate avoidance as a response to prevent violence. CSCT views conflict as a cognitive process based on beliefs concerning needs and the expectations for satisfying them. Conflict, defined as "perceived divergence of interest" is regarded as inevitable, ubiquitous and necessary for change. For CSCT, contention (fighting) is one of five response modalities – accommodation, avoidance, compromise, and problem solving -- are the other "Conflict Management Styles (CMS's), each with predictable consequences.

Conventional views of conflict limit us to consideration of the contentious CMS which has implications for health ranging from covert effects of stress from using this CMS on a regular basis to overt effects of violence that can result from this CMS. However, other CMS's have implications for health outcomes, raising a variety of research questions, e.g., who gets better treatment, the demanding "contentious" patient or the compliant "accommodating" patient? Does an avoidant CMS result in lessened ability to address important health care issues with family or healthcare providers (HCP"s)? Does a problem solving CMS result in proactive health behavior, better communication with HCP's, and higher rates of compliance?

In this context the role of interpersonal conflict and conflict management in health and health related behaviors will be discussed. Both research questions and practical applications will be explored.

Seminar #14: Translating Research for Policy Makers: A Case Study Approach
Pre-Registration and ticket required. See registration desk for fee.
Capitol Hill, 3rd Floor
Prabhu Ponkshe, MA, LLB, Health Matrix, Inc. Mc Lean, VA

Summary: Scientifically rigorous and policy-relevant research has played a critical role in informing the policy process and policy debates on many health issues. Research has the potential to provide a rationale for policy change. It can also provide a challenge to an ideological approach to policy-making. Researchers who are able and interested in networking with policy makers also stand to gain insights and ideas for developing studies that incorporate variables from the policy debates.

Translating research for policy makers, however, remains somewhat of an elusive task. The results of a single study are rarely sufficient to change policy, nor should they always be. But studies that confirm or replicate existing knowledge, or add a new insight, provide opportunities for restating the science. Translating that science into language that policy makers can understand and delivering it through forums of interest to policy makers can make a big difference. Systematic reviews and meta-analysis also provide opportunities to translate research for policy makers.

The key for the research community is to step out of the academic environment and enter into the world of policy and politics. They can also bring the world of policy makers into academia. This seminar will provide an overview on the impact of research on policy and look at the evidence base on how research can influence policy. That presentation will be followed by three case studies on how researchers were able to take draw research ideas from the policy process and develop studies as well as results to create platforms for engagement with policy makers. The three case studies will focus on examples from tobacco, obesity and diabetes.

Behavioral research, especially research that focuses on chronic conditions, will always be of interest to policy makers. The starting point is finding those policy makers, as few or as many as there may be, and connecting with them with science and research.

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