Outlook: Newsletter of the Society of Behavioral Medicine

Spring 2021

A Year Like No Other

Monica Baskin, PhD, SBM President

Monica Baskin, PhD, SBM president
Monica Baskin, PhD
SBM President

I can hardly believe that we are only a few short weeks away from the Society of Behavioral Medicine’s (SBM’s) 42nd Annual Meeting & Scientific Sessions. This meeting has already been historic as SBM’s first ever virtual conference and the first time our annual meeting will be held over one week (April 12-16, 2021). The meeting this year features 20 pre-conference workshops, a full slate of scientific sessions, world-renowned keynote speakers and master lectures, social networking opportunities, and the ability to participate from the comfort of your own home or office with a combination of live and on-demand sessions. While it will not be the exact same experience as we all would have preferred, the Board’s decision last summer to move to a virtual conference this year allowed the Program Committee and SBM staff to carefully plan the upcoming meeting. I have had the honor of a front row seat to the hard work, creativity and determination of this group to make this year’s meeting informative, engaging and fun. Trust me, this is one meeting you do not want to miss out on (so register today if you haven’t already).   

The annual meeting focuses on my presidential theme Let’s Go All IN: Inclusion, Innovation, Influence. I hope that you will tune in to my keynote address on Wednesday, April 14, 2021 from 12-12:50P.  I look forward to sharing with you some of the ways that our members and Board have gone All IN this past year. SBM committees, councils, SIGs, and other groups of members have been more intentional about bringing diverse perspectives to the table and insuring better representation in our work. In addition, I am in awe of the many ways that members and partners have continued to come up with so many new and creative ways to disseminate evidence-based practice and messages to reach the broadest possible audiences in the face of unique challenges this past year (COVID-19, systemic racism, political uncertainty, economic instability). It has also been a year that has reaffirmed that we cannot go this road alone. Multiple collaborations within SBM and with other organizations have helped us to further exert the significance of behavioral science and medicine in addressing the complex behavioral and health issues plaguing our society.  

As the annual meeting also cements my final days as president of SBM, I am honored and proud to have been entrusted with the responsibility of leading this amazing society. I am even more excited about the years to come. The Board recently adopted a new strategic framework to guide SBM over the next five years. This framework was developed with significant input from a survey of our membership (current and past) and past annual meeting attendees, followed by a two-day virtual retreat of the Board and special guests that was facilitated by an expert consultant. You will learn more details about the framework in communications to the membership in the weeks to come, but four things stick out to me from this work.  

  1. We must reaffirm our identity and keep up the quest that SBM will no longer be the “best-kept secret in health and medicine.”
  2. We must do more to develop the current and future behavioral medicine workforce to take on current and emerging issues.
  3. We must educate, inform and bring awareness of our science to diverse audiences, beyond our fellow behavioral scientists. 
  4. We must use our powerful voice to advocate for policies and practices that ensure that our proven science is equitably distributed to achieve better health for all.   

With these new goals for the society, I hope that you will also Go ALL IN and Invest. Before your mind starts to wander, SBM is in strong financial standing thanks to so many on the Board who have been great stewards of our resources. However, our current revenue is not sufficient to match the ambitious goals that the membership has laid out for our next five years. As such, you will soon receive communication about the full launch of the SBM Proven Science – Better Health Giving Campaign and I will also speak to this during my presidential keynote. We recognize that not everyone will be in a position to give and the amount of gifts will vary significantly, but every amount helps bring us closer to the large-scale impact that we know SBM can make in the world.  

Thank you for affording me this opportunity to lead the best professional society there is in a year like no other. I look forward to “seeing you” at the annual meeting!

Editor's Note: Spring Forward and Go All IN

Crystal Lumpkins, PhD; Editor, Outlook

Crystal Lumpkins, PhD

Happy Spring! As we prepare to see each other in the first-ever virtual SBM Annual Meeting and Scientific Sessions in April, we can certainly embrace the often used expression that “spring has sprung”. We are in a season where we are witnessing longer days, warmer weather, new life (through nature) and can position ourselves to spring forward and to go All IN.

Springtime, for our society, also means that we are approaching an opportunity to recharge, reconnect and renew our energies in the work that we do. In this issue of Outlook, we highlight several of our SIGs that are on the cusp of something new, celebrating change and or positioning for change.

The ETCD’s new Early Career Researcher Mentoring Program and the SBM Diversity Institute for Emerging Leaders will give early career members an opportunity to gain experience for a strong trajectory of leadership. We also highlight the Scientific and Professional Liaison Council’s (SPLC) efforts to form new partnerships and expand the reach of SBM.

Readers also will have the opportunity to learn more about the Women Health SIG’s Call To Action on Racial Injustice and Systemic Racism. We also remember two landmarks in Sexual Health and celebrate strides to address stigma and discrimination among marginalized populations.

The BIT SIG showcases a Digital Health Checklist and Framework to inform digital health research and the Student SIG discusses the importance of a Resilience-Oriented approach to care for Behavioral Medicine Practitioners. The Cancer SIG also provides a provocative piece on the science of cancer caregiving and the inclusivity of caregivers into research design.

Finally, as we spring forward into this year and also through the next phase of the pandemic, we see a glimpse into the aftermath and impact of this public health crisis on various forms on Population Health. The PHS SIG discusses the “ecodemic” and how the pandemic has contributed to a “diseased ecosystem” and Dr. Stephanie Fitzpatrick, SBM Member Delegate, highlights the value of Community Based and Faith Based Organizations and how these organizations have been at the forefront to disseminate behavioral medicine. As always, we hope that this issue of Outlook will be resourceful and resonate with you for the work that you do. We welcome any questions, feedback, or suggestions that you may have.

SBM’s New Strategic Plan: Your Membership Expanded

The Society of Behavioral Medicine has a new Strategic Plan to make the field—and your career—even more impactful.

Our outcomes for the Strategic Plan were determined by you, our members. Through your input in our survey, the SBM Board of Directors was able to set the course for what SBM should achieve over the next 5 years, in three core areas. We are already hard at work making the plan a reality, to ensure you always have what you need to thrive in your career and are always proud to call SBM your professional home.

Awareness and Impact of Behavioral Medicine

Many members identified a pressing need for the larger biomedical community to better acknowledge and engage with the behavioral medicine specialty. We recognize this opportunity, and one outcome of our Strategic Plan is to ensure that SBM members are seen as knowledge brokers of evidence-based behavior change science. We want to elevate behavioral medicine so that we can help you improve clinical and population health. We know you’re tired of SBM being medicine’s best kept secret—we are too. We are already working on strategic partnerships and how to communicate behavioral medicine’s relevance in solving today’s health problems.



Public Education and Behavioral Change

Scientific research is currently undervalued, and science is often disparaged by those falsely claiming expertise. That’s why another outcome in our Strategic Plan is to increase the public’s access to your science. We want to give you more opportunities to translate your expertise into real-world impact. As engagement with science communication increases, we want to ensure you have the resources you need to broadcast your research on every possible avenue. SBM will help members disseminate their results beyond the traditional behavioral medicine community. To start, we’re creating a list of relevant journalists, assessing science communication barriers, and planning webinars.



Indispensable Professional Resource

In the past year, we have seen profound changes to the world we live in. COVID-19, climate change, and the global demand for racial justice, especially for Black Americans, have caused us to reflect on how we can improve our society. We have developed COVID-19 resources to help you adapt, no matter your professional level or role. We’ve also assessed our current diversity, equity, and inclusion efforts through a rigorous deep-dive, identifying successes and gaps. Inclusion is part of our Annual Meeting theme this year. More to come! Our third Strategic Plan outcome is to always be your indispensable professional home.


Learn more about the Strategic Plan by clicking here.

Behavioral Medicine, Crisis, and Opportunity in the Time of an Ecodemic

Karl J. Maier, PhD; Population Health Sciences SIG



Crisis can be a point of opportunity. In 2018 I wrote with colleagues in Outlook about behavioral medicine’s “mid-life crisis” around its 40th birthday. Rather than a real crisis, this was a time of opportunity to see the tremendous micro-level advances in precision medicine, not as reductionism redux, but as part of a more complete, ecological biopsychosocial paradigm for our field – a conceptual framework that integrates all levels of analysis and views our natural environment as foundational to addressing the most challenging health problems, from asthma to, yes, zoonotic disease.

But we face a true crisis now with COVID-19, and there is tragedy in the irony that this is likely a zoonotic disease that emerged from the very natural environment that most of medicine has neglected for too long. Yet, the full crisis is not the COVID-19 pandemic alone, but the more insidious and pervasive degradation of our neglected environment - what I’ll call an “ecodemic.” If a pandemic is a disease broadly affecting population health, then an ecodemic is a diseased ecosystem broadly affecting population health.

Zoonotic diseases like COVID-19 are but one manifestation of this ecodemic. Humans are both driving this ecodemic and suffering from it, with little awareness or corrective action, despite two formal “warnings to humanity” by scientists in the past 25 years 1. Decades of consumerism, increasingly westernized diets, and an exploding human population have created increasing demands for energy, industrialized agriculture, and manufacturing practices that drive climate change, biodiversity loss, and the proliferation of zoonotic disease 2,3. Our biosphere – the foundation of our health – is in crisis, and we need to act.


Raising consciousness about the problem may not be the greatest need within behavioral medicine; it seems that we’re already in the preparation stage of change. Climate change was among the most frequently mentioned issues to address in the 2019 “Provocative Questions in Behavioral Medicine” initiative launched by past SBM president Michael Diefenbach. And, visioning work has already begun to support the integration of our collective knowledge in addressing it 4.

For the action stage of our change, we have much to start with if behavioral medicine professionals wish to address environmental issues directly. From creating and teaching a course on psychology and climate change 5, I have found that many theories, research findings, and concepts already used in behavioral medicine readily apply. For example, I regularly engage students in the climate change issue through concepts of perceived risk, perceived norms, response efficacy, stress appraisal, stages of change, and even mindfulness.

Indirectly, many of us are closer to addressing environmental issues than we may realize, with careers addressing health equity, nutrition, physical activity, walkable cities, and obesity, to name a few. These core problem areas are key factors in climate change; The Global Syndemic, for example, is so named for the common socioeconomic factors such as global corporatized food systems and infrastructure that drive the confluence of obesity, undernutrition, and climate change 6. Now with COVID-19, there is increasing realization in medicine for the need and opportunity to address health and environmental issues like these together 7.

Our foundational biopsychosocial model provides a coherent starting point to address this all. I’m excited to convene a symposium on this very topic during our upcoming Annual Meeting, sponsored by the Population Health Sciences SIG, on April 13th: “Climate to COVID, Local to Global: The Biopsychosocial Ecology of Syndemic Prevention and Response.” There we’ll be sharing work on how we can apply the biopsychosocial ecological framework 8 to integrate our efforts across disciplines and specializations to address climate change and intersecting issues like COVID-19 and structural inequities.

Beyond concepts, we as an interdisciplinary field are accustomed to reaching beyond what may be our immediate discipline or core training to expand our basic skillset, such as to learn best practices in communicating our science through dialogue. We can also learn much from those working specifically within sustainability circles. For example, oftentimes stakeholders - from individuals and communities to politicians - are best engaged by framing environmental issues in terms of the legitimate “co-benefits” of action, rather than the environmental issue itself. So, instead of focusing on climate change directly, it can sometimes be productive to focus on the health benefits and cost savings associated with plant-based diets, walking instead of driving, or reducing air pollution.

In behavioral medicine, these co-benefits are typically the primary goal, and highly valued already. Yet, the added value of considering environmental co-benefits in our work may be substantial. In community work, there can be enthusiasm and synergy with participatory research when issues of health, food, equity, and environment are addressed together. Seeing the full implications of our work could also expand our universe of funding opportunities, and expand career directions. Working across disciplines is what we do, and this is increasingly valued, as seen for example in the Growing Convergence Research initiative of the National Science Foundation.

In addition to research, is there a synergy to be found by engaging our patients, too? Consider a recent survey of U.S. adults finding that 72% of Americans think global warming is happening. Over 60% of Americans think the issue is at least somewhat important to them personally, see it as a health issue, are at least somewhat worried about it, and feel a personal sense of responsibility to help reduce it. These numbers suggest a likelihood that many of our patients have environmental awareness and concerns that might complement their health behavior goals. For example, moving toward a plant-based diet can have significant health benefits for clients, and it is one of the most necessary societal shifts to address environmental problems like climate change 9. Other clients living in urban food deserts could be empowered by helping establish green spaces for activity and growing fresh food.

Because every client and community is different, we do best when we meet each where they’re at. Not all clients will, or need to, respond to environmental motivations. Not all research and policy should, or can, directly address environmental concerns. But we have the opportunity to be agents of positive environmental change where we can in order to safeguard what is perhaps the ultimate foundation of our health. Evidence tells us that self-motivated, gradual change in attitudes and behavior tend to be the most sustainable over time, and our current ecodemic crisis tells us we should also work toward changes that are sustainable for our environment.



  1. Ripple, W. J. et al. World Scientists’ Warning to Humanity: A Second Notice. BioScience 67, 1026–1028 (2017).
  2. Tilman, D. & Clark, M. Global diets link environmental sustainability and human health. Nature 515, 518–522 (2014).
  3. Tollefson, J. Why deforestation and extinctions make pandemics more likely. Nature 584, 175–176 (2020).
  4. Diefenbach, M. A., Phillips, A. & Bullock, L. Provocative Questions in Behavioral Medicine and the Acceleration of our Science. Annals of Behavioral Medicine 54, 920–923 (2020).
  5. Maier, K. J., Whitehead, G. I. & Walter, M. I. Teaching Psychology and Climate Change: One Way to Meet the Call for Action. Teaching of Psychology 45, 226–234 (2018).
  6. Swinburn, B. A. et al. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. The Lancet 393, 791–846 (2019).
  7. Watts, N. et al. The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. The Lancet (2020) doi:10.1016/S0140-6736(20)32290-X.
  8. Maier, K. J. & al’Absi, M. Toward a Biopsychosocial Ecology of the Human Microbiome, Brain-Gut Axis, and Health. Psychosomatic Medicine 79, 947–957 (2017).
  9. Willett, W. et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. The Lancet 393, 447–492 (2019).

Countering the Negative Health Effects of Racial Injustice and Systemic Racism

Call to Action, Call to Support: Racial Equity & Inclusion Series Part I*

Veronica P.S. Njie-Carr, RN, ACNS-BC, PhD, FWACN; Tiffany L, Carson, PhD, MPH; Alicia A. Dahl, PhD, MS; Megan J. Shen, PhD; and Lisa T. Wigfall, PhD, MCHES®; Women's Health SIG

Systemic racism is designed to disadvantage and oppress People of Color (POC) through limited economic mobility, access to health care, hiring discrimination, residential segregation, and biased enforcement of policies and laws resulting in numerous negative poor health outcomes.1,2,3,4 Police brutality in the killing of George Floyd and Breonna Taylor, two recent examples, are manifestations of more egregious and persistent societal problems embedded in historical contexts and reflective of White entitlement and perception of superiority.5,6 Compared to Black males, female victims of police brutality have not been widely publicized. Only recently have movements such as Say Her Name spotlighted these encounters.7,8 Importantly, each time police brutalize POC and the events are aired or broadcasted, people in general, especially, POC, experience traumatic effects including, anger, agitation, frustration, outrage, and helplessness.9 Pause for a moment and reflect on these negative experiences, occurring repeatedly and cumulatively overtime. Consequently, the negative responses for POC cause profound debilitating physical, psychological, and behavioral effects with continued exposure5,10 that some metaphorize as “weathering.”11 The objective of this paper is to highlight the health consequences of racial injustice and systemic racism and provide practical recommendations for actionable and supportive interventions to contribute to racial justice.

The resultant negative health consequences from cumulative stress that emanate from racial injustice are clear and have been extensively investigated.12,13,4 Although minimal progress has been made to address the root causes, the plethora of evidence suggests alarmingly profound negative health outcomes that must not be ignored. Allostatic load is the accumulation of stress over time and its effects on the body and brain.14,12 Brain and body responses target important body systems and functions such as physiologic (immune, autonomic, cardiovascular, neurocognitive, gastrointestinal, and metabolic systems) psychologic (stereotype threat, internalized racism, racial identity), and behavioral (poor lifestyle practices, low productivity),5,15,10,12 resulting in increased risk and vulnerabilities for a myriad of illnesses for POC. Specially, these may include, anxiety, depression, taking risks, excessive reaction to situations, cancer, obesity, hypertension, diabetes, infections, negative birth outcomes, pregnancy-related deaths, and other related disorders.4,12,10,16 Immigrant people, who are often shown to be healthy initially, develop similar risks and vulnerabilities as their U.S. born counterparts overtime with persistent exposure to discrimination, racism, and exclusionary practices.17 Thus, demonstrating that allostatic load resulting from chronic stress is a real public health threat in the U.S., which must be addressed to realize racial justice and health equity for a healthy population. Additionally, the mechanisms associated with allostatic load outcomes may be influenced by sex, environment, genes, age, among others.5,12 The cumulative stressful effects lead to the substantiated overall unhealthy and increased mortality rates of POC.10,17,18 Without addressing the root causes of racial injustice and racism, the trend will continue as seen with the disproportionate burden of the COVID-19 pandemic on POC;18,19,20 It is even more critical now to address racial injustice because “… health equity benefits everyone”13 (K. Sebelius, Secretary, HHS, p.1).  Efforts to realize racial justice and health equity must be made within the context of the historic backdrop that established laws propagating racism for over a century and continue to view POC as less than, inferior, and unentitled6,15 to provide a framework for effective responses to racial injustice and systemic racism.19

Prevention efforts for racial injustice and systemic racism have mostly focused on individual level interventions. The notion that if only individuals do certain things, racism will be eliminated has been widely touted. Decades of empirical and theoretical data demonstrate that while individual interventions are a great starting point, even more important, are systemic level interventions to address the legitimation and normalization of laws and policies that suppress and oppress POC.

Viewed through the lens of the social determinants of health and the intersections of biases (race, gender, immigrant status), we offer evidence-based recommendations12,14,21 utilizing a holistic, multi-level, and multi-faceted approach to reduce allostatic load.22,12,16 At the individual level, physical exercise has been shown to relieve stress, depressive symptoms, strengthen cognitive resilience, improve physical and mental health, and body weight among participants who show high levels of allostatic load.12 Social support and social interaction increase the adaptation and coping from stressors, thus increasing resilience that would be helpful in countering the negative effects of stress. Yoga and meditation improve sympathetic nervous system function and cortisol levels through reduction of stress, blood pressure, lipids, better cognitive function, and other physiologic measures.12,21,23

At the systemic level, efforts should be placed on widespread programs that are equally distributed across neighborhoods and class for more effect and sustainability across generations for sustainability.1 For example, policies that promote well-being and mitigate childhood poverty, provide adults with socio-economic access and opportunities to propagate economic mobility, and increase workforce diversity.22  Also, important is establishing policies that ensure the collaborative and coordinated engagement of more POC in research19 by providing the grants, mentorship, and tools to support the conceptualization of systemic racism, develop frameworks to further our understanding of the mechanisms of systemic racism, and implement the appropriate interventions.4,22,24,25,26 Required training for employees at all levels would help bridge the knowledge-gap to provide the historical context and recommend strategies to address racial injustice as a recipient and an observer.22,19

Importantly, at the most granular level, the inclusive, intentional, and thoughtful interactions of White People with people from diverse backgrounds is warranted. Specifically, consciously treating, speaking to, supporting a POC the same way a White Person would be treated provides enormous opportunities for the recognition and acknowledgement of behaviors that could potentially incite discrimination and exclusionary practices.5 With thoughtfulness and intentionality, we will “go all IN” to usher in a new day for racial justice.  

For progress to be made important questions must be asked and investigated to deepen understanding. For example, how should the daily impact of racism experienced by POC be investigated and quantified? How should the multilevel and intersectional factors (gender, class, culture, etc.) of racism be investigated and quantified? How should policing be reframed? What is the level of funding to address racism at the granular and systemic levels? What are the roles of policy makers and professional organizations in facilitating this process? Should gymnasiums and yoga studios be run free of charge by the government for equal access? How should data be mined to inform the implementation of these interventions?

To ensure that the recommendations are implemented and sustainable, institutions, health providers and researchers must lead to support, commit, and act. We call on clinicians and academic scientists to systemically investigate the root causes of racial injustice, systemic racism, and other discriminatory practices and contribute to its eradication for positive overall health outcomes. With the new White House Administration and the first female and Person of Color as Vice President of the United States, there is renewed hope for justice, equity, and multiple dimensions of health.


*The Women’s Health and Health Equity SIGs are collaborating on a series of publications to evaluate challenges of racial injustice and systemic racism and provide practical and actionable recommendations to begin to succeed in racial justice, health equity, inclusion, and consequently, better health outcomes.

Jessica Gorzelitz is the Women's Health SIG Trainee Co-chair and has made substantive contributions to the discussions. Her position as a fellow at the NIH requires that she obtains approval for co-authorship. Approval is pending at the time of this publication.  



  1. Chetty R, Hendren N, Jones MR, Porter SR. Race and Economic Opportunity in the United States: an. Am Educ Res Assoc. 2020;135(2):711-783.
  2. Quillian L, Pager D, Hexel O, Midtbøen AH. Meta-analysis of field experiments shows no change in racial discrimination in hiring over time. Proc Natl Acad Sci U S A. 2017;114(41):10870-10875. doi:10.1073/pnas.1706255114
  3. Alang S, McAlpine D, McCreedy E, Hardeman R. Police brutality and black health: Setting the agenda for public health scholars. Am J Public Health. 2017;107(5):662-665. doi:10.2105/AJPH.2017.303691
  4. Williams DR, Lawrence JA, Davis BA. Racism and Health: Evidence and Needed Research. Annu Rev Public Health. 2019;40(15):105-125. doi:10.1146/annurev-publhealth-040218-043750
  5. Elias A, Paradies Y. The Costs of Institutional Racism and its Ethical Implications for Healthcare. J Bioeth Inq. 2021. doi:10.1007/s11673-020-10073-0
  6. Wilkerson I. Caste: The Origins of Our Discontents. New York: Random House; 2020.
  7. Goldman F. Say Her Name. 2011;1.
  8. Prison Policy Initiative. Policing Women: Race and gender disparities in police stops, searches, and use of force. Prison Policy Initative. https://www.prisonpolicy.org/blog/2019/05/14/policingwomen/. Accessed January 11, 2021.
  9. Cogburn CD. Culture, Race, and Health: Implications for Racial Inequities and Population Health. Milbank Q. 2019;97(3):736-761. doi:10.1111/1468-0009.12411
  10. Williams DR, Mohammed SA. NIH Public Access. Am Behav Sci. 2013;57(8):1-19. doi:10.1177/0002764213487340.Racism
  11. Demby G. Making the case that discrimination is bad for your health. January 14, 2018. https://www.npr.org/sections/codeswitch/2018/01/14/577664626/making-the-case-that-discrimination-is-bad-for-your-health.
  12. D’Alessio L, Korman GP, Sarudiansky M, et al. Reducing Allostatic Load in Depression and Anxiety Disorders: Physical Activity and Yoga Practice as Add-On Therapies   . Front Psychiatry  . 2020;11:501. https://www.frontiersin.org/article/10.3389/fpsyt.2020.00501.
  13. HHS action plan to reduce racial and ethnic health disparities: A nation free of disparities in health and health care. Natl Strateg Achiev Heal Equity a Plan to Reduce Racial Ethn Heal Disparities. 2014:197-230.
  14. McEwen BS, Stellar E. Stress and the Individual: Mechanisms Leading to Disease. Arch Intern Med. 1993;153(18):2093-2101. doi:10.1001/archinte.1993.00410180039004
  15. Cozier YC, Yu J, Coogan PF, Bethea TN, Rosenberg L, Palmer JR. Racism, segregation, and risk of obesity in the black women’s health study. Am J Epidemiol. 2014;179(7):875-883. doi:10.1093/aje/kwu004
  16. Prather C, Fuller TR, Marshall KJ, Jeffries WL. The impact of racism on the sexual and reproductive health of African American women. J Women’s Heal. 2016;25(7):664-671. doi:10.1089/jwh.2015.5637
  17. Krieger N, Kosheleva A, Waterman PD, Chen JT, Koenen K. Racial discrimination, psychological distress, and self-rated health among US-born and foreign-born black Americans. Am J Public Health. 2011;101(9):1704-1713. doi:10.2105/AJPH.2011.300168
  18. Cunningham TJ, Croft JB, Liu Y, Lu H, Eke PI, Giles WH. Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans — United States, 1999–2015. MMWR Morb Mortal Wkly Rep. 2017;66(17):444-456. doi:10.15585/mmwr.mm6617e1
  19. Johnson-Agbakwu CE, Ali NS, Oxford CM, Wingo S, Manin E, Coonrod D V. Racism, COVID-19, and Health Inequity in the USA: a Call to Action. J Racial Ethn Heal Disparities. 2020;(Cdc). doi:10.1007/s40615-020-00928-y
  20. Cunningham GB, Wigfall LT. Race, explicit racial attitudes, implicit racial attitudes, and COVID-19 cases and deaths: An analysis of counties in the United States. PLoS One. 2020;15(11 November):1-14. doi:10.1371/journal.pone.0242044
  21. Geneviève LD, Martani A, Shaw D, Elger BS, Wangmo T. Structural racism in precision medicine: Leaving no one behind. BMC Med Ethics. 2020;21(1):1-13. doi:10.1186/s12910-020-0457-8
  22. Williams DR, Cooper LA. Reducing racial inequities in health: Using what we already know to take action. Int J Environ Res Public Health. 2019;16(4). doi:10.3390/ijerph16040606
  23. McEwen BS, Gianaros PJ, Milliken M. Stress-and Allostasis-Induced Brain Plasticity. 2011. doi:10.1146/annurev-med-052209-100430
  24. Njie-Carr, V.P.S. & Sharps PW. A response to the call to increase NIH funding for underrepresented minorities: Why should we care. In: In Veronica P.S. Njie-Carr, Yolanda Flores Niemann, & Phyllis W. Sharps (Eds.), Disparities in the Academy: Accounting for the Elephant. Dorrance Publishing; 2020:185-201.
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  26. Hardeman RR, Murphy KA, Karbeah J, Kozhimannil KB. Naming Institutionalized Racism in the Public Health Literature: A Systematic Literature Review. Public Health Rep. 2018;133(3):240-249. doi:10.1177/0033354918760574

Fostering Research-Community Based Organization Partnerships to Disseminate Behavioral Medicine

Stephanie L. Fitzpatrick, PhD; SBM Member Delegate

The socioeconomic consequences of the COVID-19 pandemic have left record numbers of U.S. families food insecure, homeless, and uninsured. These health-related social needs are major barriers to engaging in the behaviors we know are key to chronic disease prevention and management (e.g., healthy eating, physical activity, medication adherence). In this time of medical mistrust, health inequities, and persistent structural racism, the importance of behavioral medicine research has never been clearer. Yet, dissemination and implementation will continue to be a challenge unless we foster key partnerships.

Community and faith-based organizations (CFBOs) have always been at the forefront of addressing community member needs through advocacy and delivery of social services. During the pandemic, CFBOs have played a pivotal role in communicating accurate information about the coronavirus and vaccines, increasing access to testing and vaccinations, contact tracing, and providing wraparound services. This effort has especially been imperative to addressing health inequities among vulnerable communities of color, low-income, older adults, and LGBTQ+. As suggested by a recent review,1 CFBOs are ideal partners to disseminate evidence-based behavioral interventions to have a larger impact on public health and health policy.

The goal of this article is to provide some actionable steps grounded in community based participatory research (CBPR) to help early career and even senior behavioral medicine researchers foster successful partnerships.

Be ready to invest some time. Engaging CFBOs and building trust takes time and does not always align with project or grant submission timelines or tenure track schedule. Be mindful of the pace in which the CFBO works, which may be determined by capacity, resources, and culture.

Your authenticity and transparency often matters more than your degree. When initiating communication with CFBOs, figure out why engaging with this CFBO and the community they serve is important to you and be ready to share this story. Be honest and transparent in terms of your ultimate goals, including if they change over time.

Meet with CFBOs on their turf. This approach helps to address the power dynamics that often make partnerships challenging to establish and sustain. Although in-person meetings are less likely these days, ask the CFBO which communication platform they prefer to use. It is important to create a safe space, even virtually, that fosters shared power and decision-making.

The relationship has to be reciprocal. You need this partnership to engage hard to reach communities and disseminate your science, but also be willing to give back to support efforts to build social and community capital.

Don’t come to meetings with only your own agenda in mind. The CFBOs are trying to address the current needs of the community while maintaining limited staff and resources. Listen during meetings (including meetings that don’t involve discussing your project) to better understand their needs to build a partnership around common goals.

Allow the CFBO to co-own the program and/or related products to enhance sustainability. CFBOs are also experts and know the community and the best strategies to disseminate and implement programs. Present research findings to the CFBO partners and give them a chance to provide feedback to ensure the community voice is heard.

Please refer to these resources2-4 for additional literature on principles and application of CBPR.

The author would like to acknowledge Akiko L. Betcher, MAEd (Community Clinic Integrator at Kaiser Permanente Northwest) as well as Katherine Hoerster, PhD, MPH, Barbara Baquero, PhD, MPH, and Evalynn Romano, MPH/MSW candidate (University of Washington) for their wisdom and important contributions in this space.



  1. Mazzucca S, Arredondo EM, Hoelscher DM, Haire-Joshu D, Tabak RG, Kumanyika SK, Brownson RC. Expanding Implementation Research to Prevent Chronic Diseases in Community Settings. Annu Rev Public Health. 2021 Jan 19. doi: 10.1146/annurev-publhealth-090419-102547.
  2. Wallerstein N, Duran B, Oetzel JG, Minkler M, eds. Community-Based Participatory Research for Health: Advancing Social and Health Equity. 3rd ed. San Francisco: Jossey-Bass; 2018.
  3. Israel BA, Eng E, Schulz AJ, Parker EA, eds. Methods for Community-Based Participatory Research for Health. 2nd ed. San Francisco: Jossey-Bass; 2013.
  4. Viswanathan M, Ammerman A, Eng E, et al. Community‐Based Participatory Research: Assessing the Evidence: Summary. Rockville, MD: Agency for Healthcare Research and Quality (US); 2004.

Making Responsible Choices in Digital Health Research

Camille Nebeker, EdD, MS and Rebecca J. Bartlett Ellis, PhD; Behavioral Informatics and Technology SIG


Looking for that perfect wearable technology or mobile app for your research study?  With so many technologies available, how do you know which ones to choose? Cost is certainly something to consider. Beyond cost, what other factors come into play when selecting a technology for your digital health research?

Digital health research findings show great promise for improving health and are beginning to directly influence health policies and practices so that millions of people can lead healthier lives. However, to do digital health research ethically and responsibly requires that we, the researchers, think prospectively about possible risks of harm and then, work to fix rather than break things2–4. To help guide your decision-making process, we introduce the Digital Health Checklist (DHC), which is organized across an interconnected framework below1.

 We initiated research that resulted in the Digital Health Checklist and Framework (see Figure 1) to address a gap in available guidance. The DHC was developed with a group of subject matter experts and further evaluated by digital health researchers affiliated with the Society of Behavioral Medicine1. The resulting framework is grounded by ethical principles and consists of four intersecting domains identified as critical to decision-making including: 1- access and usability, 2- risks and benefits, 3- privacy, and 4- data management.

Figure 1: Digital Health Framework with examples of checklist prompts embedded within each domain. (Used with permission of C. Nebeker, ReCODE Health)

The DHC-R is licensed under a Creative Commons Attribution-Non-Commercial 4.0 International License (2018-2020) and available at https://recode.health/tools/.

Digital Health Checklist Domains

Privacy prompts researchers to consider the types of personal information that is collected about participants. For example, commercial digital tools include Terms of Service and Privacy agreements that should be read by researchers. These agreements may collect, store, and share personal information that conflict with participant expectations.

Access and Usability focuses on whether the participant can access and use the proposed device. For example, consider whether the participant will need a certain version or type of device,  whether Internet or Bluetooth access is needed and whether costs might be associated with these requirements. Whether the product/tool has been tested with the target or similar populations is also important to consider.

Data Management is a broad topic and includes how data collected, stored, shared and the extent to which the data are accessible with other systems or interoperability. Considering how the research team will manage participant data as it is collected by digital tools, how data will be transmitted and the interface with other digital products influences risk assessment. Lastly, whether and how data will be shared with research participants is increasingly important to factor in prospectively.

Risks and Benefits involves an evaluation of the probability and magnitude of potential harms and discomforts weighted against the potential benefits of knowledge to be gained from the study. Risks assessment includes defining the type of harm (e.g., physical, economic, psychological) along with duration, severity, and intensity. Risk assessment is increasingly nuanced and complex in the digital age.

For more information, contact Drs. Nebeker and Ellis or visit the ReCODE Health resources at https://recode.health. ReCODE Health is a global center physically located at UC San Diego. Our team and collaborators conduct research and also provide education and consultation on aspects of digital health. You can access our ReCODE Health publications to learn about our research and, if you want to use the DHC, check out our beta version of the checklist online and share your feedback.

Developing the Leaders for Behavioral Medicine: Introducing SBM’s Early Career Researcher Mentoring Program and SBM Diversity Institute for Emerging Leaders

Courtney Bonner, PhD; Steering Committee Chair, Diversity Institute for Emerging Leaders; Education, Training, and Career Development (ETCD) Council member and Carina Nigg; Steering Committee Chair, Early Career Researcher Mentoring Program; ETCD Council and Student SIG liaison and member


Welcome to the “Education, Training, and Career Development (ETCD) Council corner!” In each issue of Outlook, the ETCD provides SBM members with opportunities and support to enhance their training and career development in behavioral medicine. In this issue, we highlight two new training opportunities for early-career members: the SBM Early Career Researcher Mentoring Program and the Diversity Institute for Emerging Leaders. These opportunities seek to support members and develop strong, diverse leaders in behavioral medicine and for SBM.

The Student SIG and the ETCD Council are sponsoring SBM’s first Early Career Researcher (ECR) program in collaboration with the Health Equity SIG, which will kick-off during the 2021 SBM Annual Meeting and Scientific Sessions. The ECR program is an exciting opportunity for SBM´s early career researchers to receive mentoring from an SBM expert and from peers to pursue a goal in a relevant topic area across the field of behavioral medicine. Topics include, for example, digital health; diversity, equity, and inclusion; grant writing and funding opportunities; and general career consultation. The program is targeted towards graduate students and post-docs. Groups of mentees will be matched with experienced SBM members to offer support toward their goals. Peer mentee groups will meet with the mentor bimonthly for one year. During alternating months, peers-only groups will meet to work on their goals.

We experienced a great interest in the program, receiving 53 mentee applications. We wish the mentees and the mentors all the best for the mentoring year! We are planning to offer this program on a regular basis. If you are interested in participating, keep your eyes open for the next call!

The Diversity Institute for Emerging Leaders was developed out of a workgroup commissioned by Past President Dr. Gary Bennett and led by President Dr. Monica Baskin from 2018-2019 to ensure that the principles of Diversity, Inclusion, and Equity were institutionalized within SBM. The Institute was scheduled to launch during the 2020 Annual Meeting and Scientific Session, but due to COVID-19 it was postponed. However, we are happy to announce that the ETCD Council will sponsor the first Diversity Institute for Emerging Leaders during the 2021 Annual Meeting and Scientific Sessions!

The past year illustrated the dire need for equity in every institution of our nation, including in research and medicine. The SBM Diversity Institute for Emerging Leaders seeks to address this need by helping early-career SBM members develop into effective, thoughtful leaders through fostering leadership skills and a deep understanding of the principles of diversity and inclusion. The Institute will kick-off with a 2-day virtual training with Dr. Kumea Shorter-Gooden, a renowned Diversity, Equity, and Inclusion consultant. Throughout the year, 24 participants will develop their leadership skills and deepen their understanding of diversity and inclusion through quarterly learning opportunities and mentoring. After the year-long institute, participants will be able to identify their leadership strengths and areas for improvement; recognize their “blind spots” related to diversity and inclusion; respond to challenges related to diversity and inclusion, and use their leadership skills to implement and/or advocate for inclusive practices or policies within their sphere of influence. We look forward to welcoming our first class of leaders!

SBM Partnerships and You: How Can Members Get Involved? 

Amy Janke, PhD; Scientific and Professional Liaison Council Chair

The Scientific and Professional Liaison Council (SPLC) is the internal leadership group supporting SBM’s partnership activities with external organizations. Recently, the SPLC has been updating our approach to forming and supporting partnerships. Our goal is simple: we want more members involved in mutually rewarding partnerships. Partnerships with organizations help SBM extend its reach. When members help lead these partnerships, we create new opportunities and expand professional networks beyond our society. If you are interested in being a partner champion for SBM, here’s what you need to know.

What kinds of partners are good for SBM?

Groups that share our vision and organizational priorities make the best partners. Chances are, you already belong to another organization that has goals similar to SBM--you probably already know a great partner and have new ideas for partnership projects. For more information on partnerships, click here.

I know a good partner...now what??

Have a partnership idea? Reach out to the SPLC and we’ll help you get it started.

The first step in partnership is evaluating whether the proposed organization’s vision and priorities align with ours. The SPLC is developing tools to help you assess partnership alignment. These tools will help you identify how the partner aligns with SBM’s long-term strategic plan and organizational initiatives.  If you are a member of a SIG, it’s also a good idea to reach out to your SIG colleagues and leadership to discuss the prospective partnership. Partnerships need champions to succeed--often these champions can be found in our SIGs.  

The SPLC will need some basic information about the proposed partnership to move it forward. For example: What kind of collaborative activities will happen? Who will be involved? Are there any costs to partnership?

Once you’ve provided basic information about the potential partner to the SPLC, the first step is done. The SPLC will review the information you provide and give feedback on next steps.

What happens after I propose a partnership?

If the partnership seems like a good fit, the SPLC likely will ask for you and your SIG to help as the partner-champion. While some partnerships may be led by members of the SPLC or the Executive Committee, the majority of partnerships will be led by SBM members and SIGs with support from the SPLC. Members do the work that makes the partnership successful, so we want you involved!

Not all partnerships are created alike!

Some partners are great sources of information and resources, while other partners work closely with SBM members on shared activities like policy briefs. The SPLC approaches each kind of partnership differently. Some partnerships may do best with the SIG leading the way sharing information and resources within their membership. Other partnerships may require more engagement and support from the SPLC. Our goal is to understand what kind of partner you are proposing and who in SBM is best suited to champion the work.

How can the SPLC support a partnership?

Consider the SPLC a node in a larger network helping to connect partners and people. We see the “big picture” view of SBM’s work across all our partnerships and we offer the organizational support to help make your partnership thrive and grow. We can offer linkages to other internal and external groups,  ideas for activities, problem-solving of issues that arise, and coordination across the society. When SBM is asked to sign on or lend support to an issue with one voice as an organization, we can facilitate this review process with the Board of Directors.

Where can I go for more information?

Email the chair of the SPLC for more information and help with your partnership, you can find more information on the SPLC page of the SBM website.

Phoenix Rising: A Resilience-Oriented Approach to Care for the Behavioral Medicine Practitioner

Terence Matthew Penn, MA; Student SIG

Humans are an incredibly resilient and adaptive species. Like a phoenix rising from the ashes, we have survived – and thrived – under countless crises including war, famine, plague, and natural disaster. Thus, it is reasonable to assume that everyone has the capacity to remain resilient in the face of adversity. It is my belief that recognizing and trusting the human potential of resilience is the foundation to ensuring a successful therapeutic intervention.

As captured by the Merriam-Webster Dictionary, resilience refers to the “ability to recover from or adjust easily to misfortune or change.” Resilience captures both the necessity to accept the negatives in life and the acknowledgement that we have or can develop the skills necessary to manage life’s difficulties. For the client to reach this actualization, it is imperative for the therapist to provide a safe, encouraging environment. Client rapport is earned by the therapist demonstrating empathic understanding, unconditional positive regard, and tactfully honest communication. This enables clients to appropriately process thoughts and emotions relating to the presenting complaint, under the guidance of the therapist.

Therapy is a process of change; therefore, the focus must pivot from guided reflection to concrete action on the part of the client. Utilizing elements of Motivational Interviewing, this transition can be achieved by helping the client identify discrepancies between their current behavior and personal values and by portraying the client as a capable agent of change who bears the responsibility for resolving the presenting complaint.

From a cognitive behavioral framework, I guide the client to examine the bidirectional relationships between their thoughts, emotions, and behaviors. As a case example, an individual with chronic pain experiences a maladaptive automatic thought in reaction to a pain flare (e.g., “This pain will never end”), leading to panic and subsequent abnormal, shallow breathing. To break this cycle, one approach may consist of replacing the automatic thought with an adaptive one (e.g., “This flare is temporary”).

Emotion follows action: psychologist William James was one of the first to propose this theory, now supported by numerous studies. In my clinical experience, initially targeting behavioral changes before maladaptive thoughts has the advantage of building client self-efficacy due to how quickly behavior can influence emotion. In the case of the above example, I may start by providing psychoeducation about the influence of breathing on the central nervous system and emotion, then proceed to invite the client to participate in my demonstration of diaphragmatic breathing and/or coherent breathing.

In conjunction, I apply a strengths-based approach to further build client resilience. Particularly, I guide clients to identify personal strengths and values that can be generalized into strategies and applied to the presenting complaint. In other words, I help individuals recognize they already have tools within themselves to overcome challenges.

Ultimately, the client’s persistence and genuine attempts to change are the most important aspects to reinforce, especially when the individual perceives failing to achieve a desired outcome. Each subsequent attempt to change becomes easier over time, regardless of the result: resilience is the culmination of this process.

Growing evidence suggest that resilience-oriented interventions, particularly those based on a combination of cognitive behavioral and mindfulness strategies, result in improved psychological and physical health.1 While the majority of such studies examine traditional face-to-face formats, emerging research is now exploring resiliency training delivered via digital health platforms. As it relates to behavioral medicine, resilience-oriented therapy may particularly benefit individuals at risk for exposure to trauma or distress in medical settings, including health care professionals and patients with acute and chronic illness.



  1. Joyce, S., Shand, F., Tighe, J., Laurent, S. J., Bryant, R. A., & Harvey, S. B. (2018). Road to resilience: a systematic review and meta-analysis of resilience training programmes and interventions. BMJ open, 8(6).

The State of the Science of Cancer Caregiving

Sharon Manne, PhD; Cancer SIG

As the effectiveness of cancer treatments improves, the population of cancer survivors has grown exponentially. It is widely recognized that cancer diagnosis and treatment can have a detrimental psychosocial, medical, and financial impact on those diagnosed with this disease and that these adverse effects may persist and even worsen across the person’s lifespan. Over the past 30 years, our lens has broadened to consider the “hidden patients”– that is, the family and friends who provide the essential practical and emotional care to cancer survivors during their cancer journey.  Since studies have consistently shown a strong correspondence between psychological distress experienced by survivors and caregivers (e.g., Hodges et al., 2005; Li, Xu, & Zu, 2019), attention to enhancing caregivers’ well-being will likely impact cancer survivors’ well-being, as well.

Precise estimates of the number of caregivers are difficult to calculate because cancer registries and other national organizations do not collect such data. The National Alliance for Caregiving Report (2016) and the Behavioral Risk Factor Surveillance System Survey (2015) have estimated that there are between 1.1 and 2.8 million Americans providing care for an adult with cancer, with this number likely increasing in the future with the aging of the US population. Due to a lack of national data, characterizing the population is difficult.  The majority of caregivers in the US are female, report a high school level education or lower, and over half provide care to either a parent, parent in-law, or spouse (Kent & Odom, 2018).

The support caregivers provide is clearly essential, but the toll is significant and persistent. Family and friends providing more hours of care and care of a longer duration report more mental health issues, anxiety, and depression (Kent & Odom, 2018; Li et al., 2019).  While rates of clinically-significant depressive symptoms vary at the time of diagnosis and initial treatment, it is concerning that up to 40% report elevated depressive symptoms years later (Mitchell, et al., 2013; Shaffer et al. 2017). Adverse employment and financial impacts during the treatment (Longo et al., 2006) and end of life phases are prevalent, with caregivers missing work, taking unpaid leave, or changing careers to accommodate caregiving needs (Carey et al., 2012; Mosher et al., 2013).  Care provision to patients whose disease progresses or recurs results in persistent psychological and financial challenges for caregivers (Vivar et al., 2010). Caregivers are more vulnerable to chronic illness if the cancer patient dies than if the cancer patient is alive and in remission (Kim et al., 2017). However, even among those who provide care to a person living with cancer, these individuals are at risk for both chronic illnesses and depression if they are older, less educated, and provide care for a longer duration (Shaffer et al., 2017). In short, no matter what the patient’s disease trajectory, cancer caregiving has adverse effects on long-term and wide-ranging psychosocial, economic, and physical outcomes.

Given the immense scope of this problem, it is important that cancer care researchers, care providers, and our oncology care system actively seek to identify and address the needs of caregivers. What have we accomplished in meeting this challenge? Recent literature reviews of caregiver interventions illustrate we can be cautiously optimistic, at least in terms of the number of studies conducted: More than 50 randomized clinical trials were published between 2010 and 2016 (Ferrell et al., 2017), suggesting we are well on our way to developing evidence-based treatments. About half of the studies focus on couples, and most address the improvement of caregiving skills in managing patient symptoms such as pain and physical care and management of the caregiver’s own psychosocial needs (Ferrell et al., 2017). However, a recent Cochrane review (Treanor, Santin, Prue, Coleman, Cardwell, O’Halloran, & Donnelly, 2020) was much less positive in its conclusions about the state of the science. This review included 19 randomized and quasi-randomized controlled trials conducted in high income countries. Interventions included in the review focused on teaching caregivers or couples coping, problem-solving, and/or communication and did not include palliative care and pharmacological treatments. There was evidence of minimal benefit to caregiver quality of life immediately post-intervention, and these effects did not persist. There was little to no impact on caregiver psychosocial outcomes and evidence that there may be adverse effects. The review excluded a number of studies that were ongoing at the time of the review, thus limiting the conclusions. The authors concluded that the research was low quality and there was insufficient evidence to conclude what intervention focus (caregiver only versus dyad) and components (e.g., communication vs coping skills) were most effective. A broader range of outcomes such as relationship quality may provide more conclusive data on the impact of these interventions.

Given the diverse sources of psychosocial distress and what we know about caregiver populations who are particularly vulnerable – older caregivers, less educated caregivers, caregivers providing intensive care focusing on practical and emotional needs and providing care of a longer duration, caregivers who compromise their own employment and/or financial situations in order to provide care, and those with lower relationship quality before the caregiving begins  –  it will be key that interventions developed be tailored to the unique needs and concerns of the most vulnerable of cancer caregivers. A focus on our most vulnerable will prove to be particularly important given the aging of both our cancer population and the family and friends providing care for them. Studies have focused primarily on improving caregiver quality of life, psychological distress, relationship communication, and efficacy in providing care. Although these are important targets for intervention, addressing the financial hardship and physical tolls associated with cancer caregiving are also important goals. Critically, to ensure dissemination, any evidence-based interventions that are developed must be designed for delivery in community oncology care settings and available to informal caregivers who may not accompany their loved one to clinic and/or interact with oncology care providers. A “design for dissemination” approach that includes caregivers and patients in the treatment development phase may enhance impact. Scalable interventions may be offered online, particularly if in-person interventions may not be possible. Providing targeted interventions to caregivers may prevent declines in emotional  and physical functioning in this growing population.



Carey, M., Paul, C., Cameron, E., Lynagh, M., Hall, A., & Tzaelepis, F. (2012). Financial and social impact of supporting a haematological cancer survivor. European Journal of  Cancer Care, 21, 169-176.

Ferrell, B., & Wittenberg, E. (2017). A review of family caregiving intervention trials in oncology. CA: A cancer journal for clinicians, 67, 318-325.

Hodges, LJ., Humphris, GM, & Macfarlane G. (2005). A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. Social Science and Medicine, 60:1–12.

Kent, E., & Odom, N (2019). Population based Profile of mental health and support service need among family caregivers of adults with cancer. Journal of Oncology Practice, 15, e122-e130.

Li, Q., Zu, Y., & Zhou, H. (2018). The impact of depression and quality of life in Chinese cancer patient family caregiver dyads, a cross-sectional study anxiety. Health and Quality of  Life Outcomes 16, 230. https://doi.org/10.1186/s12955-018-1051 .

Longo C., Fitch, M., Deber, R., & Williams, A. (2006). Financial and family burden associated with cancer treatment in Ontario. Canada Supportive Care in Cancer, 14, 1077–85. 

Mitchell, A., Ferguson, D. Gill, P., & Symonds, P. (2013).  Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls. A systematic review and meta-analysis. The Lancet Oncology, 14, 721-732.

Mosher, C. Champion, V., Azzoli, C., Hanna, N., Jalal, S., Fakiris, A., et al. (2013). Economic and social changes among distressed family caregivers of lung cancer patients. Supportive Care and Cancer, 21, 819-826.

National Alliance for Caregiving: Caregiving in the US. An intense, episodic. and challenging care experience. 2016. www.caregiving.org/wp-content/uploads/2016/06/cancercaregivingreport_final_june-17-2016.pdf.

Shafer, K.., Kim, Y., Carver, C., & Cannady, R. (2017). Effects of caregiving status and changes in depressive symptoms on the development of physical morbidity among long-term cancer caregivers. Health Psychology, 36, 770-779.

Treanor, C., Santin, O., Prue, G., Coleman, H. Cardwell, C, O’Halloran, P., & Donnelly, M. (2020). Psychosocial interventions for informal caregivers of people living with cancer. The Cochrane Collaboration.

Viviar, C., Whyte, D., & McQueen, A. Again: The impact of recurrence on survivors of cancer and family members. Journal of Clinical Nursing, 19, 2048-2056.

Two Landmarks in Sexual Health: Looking Back to 1981

Brett Millar, PhD; Eric Layland, PhD; Kimberly Nelson, PhD, MPH; and Lisa Eaton, PhD; HIV & Sexual Health SIG Leadership

In 2021, we look back 40 years to two distinct, seemingly unrelated, sexual health landmarks. First, on July 3, 1981, the New York Times published a story entitled “Rare Cancer Seen in 41 Homosexuals." This article marked the first public announcement of what would later become known as acquired immunodeficiency syndrome (AIDS) arising from untreated human immunodeficiency virus (HIV), although we are now aware that numerous cases long preceded that date.  Also, in 1981, Dr. Virginia R. Brooks’ seminal work on Minority Stress Theory was published in her groundbreaking book entitled Minority Stress and Lesbian Women.  Though these two landmarks may have emerged separately 40 years ago, the connection between minority stress and sexual health has become increasingly evident.

Dr. Brooks (1938-2008), later known as Dr. Winn Kelly Brooks, expanded upon the findings of her 1977 doctoral dissertation in Social Work and Social Welfare at University of California-Berkeley, with her 1981 book Minority Stress and Lesbian Women (Lexington Books, currently out-of-print). Her work was groundbreaking in a number of ways, as described in an excellent and long-overdue celebration of her work by Rich and colleagues (2020) in LGBT Health.

The scope of Brooks’ work far surpassed that of existing studies at the time and generated a truly multilevel model detailing the various sources of stress (cultural, social, economic) to which sexual minority women are chronically exposed and their downstream effects on psychological and physical health.

Brooks’ visionary work repudiated the existing discourse that sexual minority individuals’ distress was caused by inherent pathology, dysfunction, or trauma, and set a foundation for subsequent work on stigma, discrimination, and stress (e.g., DiPlacido, 1998). Later her work would be applied to sexual minority men (Meyer, 1995) and gender minority populations (Hendricks et al., 2012), as well as integrated with intersectional approaches to stigma research. Meyer’s extension of minority stress energized an entire field and subsequent minority stress research has proliferated, with applications for HIV-related stigma (Logie et al., 2012; Rendina et al., 2017) and HIV prevention (Layland et al. 2020). According to Rich and colleagues (2020), Minority Stress Theory “informed the landmark 2011 Institute of Medicine (IOM) report on sexual and gender minority health... [leading] to the establishment of the National Institutes of Health Sexual and Gender Minority Research Office in 2015 and subsequent designation of sexual and gender minority people as a health disparity population for research purposes in 2016” (p.3).

Now, 40 years after both the 1981 “rare cancer” headline and Brooks’ pioneering work on minority stress, we see that, although they initially seemed unrelated, the latter has meant so much for the former. Since Brook’s foundational work, ever-growing evidence of minority stress continues to inform possibilities for intervention and testifies to the importance of eradicating stigma and discrimination for the ongoing health of marginalized populations.



Brooks, V.R. (1981). Minority Stress and Lesbian Women. Lexington, MA: Lexington Books.

DiPlacido, J. (1998). Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia, and stigmatization. In G. M. Herek (Ed.), Psychological perspectives on lesbian and gay issues, Vol. 4. Stigma and sexual orientation: Understanding prejudice against lesbians, gay men, and bisexuals (p. 138–159). Sage Publications, Inc. https://doi.org/10.4135/9781452243818.n7

Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the Minority Stress Model. Professional Psychology: Research and Practice43(5), 460-467.

Layland, E. K., Carter, J. A., Perry, N. S., Cienfuegos-Szalay, J., Nelson, K. M., Bonner, C. P., & Rendina, H. J. (2020). A systematic review of stigma in sexual and gender minority health interventions. Translational behavioral medicine10(5), 1200-1210.

Logie, C. H., Newman, P. A., Chakrapani, V., & Shunmugam, M. (2012). Adapting the minority stress model: associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India. Social Science & Medicine, 74(8), 1261-1268.

Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 38-56.

Rendina, H. J., Gamarel, K. E., Pachankis, J. E., Ventuneac, A., Grov, C., & Parsons, J. T. (2017). Extending the minority stress model to incorporate HIV-positive gay and bisexual men's experiences: A longitudinal examination of mental health and sexual risk behavior. Annals of Behavioral Medicine51(2), 147-158.

Rich, A. J., Salway, T., Scheim, A., & Poteat, T. Sexual minority stress theory: Remembering and honoring the work of Virginia Brooks. LGBT Health, 7(3) 124-127. DOI: 10.1089/lgbt.2019.0223

New Articles from Annals of Behavioral Medicine and Translational Behavioral Medicine

SBM's two journals, Annals of Behavioral Medicine and Translational Behavioral Medicine: Practice, Policy, Research (TBM), continuously publish online articles, many of which become available before issues are printed. Three recently published Annals and TBM articles are listed below.

SBM members who have paid their 2021 membership dues are able to access the full text of all Annals and TBM online articles via the SBM website by following the steps below.

  1. Go to the Members Only section of the SBM website.
  2. Log in with your username and password.
  3. Click on the Journals link.
  4. Click on the title of the journal which you would like to electronically access.

To check if you are a current SBM member, or if you are having trouble accessing the journals online, please contact the SBM national office at info@sbm.org or (414) 918-3156.

Annals of Behavioral Medicine

Theory-based Behavioral Predictors of Self-reported Use of Face Coverings in Public Settings during the COVID-19 Pandemic in the United States

John P Barile, PhD, Rebecca J Guerin, PhD, Kiva A Fisher, PhD, Lin H Tian, MD, Andrea H Okun, DrPH, Kayla L Vanden Esschert, MPH, Alexiss Jeffers, MPH, Brian M Gurbaxani, PhD, William W Thompson, PhD, Christine E Prue, PhD

Investigating antecedents of behaviors, such as wearing face coverings, is critical for developing strategies to prevent SARS-CoV-2 transmission.

The purpose of this study was to determine associations between theory-based behavioral predictors of intention to wear a face covering and actual wearing of a face covering in public.

Data from a cross-sectional panel survey of U.S. adults conducted in May and June 2020 (N = 1,004) were used to test a theory-based behavioral path model. We (a) examined predictors of intention to wear a face covering, (b) reported use of cloth face coverings, and (c) reported use of other face masks (e.g., a surgical mask or N95 respirator) in public.

We found that being female, perceived importance of others wanting the respondent to wear a face covering, confidence to wear a face covering, and perceived importance of personal face covering use was positively associated with intention to wear a face covering in public. Intention to wear a face covering was positively associated with self-reported wearing of a cloth face covering if other people were observed wearing cloth face coverings in public at least “rarely” (aOR = 1.43), with stronger associations if they reported “sometimes” (aOR = 1.83), “often” (aOR = 2.32), or “always” (aOR = 2.96). For other types of face masks, a positive association between intention and behavior was only present when observing others wearing face masks “often” (aOR = 1.25) or “always” (aOR = 1.48).

Intention to wear face coverings and observing other people wearing them are important behavioral predictors of adherence to the CDC recommendation to wear face coverings in public.

Trajectories of Mental Distress Among U.S. Adults During the COVID-19 Pandemic

Kira E Riehm, MSc, Calliope Holingue, PhD, Emily J Smail, BSc, Arie Kapteyn, PhD, Daniel Bennett, PhD, Johannes Thrul, PhD, Frauke Kreuter, PhD, Emma E McGinty, PhD, Luther G Kalb, PhD, Cindy B Veldhuis, PhD, Renee M Johnson, PhD, M Daniele Fallin, PhD, Elizabeth A Stuart, PhD

Cross-sectional studies have found that the coronavirus disease 2019 (COVID-19) pandemic has negatively affected population-level mental health. Longitudinal studies are necessary to examine trajectories of change in mental health over time and identify sociodemographic groups at risk for persistent distress.

To examine the trajectories of mental distress between March 10 and August 4, 2020, a key period during the COVID-19 pandemic.

Participants included 6,901 adults from the nationally representative Understanding America Study, surveyed at baseline between March 10 and 31, 2020, with nine follow-up assessments between April 1 and August 4, 2020. Mixed-effects logistic regression was used to examine the association between date and self-reported mental distress (measured with the four-item Patient Health Questionnaire) among U.S. adults overall and among sociodemographic subgroups defined by sex, age, race/ethnicity, household structure, federal poverty line, and census region.

Compared to March 11, the odds of mental distress among U.S. adults overall were 1.84 (95% confidence interval [CI] = 1.65–2.07) times higher on April 1 and 1.92 (95% CI = 1.62–2.28) times higher on May 1; by August 1, the odds of mental distress had returned to levels comparable to March 11 (odds ratio [OR] = 0.80, 95% CI = 0.66–0.96). Females experienced a sharper increase in mental distress between March and May compared to males (females: OR = 2.29, 95% CI = 1.85–2.82; males: OR = 1.53, 95% CI = 1.15–2.02).

These findings highlight the trajectory of mental health symptoms during an unprecedented pandemic, including the identification of populations at risk for sustained mental distress.

Prime Movers: Effects of Subliminal Primes, Music, and Music Video on Psychological Responses to Exercise

Suzanne T Pottratz, PhD, Jasmin C Hutchinson, PhD, Costas I Karageorghis, PhD, Elizabeth M Mullin, PhD, Zachary Zenko, PhD

Priming is a process in which exposure to a stimulus activates relevant mental representations that are given increased weight in subsequent judgment tasks. Affective primes can influence affective evaluations and associations. Such influence has meaningful implications for the promotion of exercise behavior, yet there is scant research on priming effects in exercise settings.

The purpose of the present pair of studies was to examine the efficacy of music (M), music video (MV), and music video with affective primes (PRIME) in modulating psychological responses during and immediately following an exercise bout among two distinct populations.

In Study 1, physically active participants completed a brisk walking task on a treadmill under four conditions: M, MV, PRIME, and control. Affective valence and rating of perceived exertion (RPE) were assessed during exercise and remembered/forecasted pleasure was measured immediately following each exercise bout. In Study 2, largely inactive and overweight participants completed a brisk walking task on a treadmill under two conditions: MV and PRIME. Affective valence was assessed during exercise, while exercise enjoyment and remembered/forecasted pleasure were assessed postexercise.

In Study 1, PRIME yielded more positively valenced affect, remembered/forecasted pleasure, and lower RPE when compared to the other conditions (MCohen’s d for all DVs = 0.91). In Study 2, PRIME elicited more positively valenced affect, greater enjoyment, and enhanced remembered/forecasted pleasure when compared to MV (MCohen’s d for all DVs = 0.64).

Subliminal primes embedded in music video can elicit positive changes in psychological responses during and immediately following exercise.


Translational Behavioral Medicine

Transparency and openness in behavioral medicine research

Megan A McVay, David E Conroy

Behavioral medicine aims to improve the health of individuals and communities by addressing behavioral, psychosocial, and environmental contributors to health. Succeeding in this endeavor requires rigorous research and effective communication of this research to relevant stakeholders and the public at large. Both research rigor and effective communication of research may benefit from adopting transparent and open research practices, sometimes called “open science.” Such practices include preregistering designs, hypotheses, and data analysis plans; making publically available study materials, data, and analytic code; sharing preprints (works-in-progress) of articles; and publishing open access. In this commentary, we describe the evolving pressures to increase the transparency and openness of research, examine the status of open science practices in behavioral medicine, and recommend a path forward to find the right fit for these practices in behavioral medicine research.

Behavior science in the evolving world of digital health: considerations on anticipated opportunities and challenges

Madalina Sucala, Heather Cole-Lewis, Danielle Arigo, Megan Oser, Stephanie Goldstein, Eric B Hekler, Michael A Diefenbach

Digital health promises to increase intervention reach and effectiveness for a range of behavioral health outcomes. Behavioral scientists have a unique opportunity to infuse their expertise in all phases of a digital health intervention, from design to implementation. The aim of this study was to assess behavioral scientists’ interests and needs with respect to digital health endeavors, as well as gather expert insight into the role of behavioral science in the evolution of digital health. The study used a two-phased approach: (a) a survey of behavioral scientists’ current needs and interests with respect to digital health endeavors (n = 346); (b) a series of interviews with digital health stakeholders for their expert insight on the evolution of the health field (n = 15). In terms of current needs and interests, the large majority of surveyed behavioral scientists (77%) already participate in digital health projects, and from those who have not done so yet, the majority (65%) reported intending to do so in the future. In terms of the expected evolution of the digital health field, interviewed stakeholders anticipated a number of changes, from overall landscape changes through evolving models of reimbursement to more significant oversight and regulations. These findings provide a timely insight into behavioral scientists’ current needs, barriers, and attitudes toward the use of technology in health care and public health. Results might also highlight the areas where behavioral scientists can leverage their expertise to both enhance digital health’s potential to improve health, as well as to prevent the potential unintended consequences that can emerge from scaling the use of technology in health care.

Research translation for military and veteran health: research, practice, policy

Jeffrey P Haibach, Katherine D Hoerster, Lindsey Dorflinger, Lisa M McAndrew, Daniel G Cassidy, David E Goodrich, Jill E Bormann, Julie Lowery, Steven M Asch, Susan D Raffa, Tannaz Moin, Alan L Peterson, Michael G Goldstein, Tracy Neal-Walden, Gerald W Talcott, Christopher L Hunter, Sara J Knight

Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembers and eligible family members, many veterans, and retirees receive health care through the two largest learning health care systems in the USA, managed and delivered through the Departments of Defense (DoD), Veterans Affairs (VA), and contracted health care organizations. Through a network of collaborative relationships, DoD, VA, and partnering health care and research organizations (university, corporate, community, and government) accelerate research translation into best practices and policy across the USA and beyond. This article outlines military and veteran health research translation as summarized from a collaborative workshop led by experts across health care research, practice, and administration in DoD, VA, the National Institutes of Health, and affiliated universities. Key themes and recommendations for research translation are outlined in areas of: (a) stakeholder engagement and collaboration; (b) implementation science methods; and (c) funding along the translation continuum. Overall, the ability to rapidly translate research into clinical practice and policy for positive health outcomes requires collaborative relationships among many stakeholders. This includes servicemembers, veterans, and their families along with researchers, health care clinicians, and administrators, as well as policymakers and the broader population.


Honors and Awards

Congratulations to the following Society of Behavioral Medicine (SBM) members who recently received awards or were otherwise honored. To have your honor or award featured in the next issue of Outlook, please email aschmidt@sbm.org.

David B. Allison, PhD
The American Statistical Association's San Antonio Chapter recently distinguished Dr. Allison with the 2020 Don Owen Award.

Danielle Arigo, PhD, LP
Dr. Arigo received a 2021 Short-Term Research Travel Award from the University of Bayreuth Humboldt Centre for International Excellence for her collaborative project, Reducing Measurement Reactivity in Physical Activity Research (local host: Dr. Laura König).

Jamie S. Bodenlos, PhD
Psi Chi elected Dr. Bodenlos Eastern Regional Vice-President for 2021-2022.

Belinda Borrelli, PhD
Dr. Borrelli was recently appointed as Associate Editor of American Psychologist.

Paul K. Han, MD, MPH
Dr. Han was recently appointed as a Senior Scientist for the National Cancer Institute’s Behavioral Research Program.

Robin M. Lally, PhD
Dr. Lally was recently named a Distinguished Scientist at the University of Nebraska Medical Center.

Stacy A. Ogbeide, PsyD, MS, ABPP
Dr. Ogbeide and her team received the 2nd place award for Innovations in Health Science Education at the University of Texas System Innovations in Health Science Education Conference in February 2021.

Members in the News

The following SBM members and their research were recently featured in news articles, videos, or journals. To have your news spot featured in the next issue of Outlook, please email aschmidt@sbm.org.

Hannah Getachew-Smith, MPH, CHES
The New York Times interviewed Ms. Getachew-Smith for an article entitled "How Confident Can You Be in a Coronavirus Test?"

Jennifer D. Roberts, DrPH, MPH
Dr. Roberts was quoted in a Newsweek story on COVID-19 vaccine uptake, Al-Jazeera interview addressing risks posed to service industry workers by unmasked rallygoers, and article in US News and World Report about prematurely reversing indoor dining bans.

Michelle Segar, PhD, MPH, MS
Dr. Segar was featured in a Wall Street Journal article entitled "Are Gyms Dead? Why Home Workouts Are Here to Stay" and a piece on everydayhealth.com, "Study: Can Fitness Trackers and Apps Give Your Exercise Routine a Boost?"