Outlook: Newsletter of the Society of Behavioral Medicine

Spring 2022

Buzzing with Excitement for Baltimore

David E. Conroy, PhD, SBM President

David E. Conroy, PhD, SBM president
David E. Conroy, PhD
SBM President

 

Have you registered yet? After all of the uncertainty wrought by the pandemic, I am bubbling with excitement at the thought of seeing you all at our 43rd Annual Meeting & Scientific Sessions in Baltimore, MD, from April 6-9! Program Chair Dr. Ellen Beckjord and the entire Program Committee have assembled a phenomenal program to fill your brain and your heart. You can get previews of the great programming in weekly episodes of our new podcast hosted by Dr. Matt Whited, The Buzz in Behavioral Medicine. In the meantime, here’s a sampling of what you can look forward to in Baltimore.

The Welcome Session on Wednesday night will be buzzing as we see friends and colleagues in person for the first time in two years. Remember – we all look great and haven’t aged a day! The theme for the Welcome Session is “Building a Bridge for Behavioral Medicine.” The last SBM president to host an in-person conference (Dr. Sherry Pagoto) will moderate a discussion with the SBM presidents (Dr. Monica Baskin and Dr. Michael Diefenbach) and program chairs (Dr. Alison Phillips and Dr. Dori Steinberg) who kept our scientific exchanges (and more) moving forward the past two years. The focus of the discussion is on leadership lessons learned and how SBM grew from the challenges of the past two years.

Three of the Keynote Presentations will address the role of behavioral medicine in addressing the pandemic (Dr. Mercedes Carnethon), the climate crisis (Dr. Ed Maibach), and systemic racism’s effects on health disparities (Dr. Lorraine Dean). Our Closing Keynote will cast an eye inward and ahead as Dr. Jacqueline Kerr shares her experience in “Finding a New Mission in Burnout Recovery.” The personal and professional costs of the pandemic have been real and we can all benefit from pausing to reflect on the ways we want to live and work in the days, months, and years ahead.

The Master Lectures are equally impressive. Thought leaders will address caregiving (Dr. Christine Richie), technology for sustainable design (Ms. Julia Watson), systemic racism in medicine (Dr. Sabrina Strings), and commercial influence on health behaviors (Mr. Steve Downs). Behavioral medicine is a solutions-focused field and these experts will bring innovative perspectives on vexing problems.

Two additional Master Lectures will be given by recipients of the Distinguished Scientist Award (Dr. Bonnie Spring) and the Jessie Gruman Award for Health Engagement (Dr. Laura Hayman). Both of these honorees are past presidents of SBM who have contributed to our field’s success today. We will recognize a large slate of new award winners following my presidential keynote Thursday on “The Urgency of Adaptation in Behavioral Medicine.”

In addition to these plenary sessions, the days are packed with more networking sessions, panel discussions, research spotlights, roundtables, and symposia than I can possibly preview here. One thing you will notice is that the Program Committee made the schedule a bit more humane – starting each day a bit later, preserving a dedicated lunch hour (with food trucks outside the hotel!), and ending formal programming at a civilized hour. I hope this schedule frees us all to reconnect and form new connections while moving through the week.

Speaking of moving, I invite you to join me for two special events. On Thursday evening, we will have a Health Freedom Walk to retrace part of the Underground Railroad that ran through Baltimore. On Saturday morning, we will have the Stride for Science Run/Walk. It’s a flat course, so please sign up with a friend and go at a speed that’s pleasant for you!

While the Program Committee has worked to fill our brains and hearts during the week, the Executive Committee worked in parallel to ensure as much safety as possible at our meeting. We have monitored COVID-19 case rates/hospitalization/deaths in Baltimore and nationally through the omicron surge, monitored plans for other conferences this spring, and evaluated guidance from infectious disease experts in government and medicine. Proof of vaccination (including booster if eligible) or legal exemption is required for all attendees. Our COVID-19 FAQ page has full details on all COVID-19 countermeasures for the meeting.

In addition to all of our Annual Meeting preparations, SBM leaders have been hard at work advocating with other organizations for the Biden Administration to nominate a new NIH Director who values the potential for social and behavioral science to address the pressing health problems of our day (December 7 2021 letter, March 1, 2022 letter).

Our Nominating Committee (chaired by Dr. Monica Baskin) prepared a slate of great candidates for the Board of Directors. Please vote! The voting form also includes Bylaws amendments to restructure our Board to meet the needs of the membership more effectively. I encourage you to support this proposal which has received initial approval from the Board of Directors.

I hope you share my excitement about the state of SBM. I look forward to seeing you in April. Register now and book your travel so you don’t miss a minute of the fantastic programming (including the amazing preconference offerings!). See you in Baltimore!

 


Editor's Note: Our Collective Voices Make Us Mighty

Crystal Y. Lumpkins, PhD; Editor, Outlook


Crystal Y. Lumpkins, PhD


When you read this note, we will be just about a few weeks away from convening at the 43rd Annual Meeting and Scientific Session in Baltimore, Maryland.  

This year’s annual meeting theme, “The Urgency of Adaptation,” is most certainly timely given the present state of our world where Russia has invaded Ukraine and a humanitarian crisis is unfolding before our eyes. As I transition out of my role as Outlook editor and start a new chapter within the Society of Behavioral Medicine, I am reminded of the strength of this collective and the undaunted efforts to address society’s issues whether they are on a local or global level. Our collective voices have made us mighty. SBM members are forceful through research, policy, and practice and have a lot to say and share for the greater good.

In this issue, we are afforded an opportunity to peek into some of our fellow members’ personal lives and how their experiences have influenced their research and shaped their world views.  Stories about personal development, advancing equity in digital technology, and meeting the needs of LGBTQ students in the STEM disciplines are just a few of the articles that you can read in this issue. It’s because of these stories and other Outlook stories that we can see a push for change.

Finally, I feel so fortunate to have had an opportunity to co-edit this issue with your incoming Outlook Editor, Dr. Linda Trinh. You’re in good hands. Many thanks for allowing me to serve as your editor and I look forward to seeing many of you in April.
 

With Gratitude,

Crystal Y. Lumpkins, PhD


Pandemic Parenting: Challenges and Silver Linings

Alicia A. Dahl, PhD, MS; Molly E. Waring, PhD; Rizwana Biviji, PhD, MS; Tisha Felder, PhD, MSW; and Jodie Lisenbee, MA; SBM Women's Health SIG

“Unsustainable.” “Burnout.” “Liberating.” “Cognitive overload.” “Exhausting.” “Anxiety.” “Resourceful.” These are some of the words filling the Women’s Health SIG Twitter feed as parents discuss their experiences balancing personal and professional responsibilities during the COVID-19 pandemic. We reached out to the SIG via email, and four members offered to share their experiences parenting during the pandemic with us. Respondents were mothers of one to three children aged 18 months to 10 years, and all work in academia. While their experiences certainly do not represent all parents’ experiences over the past two years, they echo themes reported in recent research and covered in the media.

Nationally, many academics report that the pandemic has brought challenges to both their teaching and research roles. While many research labs were shut down for weeks or months during the pandemic, even those who have managed to keep their projects going may face negative repercussions for their careers. One respondent, who considers herself fortunate that she could conduct her research projects remotely, lamented:

“With increased teaching, mentoring, and service workload, research team challenges, and limited sustained time blocks for deep thought and focused writing, my program of research has taken a hit that will take years to recover from.”

There’s evidence that the pandemic will have long-term career effects on criteria used in the tenure and promotion process.1,2 Grant funders such as NIH and NSF and academic institutions should consider additional policies to support academic parents, especially women. Suggestions included:

  • Extending deadlines to use internal funds
  • Funding for a postdoc or PhD student to help with analyses and writing
  • Sabbatical options offered pre-tenure to focus on research
  • NIH grants specifically to protect research time for junior investigators
  • While the NIH allows extensions to Early Stage Investigator status,1 longer extensions would do more offset long-last effects of the pandemic on research productivity

Many parents have had to pivot their roles and responsibilities at home as well. One respondent, a mother of an infant whose husband was also working from home, “we tried to balance our meetings such that there was at least one of us present with her and the other parent would concentrate on the meeting.” Others echoed this challenge of meeting professional obligations while caring for children during daycare closures or periods of remote schooling. Recent research reports that mothers have borne the brunt of childcare gaps during the pandemic.3 Close to two years in, parents still face inconsistent availability of childcare.

Respondents also expressed disappointment and frustration about having to deny their children social opportunities that otherwise are a regular part of this life stage, such as birthday parties, sleepovers with friends, and extracurricular activities.

“The hardest parenting decisions were about how to interact with our families, playdates, and putting our kids in extracurricular activities.”

Another respondent noted wanting to make the “right” decisions to keep her family physically and psychologically healthy, but found balancing emerging science, public policy, and practical logistics mentally exhausting.

However, the pandemic hasn’t been all bad. While daycare center and school policies have varied widely, many parents are pleased with how their childcare providers and schools have responded to the pandemic, including daily health check requirements, mandatory masking, regular testing, and hosting vaccination clinics.

A silver lining to the challenges of childcare disruptions and limited social engagement was more opportunities for creative play and for parents to bond with their children.

“With lots more unstructured time at home, my children engage in so much imaginative play, which is something there's not always time for when you're running from one activity to another.”

“We have gotten to spend way more time hanging out with our children than we would have. My kids are totally awesome people, and I will forever cherish the time we've spent together.”

For many parents, the pandemic has prompted reflection on their approach to parenting and helped them cultivate a positive outlook.

“Because we've had to say ‘no’ to our kids so often, I've become more mindful about saying ‘yes’ whenever possible. Yes we can go get ice cream, yes you can create your own waterslide in the backyard, yes you can watch another episode, yes you can stay in your pajamas all day, yes you can go swimming in your clothes, yes you can make slime.”

Another parent shared, “I firmly believe that the pandemic has taught me the value of gratitude. Gratitude for the good times and being prepared for bad times. I want to instill this mantra in my child, to always value what we have and be humble during not-so-good times.”

Parents, we see you. It may not always feel like it, but you’re doing a great job in a really hard situation. We’d love to hear your experiences parenting during the pandemic – the good, the bad, and the hopeful. Join the conversation on Twitter @SBMWomensHealth.

 

References

  1. Mogro-Wilson C, Negi N, Acquati C, et al. Reflections From Academic Mothers of Young Children on Social Work Research and Education, J Soc Work Educ. 2022;58(1):9-33. doi: 10.1080/10437797.2021.2014726
  2. Krukowski RA, Montoya Williams DC, Cardel MI. A Year Into the Pandemic: An Update on Women in Science, Technology, Engineering, Math, and Medicine (STEMM). [published online ahead of print, 2021 Nov 30]. Ann Am Thorac Soc. 2021. doi: 10.1513/AnnalsATS.202107-875CME
  3. Calarco JM, Meanwell E, Anderson EM, et al. By Default: How Mothers in Different-Sex Dual-Earner Couples Account for Inequalities in Pandemic Parenting. Socius. 2021;7:1-15. doi:10.1177/23780231211038783

A Priority for Today to Empower Tomorrow: A Student Perspective on LGBTQ Resources and Mentorship in the Academy  

Viktor Clark, MS; Lisa Eaton, PhD; José Bauermeister, PhD; and Brett Millar, PhD; HIV and Sexual Health SIG


 

Meeting the Needs of LGBTQ Students in STEM Disciplines

The demand for employees within the fields of science, technology, engineering, and math (STEM) in the United States has boomed since 1990 growing from 9.7 million jobs to 17.3 million.1 However, the influx of STEM employment is not absent of disparities, specifically, disparities pertaining to diversity. In 1980, Congress passed an act mandating the National Science Foundation to not only include but track the progression of cis-gender women and racial and ethnic minorities in STEM.2 Cis-gender women now make up ~50% of the STEM workforce but lack representation and/or leadership opportunities across all STEM sectors, while only 9% of STEM employees identify as Black and/or 7% Hispanic.1 Although the 1980 Act was a step towards progress, lesbian, gay, bisexual, transgender, and queer (LGBTQ) were excluded from any prioritization resulting from this act and still today, remain virtually invisible in STEM.3 As of 2020, the United States is facing a dual dilemma. Younger generations of workers (20­–25-year-olds) are identifying as LGBTQ at higher rates than prior generations (15.9% in 2020)4 and the need for workers in STEM is continuing to rise.1 Research shows, however, that individuals who identify as LGBTQ are avoiding if not resigning from STEM-focused jobs.3 This dilemma has one resolution; to improve the sectors of the academy that focus on STEM in a manner that prioritizes the inclusion of LGBTQ students.
 

Potentials Avenues for Addressing Inequities

Three strategies to improve LGBTQ students’ recruitment, retention, and graduation rates include: 1) Creating an LGBTQ inclusive campus climate,5,6 2) Developing LGBTQ specific spaces,7 and 3) Connecting LGBTQ students to gainful employment within STEM fields.8 A model that provides support for the efficacy of these three strategies is the Culturally Engaging Campus Environments Model (CECE Model).9 The CECE Model describes the duality of students individually having a significant impact on their own college success through their sense of belonging, academic dispositions (e.g., self-efficacy, motivation, intent to persist), and academic performance, while also recognizing the impact that the culture of a campus has on both the individual student directly and their college success outcomes such as gainful employment. The CECE Model describes two dimensions that go into developing a campus culture–a campus providing culturally relevant experiences for students and a campus being culturally responsive. Cultural relevance in practice means recognizing students may have been victims of systemic oppression due to their social status, and providing students access to faculty who share their similar histories. Cultural responsiveness is a campus’s response to the cultural needs of their students and in practice can be creating an environment of collaboration and providing access to multiple culturally relevant supports. Both of these responses need to be implemented within campus climates in order to address inequities and promote inclusion.
 

Conclusion

In conclusion, inequities within STEM-focused disciplines will remain without concerted efforts to address the lack of representation of sexual orientation and gender-diverse populations within these fields. An important component of addressing changes within STEM-focused disciplines is assessing the experiences of LGBTQ faculty within these departments. Specifically, changes need to be met to cultivate safe environments for faculty of diverse backgrounds. University policy must support infrastructure-related and policy changes to embrace LGBTQ folks within their institutions. As leaders in the science of behavioral medicine, we are called to make LGBTQ students in STEM a priority today to help empower the future of STEM for tomorrow.

 

References

  1. Funk, C., Parker, K. Diversity in the STEM workforce varies widely across jobs. Pew Research Center; 2018.  
  2. 42 USC 1885c: Committee on equal opportunities in science and engineering.
  3. Freeman, JB. Measuring and resolving LGBTQ disparities in STEM. Policy Insights from the Behavioral and Brain Sciences, 2020;  7(2): 141-148.
  4. Jones, JM. LGBT identification rises to 5.6% in the latest US estimate. Gallup Poll Social Series, 2021.
  5. Brown, RD., Clarke, B., Gortmaker, V., Robinson-Keilig, R. Assessing the campus climate for gay, lesbian, bisexual, and transgender (GLBT) students using a multiple perspectives approach. Journal of College Student Development, 2004; 45(1): 8-26.
  6. Hughes, BE. Coming out in STEM: Factors affecting retention of sexual minority STEM students. Sci Adv, 2018; 4(3): eaao6373.
  7. Hogan, L., Rodríguez, LG., Lynn, Z., Murphy, B., Scherzer, R. Queer students navigating the academy: LGBTQ+ mentoring practices at IUPUI. Journal of the Student Personnel Association at Indiana University, 2020; 9-25.
  8. Weiss, M., Southern K., Tromble, K. Accountability that works: Restoring gainful employment and strengthening higher education accountability measures. The Institute for College Access & Success, 2021. 
  9. Museus, SD., Zhang, D., Kim, MJ. Developing and evaluating the culturally engaging campus environments (CECE) scale: An examination of content and construct validity. Res High Educ, 2016; 57: 768-793.

How a 360° Evaluation Can Strengthen Your Professional Development

Brian D. Gonzalez, PhD; SBM Member Delegate


I recently invited about 30 people to complete a survey. That part is routine, as I often ask cancer survivors to complete surveys for research projects. This survey was unusual because 1) colleagues completed it and 2) the goal was to help my professional development. It’s part of a 360º evaluation to gain insight into my strengths and weaknesses as a colleague and leader.

I first heard of 360º evaluations while reading Radical Candor by Kim Scott, a book I highly recommend for all SBM members. She recommended these evaluations, which request feedback from those who report to you, your peers, and your supervisors. This comprehensive feedback can reduce the risk that, for example, peers and supervisors may think very highly of an investigator but be unaware that they are a tyrant with lab members. These evaluations seemed interesting, but I wrongly assumed they could only be done by your institution’s Human Resources department and only as part of your annual review. I realized this could be done independently after being invited to participate in a colleague’s 360º evaluation led by their executive coach.

One of the many benefits of SBM’s Leadership Institute is that attendees are paired with an executive coach to help further their career development. SBM even covers the cost of a few initial coaching sessions and negotiates a reduced hourly rate for subsequent sessions. My coaching sessions continue, and I highly recommend this process for all investigators.

A 360º evaluation is helpful for learning how you’re perceived by others in various roles. This survey used the Task Cycle framework to request feedback on how one is perceived on the 6 steps necessary to achieve a goal. It’s important to first have a leader’s perspective. Next, a leader must set the direction for the team. Implementation doesn’t just happen next, but rather it requires team-building and timely decision-making. A leader must also set high, but achievable, standards and get results from the team. Along the way, one must provide feedback. And finally, it’s crucial to acknowledge team members’ contributions to the project. Each step is critical to the success of a research project. This feedback has been very valuable for my own professional development, as I reflect on ways to continue in strength areas and improve on my weaknesses (or “growth edges” as I’m encouraged to call them).

Here are a few suggestions for how you can seek out coaching and/or a 360º review. First, consider applying to the SBM Leadership Institute! Second, your institution’s Human Resources department may offer one or both services. Third, until these resources become routine in academia, it may be necessary to use some of your own personal funds. Lastly, leaders in your institution may be willing to contribute institutional funds if you can make a case for how coaching and/or a 360º evaluation may be helpful to the institution. It may make supervisors more likely to consider you for leadership opportunities if they know you take your professional development seriously.

 


Transforming Digital Behavioral Health Interventions to Address Inequities: A Working Group’s Mission

Maura Kepper, PhD, MPH; Abdul Shaikh, PhD, MHSc; Sophy Perdomo, PhD; Amber Blackwood, MPH; Kassandra Alcaraz, PhD, MPH; and Lisa Klesges, PhD, MS; Behavioral Informatics and Technology (BIT) SIG


COVID-19, the first global pandemic of the digital age, has ignited and spurred a rapid emergence of digital health interventions.1 This pandemic has demonstrated the potential of digital health to improve the quality, efficiency, consistency, and availability of care including behavioral interventions, but has also revealed challenges and equity concerns.2-5 Digital health encompasses a range of technologies including “mobile health (mHealth), health information technology (HIT), wearable devices, telehealth and telemedicine, and personalized medicine.”6 Inequities in access to, and implementation and sustainability of these tools, as well as the quality of care afforded by digital technology, can reinforce and even deepen the inequities that have long existed among the most vulnerable patients and communities.1 A working group was formed across the Behavioral Informatics and Technology and Health Equity Special Interest Groups (SIGs) to articulate a behavioral medicine perspective to inform use-inspired research for digital health equity.7 The group consists of behavioral scientists spanning academia, industry, and nonprofits with expertise in a broad range of disciplines that include informatics, health services research, dissemination & implementation science, and health disparities research.

We began by cataloguing challenges of equitably implementing and sustaining digital health technologies to promote healthy behaviors among diverse populations and settings, drawing from our diverse expertise and existing theories, frameworks, and models8,9 focused on health equity, technology, and dissemination and implementation (e.g., the ConNECT Framework,10 the Health Equity Implementation Framework, 11 and the Integrated Technology Implementation Model).12 We organized our efforts into three working groups that will advance the field by: 1) contributing to the peer-reviewed scientific literature; 2) developing guidelines and tools for practitioners; and 3) advocating for relevant policy change. Each group will address major challenges such as development that has occurred predominately among homogenous, highly socioeconomically advantaged populations,7 and thereby failed to account for cultural differences (e.g., languages), various reading levels, and environments. Our group may generate guidelines for participatory design that engages end-users and stakeholders (e.g., payers, administrators) that are necessary for equitable end-user adoption, utilization, and productivity. Furthermore, the development and validation of digital health tools, especially those involving artificial intelligence and machine learning, require investments in datasets that are representative of the target population. We will focus beyond design and consider challenges with access and implementation. Digital literacy and internet connectivity are the major determinants of access,13 yet, we must not overlook less visible factors (e.g., knowledge of resources, access to educational resources, technology support, affordability, insurance coverage) that may be solved by strategies that are more feasible (e.g., less expensive, within an organization). These challenges extend beyond the initial adoption of digital health tools and have critical implications for equitable sustainability and impact.3,14,15 Evaluation and the use of data to understand if we are increasing inequities should inform iterations in real time to improve usability, effectiveness, and equity. Furthermore, users should be provided access to their own data so that they may contribute to making digital health solutions more relevant safe, effective, and equitable.

We are working on: 1) an opinion piece on “Digital Health Equity for Behavior Change”; 2) a review of frameworks/methods of cultural adaption of digital behavioral interventions; 3) a policy brief focused on leveraging technology to support child nutrition, increase access to food assistance programs (WIC & SNAP), and reduce obesity inequities among underserved populations. We invite you to join us by emailing Maura Kepper at kepperm@wustl.edu.

 

References

  1. Lee P, A. Abernethy, D. Shaywitz, A. V. Gundlapalli, J. Weinstein, P. M. Doraiswamy, K. Schulman, and S. Madhavan. Digital Health COVID-19 Impact Assessment: Lessons Learned and Compelling Needs. NAM Perspectives 2022.
  2. Smith AJ, Skow Á, Bodurtha J, Kinra S. Health Information Technology in Screening and Treatment of Child Obesity: A Systematic Review. Pediatrics. 2013;131(3):e894-e902.
  3. Payne PRO, Lussier Y, Foraker RE, Embi PJ. Rethinking the role and impact of health information technology: informatics as an interventional discipline. BMC Med Inform Decis Mak. 2016;16:40-40.
  4. Zhang X, Hailu B, Tabor DC, et al. Role of health information technology in addressing health disparities: Patient, clinician, and system perspectives. Medical care. 2019;57 Suppl 6 Suppl 2(Suppl 6 2):S115-s120. PMC6589829.
  5. Coleman KJ, Hsii AC, Koebnick C, et al. Implementation of Clinical Practice Guidelines for Pediatric Weight Management. The Journal of Pediatrics. 2012;160(6):918-922.e911.
  6. Administration USFaD. What is Digital Health? . Digital Health Center of Excellence Web site. https://www.fda.gov/medical-devices/digital-health-center-excellence/what-digital-health. Published 2020. Accessed 2/7/2022.
  7. Lyles CR, Wachter RM, Sarkar U. Focusing on Digital Health Equity. Jama. 2021;326(18):1795-1796.
  8. Soobiah C, Cooper M, Kishimoto V, et al. Identifying optimal frameworks to implement or evaluate digital health interventions: a scoping review protocol. BMJ Open. 2020;10(8):e037643.
  9. Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. 2012;43(3):337-350.
  10. Alcaraz KI, Sly J, Ashing K, et al. The ConNECT Framework: A model for advancing behavioral medicine science and practice to foster health equity. Journal of behavioral medicine. 2017;40(1):23-38.
  11. Woodward EN, Matthieu MM, Uchendu US, Rogal S, Kirchner JE. The health equity implementation framework: proposal and preliminary study of hepatitis C virus treatment. Implementation Science. 2019;14(1):26.
  12. Schoville R, Titler MG. Integrated Technology Implementation Model: Examination and Enhancements. CIN: Computers, Informatics, Nursing. 2020;38(11):579-589.
  13. Sieck CJ, Sheon A, Ancker JS, Castek J, Callahan B, Siefer A. Digital inclusion as a social determinant of health. npj Digital Medicine. 2021;4(1):52.
  14. Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ (Clinical research ed). 2005;330(7494):765. PMC555881.
  15. Koppel R, Kreda DA. Healthcare IT usability and suitability for clinical needs: challenges of design, workflow, and contractual relations. Studies in health technology and informatics. 2010;157:7-14.

 


Systems-Oriented, Population Health Approaches Are Needed to Improve Health: We Are All in This Together

Candyce Kroenke, ScD, MPH; Population Health Sciences SIG Chair


As this year’s chair of the Population Health (PHS) SIG, I’ve thought a lot about population health science and its potential to inform and improve population health as our members considered our group’s interests and priorities. Our group discussed key foundational principles drawing on prior work by Kindig, Keyes and Galeo, and others such as Geoffrey Rose who wrote about improving population health by shifting the entire population distribution of a biologic marker of health (e.g., shifting blood pressure downward by 2 mmHg) rather than focusing on targeting and treating high-risk individuals, given that the majority of events in the population occur at the center of the distribution.

We sought not to reinvent the wheel but adapt previous definitions and principles to our work in a behavioral context. PHS SIG members agreed that population health-behavioral science can be characterized as multi/transdisciplinary, multilevel, incorporating social determinants, emphasizing health equity, policy-oriented, and having implications for behavioral outcomes. Our SIG also discussed next steps and strategies for moving our group’s activities forward including developing linkages to other organizations, additional member collaboration, and more public-facing content.

In the United States, we have prioritized a focus on individual behavior as underpinning health though we know that current approaches have undermined the health of the socioeconomically vulnerable. What is less well known is how this focus has broadly undermined the health of the population including those at the top of the socioeconomic distribution. A 2020 article showed that despite greater financial resources of the upper quintile of income in the US compared to the UK, health outcomes in the top quintile were worse in the US than those in the top quintile in the UK (Choi, JAMA Intern Med, 2020; 180: 1185-1193). A second article showed that health outcomes (e.g., infant and maternal mortality, acute myocardial infarction, colorectal cancer) of those in the US with the highest incomes were often worse than those of middle incomes in other (European) countries (Emanuel, JAMA Intern Med, 2020; 181: 339-344). These are striking findings given expectations that higher incomes typically result in better health outcomes.

A population health science, systems-oriented approach to behavioral research is critically needed and timely. Francis Collins at the end of his tenure as the Director of NIH noted that we need to invest more into understanding behavioral influences on health. Additional emphases on social determinants and on health equity may be key to improving population health both by improving the health of large, ‘at-risk’ population groups and because of the unavoidability that the systems we create ultimately affect all of us, with implications for our health behaviors and outcomes. Though Emanuel et al. implicated uneven systems of health care in explaining the often worse outcomes in privileged US citizens vs. middle income individuals in other countries, many other systems (e.g., food, energy, the social safety net) have produced environments that often both constrain and distort behaviors (e.g., obesity epidemic, opioid and rising alcohol consumption), leading to poorer health outcomes. 

Rather than a zero-sum game, we are all in this together, and solutions focusing on systemic approaches to ensuring health equity may lead to better population health. Emphases in population health on health equity and policy – institutional, community, and legislative – will be critical to its success. I invite you to get involved with our group to move our conversation and its activities forward. Please contact me (Candyce Kroenke, ScD – current Chair) at candyce.h.kroenke@kp.org or Jess Gorzelitz, PhD (next year’s Chair) at jessica.gorzelitz@nih.gov.

 

References

Choi H, Steptoe A, Heisler M, Clarke P, Schoeni RF, Jivraj S, Cho TC, Langa KM. Comparison of Health Outcomes Among High- and Low-Income Adults Aged 55 to 64 Years in the US vs England. JAMA Intern Med. 2020 Sep 1;180(9):1185-1193. doi: 10.1001/jamainternmed.2020.2802.

Emanuel EJ, Gudbranson E, Van Parys J, Gørtz M, Helgeland J, Skinner J. Comparing Health Outcomes of Privileged US Citizens with Those of Average Residents of Other Developed Countries. JAMA Intern Med. 2021 Mar 1;181(3):339-344. doi: 10.1001/jamainternmed.2020.7484.

Kindig D, Stoddart G. What is Population Health? American Journal of Public Health, 2003; 93(3): 380-383.

Kindig DA, Asada Y, Booske BA. Population Health Framework for Setting National and State Health Goals. JAMA, 2008; 299(17): 2081-2083.

Keyes KM, Galea S. Population Health Science. 2016. Oxford University Press, New York, NY.

Rose G, Sick Individuals and Sick Populations, International Journal of Epidemiology, Volume 30, Issue 3, June 2001, Pages 427–432, https://doi.org/10.1093/ije/30.3.427


To Diet or Not to Diet: Communicating Nutrition Information to a Lay Audience

Kathryn Knoff, PhD, CHES; Student SIG Chair


In the Health Education sector of behavioral medicine and public health, we are frequently asked a myriad of health questions, both in and outside of our niche. Most of the population is aware that nutrition and a healthy diet are a part of a healthy lifestyle and that we should aim for this. However, many are overwhelmed by the amount of information on nutrition that is available to them, as the internet is the main source of nutrition information.1 At the same time, researchers also know how it feels to have a wealth of information at their fingertips. However, with an abundance of fad diets that reach the top levels of viewership, having access to inaccurate information ends up being detrimental to society and health. It is imperative to provide accurate and beneficial information about nutrition to the public.

It is easy to become frustrated for researchers and practitioners when communicating to a lay audience that may have previously sought out information to try a fad diet. Many of these fad diets claim to, for example, (1) cure or definitively prevent cancer, (2) promote high intake of fatty foods, or (3) over-restrict food and label foods as “good” or “bad”.2 This along with many other claims can seem like an appealing route to take, especially when coupled with celebrities promoting juice cleanses, expensive supplements, and meal replacements. However, studies have demonstrated that (1) certain foods MAY help prevent some cancers, (2), fruits and vegetables are an important part of a healthy diet, or (3) overeating can lead to obesity and associated health problems.2 While fad diets are often promoted as a cure-all, we know this is not the case. Many fad diets are not sustainable long-term through severe calorie restriction, rigid rules, or elimination of essential food groups, all of which can lead to binge eating.3

There are many approaches that can be taken to discuss nutrition information with friends, family members, or colleagues. First, I would always recommend seeking a local Registered Dietitian Nutritionist (RDN) for a specific diet. RDNs can assist individuals in finding a perfect and tailored plan that is sustainable and still includes favorite foods. This is key to developing a healthy dietary lifestyle. So, whether your diabetic family member is looking to improve their lifestyle or if your nephew wants to fuel for their sport more efficiently, an RDN can help. The Academy of Nutrition and Dietetics website has a search function for finding local RDNs in all settings (i.e., schools, hospitals, etc.; https://www.eatright.org/food/resources/learn-more-about-rdns/find-an-rdn-anywhere-you-need-one). If someone is just looking to learn more about nutrition, start with the USDA’s MyPlate regimen (https://www.myplate.gov/), which focuses on a complete balanced lifestyle and provides the tools to help make healthier decisions.
 

Here are a few basic dos and don’ts of communicating nutrition information to take away:

Do:

  • Suggest valid sources, such as the USDA MyPlate website
  • Suggest a visit to an RDN for specific dietary plans
  • Suggest lifestyle changes instead of temporary diets
  • Start with small changes, such as adding 1 serving of fruit to breakfast and lunch
  • Remember that indulging in favorite comfort foods is ok in moderation
  • Remember that many budget-friendly foods are great (such as frozen or canned produce over fresh produce).
     

Don’t:

  • Promote a “one size fits all” dietary approach4
  • Promote fast weight loss (i.e., greater than 1-2 lbs/week)5
  • Promote fad diets
  • Promote expensive “diet foods”
  • Promote over-restriction or cutting out entire foods or food groups unless there is good reason (e.g., allergies)
  • Vilify any specific food or food group, or budget-friendly options

 

Additional Resources

https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf#page=31

https://www.who.int/news-room/fact-sheets/detail/healthy-diet

https://www.cdc.gov/healthyweight/losing_weight/index.html

https://www.cdc.gov/healthyweight/healthy_eating/index.html

https://www.myplate.gov/

https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss/art-20048466

https://www.nutrition.gov/topics/basic-nutrition/healthy-eating  

https://www.heart.org/en/healthy-living/healthy-eating

https://www.eatright.org/food/resources/learn-more-about-rdns/find-an-rdn-anywhere-you-need-one

https://www.eatright.org/food#resources

 

References

  1. Adamski, M., Truby, H., M. Klassen, K., Cowan, S., & Gibson, S. (2020). Using the Internet: Nutrition Information-Seeking Behaviours of Lay People Enrolled in a Massive Online Nutrition Course. Nutrients, 12(3), 750. https://doi.org/10.3390/nu12030750
  2. Hall, H. (2014). Food myths: What science knows (and does not know) about diet and nutrition. Skeptic (Altadena, CA), 19(4), 10–20.
  3. Mayo Clinic Health System Staff. (2019, May 22). Don’t fall for a fad diet. Retrieved on February 10th, 2022 from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/dont-fall-for-a-fad-diet
  4. Mayo Clinic. (2020, June 6). Weight loss: Choosing a diet that’s right for you. Retrieved February 10th, 2022 from https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss/art-20048466
  5. Centers for Disease Control and Prevention. (2020, August 17). Losing Weight. Retrieved on February 10th, 2022 from https://www.cdc.gov/healthyweight/losing_weight/index.html

 


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 your membership status, 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
 

What Predicts the Physical Activity Intention–Behavior Gap? A Systematic Review

 Ryan E Rhodes, PhD, Amy Cox, MA, Reza Sayar, MSc

Background
Intention is theorized as the proximal determinant of behavior in many leading theories and yet intention–behavior discordance is prevalent.

Purpose
To theme and appraise the variables that have been evaluated as potential moderators of the intention–physical activity (I-PA) relationship using the capability–opportunity–motivation– behavior model as an organizational frame.

Methods
Literature searches were concluded in August 2020 using seven common databases. Eligible studies were selected from English language peer-reviewed journals and had to report an empirical test of moderation of I-PA with a third variable. Findings were grouped by the moderator variable for the main analysis, and population sample, study design, type of PA, and study quality were explored in subanalyses.

Results
The search yielded 1,197 hits, which was reduced to 129 independent studies (138 independent samples) of primarily moderate quality after screening for eligibility criteria. Moderators of the I-PA relationship were present among select variables within sociodemographic (employment status) and personality (conscientiousness) categories. Physical capability, and social and environmental opportunity did not show evidence of interacting with I-PA relations, while psychological capability had inconclusive findings. By contrast, key factors underlying reflective (intention stability, intention commitment, low goal conflict, affective attitude, anticipated regret, perceived behavioral control/self-efficacy) and automatic (identity) motivation were moderators of I-PA relations. Findings were generally invariant to study characteristics.

Conclusions
Traditional intention theories may need to better account for key I-PA moderators. Action control theories that include these moderators may identify individuals at risk for not realizing their PA intentions. Prospero # CRD42020142629.

 

Historical Loss: Implications for Health of American Indians in the Blackfeet Community

 Neha A John-Henderson, PhD, Benjamin Oosterhoff, PhD, Taylor D Kampf, Brad Hall, EdD, Lester R Johnson, III, EdD, Mary Ellen Laframboise, BSW, Melveena Malatare, MA, Emily Salois, MSW, ACSW, Jason R Carter, PhD, Alexandra K Adams, PhD, MD

Background
Historical loss in American Indians (AIs) is believed to contribute to high incidence of mental health disorders, yet less is known about the associations between historical loss and physical health.

Purpose
To investigate whether frequency of thought about historical loss predicts risk factors for chronic physical health conditions in an AI community.

Methods
Using Community Based Participatory research (CBPR) and Ecological Momentary Assessment (EMA), we measured frequency of thoughts about historical loss in 100 AI adults residing on the Blackfeet reservation. Participants completed a 1-week monitoring period, during which ambulatory blood pressure and daily levels of psychological stress were measured. At the end of the week, we collected a dried blood spot sample for measurement of C-reactive protein (CRP).

Results
In hierarchical linear regression models controlling for demographics and relevant covariates, greater frequency of thoughts about historical loss predicted higher average daily psychological stress (B = .55, t = 6.47, p < .001, ΔR2 = .30) and higher levels of CRP (B = .33, t = 3.93, p < .001, ΔR2 = .10). Using linear mixed modeling with relevant covariates, we found that greater thoughts about historical loss were associated with higher systolic ambulatory blood pressure (B = .32, 95% CI = .22–.42, t = 6.48, p < .001, ΔR2 = .25; Fig. 1c) and greater diastolic ambulatory blood pressure (B = .19, 95% CI = .11–.27, t = 4.73, p < .001, ΔR2 = .19).

Conclusions
The data suggest that frequency of thought about historical loss may contribute to increased subclinical risk for cardiovascular disease in the Blackfeet community.

 

Daily Motivational Text Messages to Promote Physical Activity in University Students: Results From a Microrandomized Trial

Caroline A Figueroa, MD, PHD, Nina Deliu, MSc, Bibhas Chakraborty, PhD, Arghavan Modiri, Msc, Jing Xu, PhD, Jai Aggarwal, MSc, Joseph Jay Williams, PhD, Courtney Lyles, PhD, Adrian Aguilera, PhD

Background
Low physical activity is an important risk factor for common physical and mental disorders. Physical activity interventions delivered via smartphones can help users maintain and increase physical activity, but outcomes have been mixed.

Purpose
Here we assessed the effects of sending daily motivational and feedback text messages in a microrandomized clinical trial on changes in physical activity from one day to the next in a student population.

Methods
We included 93 participants who used a physical activity app, “DIAMANTE” for a period of 6 weeks. Every day, their phone pedometer passively tracked participants’ steps. They were microrandomized to receive different types of motivational messages, based on a cognitive-behavioral framework, and feedback on their steps. We used generalized estimation equation models to test the effectiveness of feedback and motivational messages on changes in steps from one day to the next.

Results
Sending any versus no text message initially resulted in an increase in daily steps (729 steps, p = .012), but this effect decreased over time. A multivariate analysis evaluating each text message category separately showed that the initial positive effect was driven by the motivational messages though the effect was small and trend-wise significant (717 steps; p = .083), but not the feedback messages (−276 steps, p = .4).

Conclusions
Sending motivational physical activity text messages based on a cognitive-behavioral framework may have a positive effect on increasing steps, but this decreases with time. Further work is needed to examine using personalization and contextualization to improve the efficacy of text-messaging interventions on physical activity outcomes.

 

 

Translational Behavioral Medicine
 

Anti-Black racism and behavioral medicine: confronting the past to envision the future

 Jessica Y Breland, Michael V Stanton

Behavioral medicine research and practice have not traditionally acknowledged the detrimental effects of anti-Black racism (and other forms of systemic oppression) on health, interventions, or research. This commentary describes four ways that behavioral medicine researchers and clinicians can address the past to envision the future of behavioral medicine to promote equitable health for all: 1) name anti-Black racism, 2) ensure interventions address structural inequities, 3) advocate for systemic change, and 4) change expectations for publications.

 

A multiperspective on the broad dissemination of research findings to past research participants and the community-at-large

Tilicia L Mayo-Gamble, Jennifer Cunningham-Erves, Chioma Kas-Osoka, George W Johnson, Nicole Frazier, Yvonne Joosten

Dissemination of research findings to past research participants and the community-at-large is a critical element to improving health outcomes, yet it is often overlooked by researchers. Few studies have explored how to provide study findings to the community, and no studies have investigated how community members can be involved in this process. This study explored views on the broad dissemination of research findings to community members and the role of the community in the dissemination process. We conducted a comparative analysis from the perspective of researchers, community members, and program officers (POs) from national health research funding agencies. Semistructured interviews were conducted with community members (African American, N = 10; Latino, N = 10), academic researchers (N = 10), and POs (N = 5). Thematic analysis was utilized in which codes and themes were created. One cross-cutting theme was identified, Views on Disseminating Research Findings to Communities. There were three additional themes identified among community members, five among researchers, and four among POs. All groups perceived the value of dissemination to communities as meaningful and ethical. Groups differed in their perceptions of prioritization of dissemination audiences. This study highlighted consensus on the value of broad dissemination to the community-at-large and identified areas of insufficiency in the translational research continuum that could be expanded or improved to ensure targeted groups receive the intended benefits of positive research findings. The long-term benefit of disseminating findings to the community-at-large is increased acceptability of interventions and reduced mistrust in research and researchers.

 

The preparation phase in the multiphase optimization strategy (MOST): a systematic review and introduction of a reporting checklist

 Ryan R Landoll, Sara E Vargas, Kristen B Samardzic, Madison F Clark, Kate Guastaferro

Multicomponent behavioral interventions developed using the multiphase optimization strategy (MOST) framework offer important advantages over alternative intervention development models by focusing on outcomes within constraints relevant for effective dissemination. MOST consists of three phases: preparation, optimization, and evaluation. The preparation phase is critical to establishing the foundation for the optimization and evaluation phases; thus, detailed reporting is critical to enhancing rigor and reproducibility. A systematic review of published research using the MOST framework was conducted. A structured framework was used to describe and summarize the use of MOST terminology (i.e., preparation phase and optimization objective) and the presentation of preparation work, the conceptual model, and the optimization. Fifty-eight articles were reviewed and the majority focused on either describing the methodology or presenting results of an optimization trial (n = 38, 66%). Although almost all articles identified intervention components (96%), there was considerable variability in the degree to which authors fully described other elements of MOST. In particular, there was less consistency in use of MOST terminology. Reporting on the MOST preparation phase is varied, and there is a need for increased focus on explicit articulation of key design elements and rationale of the preparation phase. The proposed checklist for reporting MOST studies would significantly advance the use of this emerging methodology and improve implementation and dissemination of MOST. Accurate reporting is essential to reproducibility and rigor of scientific trials as it ensures future research fully understands not only the methodology, but the rationale for intervention and optimization decisions.

 

 

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.
 

Ellen Beckjord, PhD, MPH
Dr. Beckjord was selected as one of Managed Healthcare Executive’s 2021 Emerging Health Leaders and named a Ragan Top Women in Wellness and HR Awardee for Behavioral Health

Martin S. Hagger, PhD
Dr. Hagger was awarded the Paper of the Year Award in the Scandinavian Journal of Medicine and Science in Sports for an article testing his trans-contextual model in the context of sport injury.

Abby C. King, PhD
Dr. King was recognized with Stanford University’s 2022 Miriam Aaron Roland Volunteer and Public Service Prize.

Rebecca A. Krukowski, PhD
Dr. Krukowski was selected as a Short Term Grantee for the University of Bayreuth Centre for International Excellence.

Bonnie Spring, PhD, ABPP
The Women’s Faculty Organization of Northwestern University Feinberg School of Medicine selected Dr. Spring to receive its 4th Annual Paula H. Stern Award for Outstanding Women in Science and Medicine.