Outlook: Newsletter of the Society of Behavioral Medicine

Fall 2019

President’s Message: Climate Change and Gun Violence Feature Prominently in Provocative Questions

Michael Diefenbach, PhD, SBM President

Michael Diefenbach, PhD, SBM president
Michael Diefenbach, PhD
SBM President

Dear Colleagues,

In my last message I sent you off into a summer that was hopefully filled with time for family and needed relaxation. Although it was just three months ago, it feels much longer and I fear the times of “slow summers” are over. During the last few months, we launched our Provocative Questions initiative and I’m grateful to all of you who took the time and responded with ideas for behavioral medicine of the future. We compiled all your responses and are in the process of clustering them into overarching themes. I will talk more about this process and some results in one of my upcoming columns. What I noticed so far, however, is that responses were influenced by present day concerns.

This summer we saw the Amazon and the Alaskan Tundra burning, and with Hurricane season upon us, facts about global warming are becoming inescapable. Not surprisingly, research questions regarding climate change and health topped our list of provocative questions. Members saw climate change as a public health problem and questions ranged from the impact of climate change on human health and the use of behavioral science to address climate change, to the role of behavioral medicine in sustainable development and the role individual behaviors to reduce the overall carbon footprint.

It appears that current events also influenced respondents’ thinking into another area of research. I am talking about gun violence and mass shootings. The tragic truth is that 2019 is on a path to become the deadliest year in terms of mass shootings. As of the time of this writing, we have experienced 295 mass shootings, which are defined as an incident during which more than four people were shot. The statistics are staggering: 10,369 individuals killed, twice the number of injuries (20,723), and 2,610 children and teens injured or killed. I have no words to describe the loss and emotional toll on individuals and their families. Our provocative question responders recognized this and asked how health behavior theory and interventions could be used to reduce gun violence.

I believe as a society that is concerned about behavior and health we are in a unique position to contribute to both the climate and the gun violence debates. The responses to the Provocative Questions initiative demonstrate that members see these topics of utmost importance and worthy of our time and effort. On a personal level, I could not agree more. I challenge you to think about ways behavioral medicine can address these problems, which go beyond advocacy and the compilation of statistics. Connect with colleagues to communicate your thoughts—our SIGs are terrific vehicles for these kind of discussions. If you have pertinent research to present, consider it for submission as a rapid communication poster at the 2020 Annual Meeting.

On the society level, SBM published a policy statement in Translational Behavioral Medicine urging Congress to restore funding to the Centers for Disease Control and Prevention (CDC) to support research on gun violence, and although the related amendment has not yet been repealed, it was clarified that the CDC is allowed to conduct gun violence research. Federal funds cannot be used, however, to advocate for gun control measures.

As you conduct your research and teaching activities over the next few months and prepare to attend the Annual Meeting next year, I hope you are thinking about the role of behavioral medicine regarding climate and gun violence issues. I’m looking forward to your comments and your thoughts. And I’m looking forward to sharing information on many of the other Provocative Question topics leading up to and and at the Annual Meeting.

Best wishes for a productive fall,

Non-Pharmacological Management of Pain: Interview with Dr. Sara Edmond

Samantha G. Farris, PhD and Emily Walsh, BA; Pain SIG

Sara Edmond, PhD Samantha G. Farris, PhD Emily Walsh, BA

The Pain Special Interest Group (Pain SIG) recently interviewed Dr. Sara Edmond, a research and clinical psychologist at the Pain Research, Informatics, Multimorbidities and Education (PRIME) Center at VA Connecticut Healthcare System and an Associate Research Scientist in the Department of Psychiatry at Yale School of Medicine about her perspectives on encouraging the uptake of evidence-based non-pharmacological pain management strategies by enhancing patient-provider communication. Dr. Edmond’s editorial on pain was recently published in JAMA Psychiatry.  We were able to catch up with her about this publication and also to capture her expert insights on non-pharmacological management of pain in clinical practice.

Thank you Dr. Edmond for speaking with us on behalf of the Pain SIG. We’re excited to hear about your expertise in the non-pharmacological management of pain. Can you tell us about your current intervention study?

Pain SMART (Shared Medical Appointment to Refocus Treatment) is a single-session shared medical appointment intervention – shared meaning multiple providers working with a group of patients. The goal of Pain SMART is to enhance patient-provider communication about pain by using motivational interviewing strategies to discuss non-pharmacological treatments. Primary care providers often say that talking with their patients about chronic pain is challenging, and shared medical appointments are a more relaxed environment to facilitate this conversation. Patients also feel like they get more time with their providers. Another benefit is that Veterans enjoy hearing from one another. For example, in one group, one Veteran shared his experience with yoga for chronic pain and other Veterans seemed to appreciate hearing from a Veteran rather than a medical provider about what has worked.

What are some of the challenges in working with patients with lower motivation for utilizing non-pharmacological pain management approaches?

We’ve studied barriers to engaging in these treatments, and we’ve found that even though they are evidence-based, patients don’t know that, and sometimes, providers also don’t know. So, providers may not do a good job of selling these approaches to patients. Patients are, understandably, less motivated to try things if they are skeptical about their efficacy. Another factor is that some of these approaches require patients take a more active role in their care. Some patients have lower self-efficacy to implement those strategies. For instance, patients with kinesiophobia, or may be nervous to try exercise or physical therapy because they are fearful that it will make their pain worse.

It sounds like you collaborate with many different types of providers. What is it like collaborating with professionals who work outside of the field of behavioral medicine.

I work quite a bit in primary care, so I work with physicians who are not necessarily experts in behavioral medicine. I think medical schools are doing a much better job of emphasizing the biopsychosocial model, but there is still a tendency to treat pain from a biomedical standpoint. Primary care providers are often very burdened and feel a time crunch during patient appointments, so I’ve tried to give them brief scripts or short phrases that they can use to convey messages to their patients efficiently.

In your recent editorial published in JAMA Psychiatry, you outline three specific recommendations for what mental health clinicians can do to address pain in clinical practice. Tell us about those recommendations.

Another thing I’m passionate about is encouraging mental health clinicians to think about pain as part of their scope of practice, instead of as a medical problem.  The editorial suggests three ways to incorporate pain into routine clinical care. First, assess pain and the impact pain has on a patient’s life. Second, incorporate that knowledge into your case conceptualization and treatment planning. For example, if you ask your patient with PTSD to do exposure-based activities, consider whether those activities may also exacerbate pain, which could reduce treatment compliance. Third, reinforce the biopsychosocial model. Mental health providers can help patients understand how pain may relate to other problems.

What advice would you have for trainees who are interested in doing research in chronic pain?

Remember that pain is one of the most common presenting problems in patients in primary care and is one of the largest causes of disability. If you’re in a research setting or work with a population in which pain is not a specific focus, , consider how you could measure the prevalence or correlates of pain.


Check out these relevant publications:

Edmond, S.N, Heapy, A.A, & Kerns, RD, JAMA Psychiatry. 2019;76(6):565-566. doi:10.1001/jamapsychiatry.2019.0254

Ankawi, B., Kerns, RD, & Edmond, SN. Enhancing motivation for change in the management of chronic painful conditions: a review of recent literature. Curr Pain Headache Rep. 2019;23(10):75. doi: 10.1007/s11916-019-0813-x

Cheers to Good Health? Challenges and Opportunities in Communicating Alcohol-related Cancer Risk

Courtney L. Scherr, PhD and Jennifer L. Hay, PhD; Health Decision Making SIG

Alcohol consumption can cause cancer. In the last five years, the evidence for this has become well-established (Rehm & Shield, 2014; U.S. Department of Health and Human Services National Toxicology Program, 2016). Heavy consumption is associated with liver cancer, whereas moderate to heavy consumption is associated with head, neck and colorectal cancers. Even light drinking is associated with increased risk for esophageal and breast cancer. A dose-response association exists - as alcohol consumption increases, so does cancer risk (Bagnardi et al., 2015).  Yet awareness of the link between alcohol consumption and cancer risk is modest, both internationally (Scheideler & Klein, 2018) and in the United States (Wiseman & Klein, 2019). Promoting public understanding of these risks present familiar communication challenges faced by behavioral scientists, public health professionals, and healthcare providers; we present some examples below.

Combatting positive associations with alcohol. Societal acceptance of drinking is deeply entrenched in culture. Positive associations and affect are intimately connected to the social and celebratory context of alcohol consumption as a way to unwind and connect with others. These associations may prevent message acceptance and behavior change motivation. In some respects, the relatively recent evidence for cancer risk associated with alcohol consumption harkens to the time when evidence was mounting for cancer risk associated with tobacco use, which traditionally had many similar positive affective associations. Similar to prior tobacco marketing, alcohol advertising works to deny, minimize or distract the consumer from associated cancer risks (Petticrew, Maani Hessari, Knai, & Weiderpass, 2018). Public health messages must consider affective implications and marketing messages in order to minimize message avoidance and/or reactance.

Addressing “mixed messages.” The belief that some drinking is healthy may complicate risk message acceptance. Over the past 30 years, messages regarding the cardiovascular health benefits of modest red wine consumption furthered this message (Lindberg & Amsterdam, 2008), in addition to more recent evidence of a protective effect for type 2 diabetes, and other cancers (e.g., renal cell carcinoma, multiple myeloma, non-Hodgkin lymphoma, and thyroid cancer) (Allen et al., 2009; Karami, Daugherty, & Purdue, 2015; Koppes, Dekker, Hendriks, Bouter, & Heine, 2005; Li, Yu, Zhou, & He, 2016; Santo, Liao, Andreotti, Purdue, & Hofmann, 2019). In a related way, messages about the health benefits of Vitamin D have complicated acceptance of cancer risk from sun exposure (Youl, Janda, & Kimlin, 2009).

Clarifying guideline changes. Current dietary guidelines for alcohol consumption do not yet stress the health risks of even light or modest consumption (U.S. Department of Health and Human Services and U.S. Department of Agriculture, 2015). Yet, recent evidence suggests only zero alcohol consumption is considered safe (GBD 2016 Alcohol Collaborators, 2018). Given the evidence, we might anticipate changes to the dietary guidelines[CL3] [CELS4]  in the coming years. As with recent changes to guidelines for mammography and prostate cancer screening (PSA), communication challenges may arise.

It is necessary for behavioral scientists, public health professionals, and healthcare providers to identify challenges to message acceptance and clarify any contradictory evidence about the risks and benefits of alcohol consumption, in order to reduce any information overload or confusion.  In large, diverse samples of adults in the United States, cancer information overload and cancer risk uncertainty are exceedingly common (Cunningham et al., 2019; Paskett et al., 2019; Rawl et al., 2019). Message strategies to reduce backlash and fatalism (Jensen et al., 2017) that provide rationale for any guideline changes will be needed to optimize public message acceptance.

Multiple opportunities for behavioral science expertise. Expertise is needed to address these challenges across a range of disciplines including behavioral health, communication science, social psychology, public health/health education, and dissemination and implementation. Message strategies must challenge existing social and cultural norms, help the public manage seemingly contradictory information, and reconcile evolving guidelines. Making communication strategies available to healthcare providers that support patient discussions will be essential to reduce confusion and support informed decision-making. It may take time and consistent messaging from multiple sources to achieve public acceptance concerning the cancer risks associated with alcohol consumption (Bagnardi et al., 2015). Careful crafting of communication and strategic public health messaging are an important starting point. Anticipating such challenges will galvanize the research agenda to reduce alcohol consumption and the associated cancer risk over the next few years.



Allen, N. E., Beral, V., Casabonne, D., Kan, S. W., Reeves, G. K., Brown, A., . . . on behalf of the Million Women Study Collaborators. (2009). Moderate alcohol intake and cancer incidence in women. JNCI: Journal of the National Cancer Institute, 101, 296-305.

Bagnardi, V., Rota, M., Botteri, E., Tramacere, I., Islami, F., Fedirko, V., . . . La Vecchia, C. (2015). Alcohol consumption and site-specific cancer risk: A comprehensive dose-response meta-analysis. Br J Cancer, 112, 580-593.

Cunningham, S. A., Yu, R., Shih, T., Giordano, S., McNeill, L. H., Rechis, R., . . . Shete, S. (2019). Cancer-related risk perceptions and beliefs in Texas: Findings from a 2018 population-level survey. Cancer Epidemiology, Biomarkers & Prevention, 28, 486-494.

GBD 2016 Alcohol Collaborators. (2018). The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry, 5, 987-1012.

Jensen, J. D., Pokharel, M., Scherr, C. L., King, A. J., Brown, N., & Jones, C. (2017). Communicating uncertain science to the public: How amount and source of uncertainty impact fatalism, backlash, and overload. Risk Analysis, 37, 40-51.

Karami, S., Daugherty, S. E., & Purdue, M. P. (2015). A prospective study of alcohol consumption and renal cell carcinoma risk. Int J Cancer, 137, 238-242.

Koppes, L. L., Dekker, J. M., Hendriks, H. F., Bouter, L. M., & Heine, R. J. (2005). Moderate alcohol consumption lowers the risk of type 2 diabetes: A meta-analysis of prospective observational studies. Diabetes Care, 28, 719-725.

Li, X.-H., Yu, F.-f., Zhou, Y.-H., & He, J. (2016). Association between alcohol consumption and the risk of incident type 2 diabetes: A systematic review and dose-response meta-analysis. The American Journal of Clinical Nutrition, 103, 818-829.

Lindberg, M. L., & Amsterdam, E. A. (2008). Alcohol, wine, and cardiovascular health. Clinical Cardiology, 31, 347-351.

Paskett, E. D., Young, G. S., Bernardo, B. M., Washington, C., DeGraffinreid, C. R., Fisher, J. L., & Huerta, T. R. (2019). The CITIES project: Understanding the health of underrepresented populations in Ohio. Cancer Epidemiology, Biomarkers & Prevention, 28, 442-454.

Petticrew, M., Maani Hessari, N., Knai, C., & Weiderpass, E. (2018). How alcohol industry organisations mislead the public about alcohol and cancer. Drug and Alcohol Review, 37, 293-303.

Rawl, S. M., Dickinson, S., Lee, J. L., Roberts, J. L., Teal, E., Baker, L. B., . . . Haggstrom, D. A. (2019). Racial and socioeconomic disparities in cancer-related knowledge, beliefs, and behaviors in Indiana. Cancer Epidemiology, Biomarkers & Prevention, 28, 462-470.

Rehm, J., & Shield, K. (2014). Alcohol consumption International Agency for Research on Cancer World Cancer Report 2014 (pp. 96-104).

Santo, L., Liao, L. M., Andreotti, G., Purdue, M. P., & Hofmann, J. N. (2019). Alcohol consumption and risk of multiple myeloma in the NIH‐AARP Diet and Health Study. Int J Cancer, 144, 43-48.

Scheideler, J. K., & Klein, W. M. P. (2018). Awareness of the link between alcohol consumption and cancer across the world: A review. Cancer Epidemiology, Biomarkers & Prevention, 27, 429-437.

U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015). 2015-2020 Dietary Guidelines for Americans.  Retrieved from https://health.gov/dietaryguidelines/2015/guidelines/.

U.S. Department of Health and Human Services National Toxicology Program. (2016). 14th Report on Carcinogens 2016.  Retrieved from https://ntp.niehs.nih.gov/go/roc14.

Wiseman, K. P., & Klein, W. M. P. (2019). Evaluating correlates of awareness of the association between drinking too much alcohol and cancer risk in the United States. Cancer Epidemiology, Biomarkers & Prevention.

Youl, P. H., Janda, M., & Kimlin, M. (2009). Vitamin D and sun protection: The impact of mixed public health messages in Australia. Int J Cancer, 124, 1963-1970.

SBM Past-President Dr. Gary Bennett Shares His Experiences Using the Multiphase Optimization Strategy (MOST)

Tiffany Bullard; Optimization of Behavioral and Biobehavioral Interventions (OBBI) SIG Student Liaison

Gary G. Bennett, PhD

The Society of Behavioral Medicine’s (SBM) Optimization of Behavioral and Biobehavioral Interventions Special Interest Group (OBBI SIG) recently interviewed SBM Past-President, Dr. Gary G. Bennett, on his experiences optimizing a standalone text messaging-based weight loss intervention as part of an ongoing R01 trial.

Tell us a bit about the aims of your grant.

We are using MOST to identify which components should be included in a standalone text messaging obesity intervention for adults. Using a full factorial design, we are randomizing 592 participants to one of 16 experimental conditions. Findings from this study will help us determine which text messaging components and levels contribute to 6-month weight change and the 6-month change in diet and physical activity. We will also assess the proportion of participants who achieve > 5% weight loss at 6 months and maintenance at 12 months.

Why was it important to use MOST to answer your specific research question(s)?

There are so many reasons! First, I love the philosophy of optimizing a treatment package for a specific purpose. I find it to be both liberating conceptually while forcing a degree of focus that’s lacking in other approaches. 

Second, iteration. What MOST describes as the continuous optimization principle could also be described as iteration, a concept that is fundamental to modern software design. MOST hasn’t been around long enough to actualize this principle, but in theory, after completing optimization, we should re-start MOST – either on our work or on that of others – to continue refining our interventions for optimal effectiveness.

Finally, the component selection phase is a critical hedge against intellectual hubris! Put another way; when developing interventions, we make so many decisions that have little to no evidentiary basis. We make them with the best intentions, extrapolating from theory and the available evidence, but these decisions are not data-driven. Also, we’re often wrong (and don’t know it).

Describe one major challenge that has emerged while conducting your study.

Just one?! Selecting components to makeup our optimized treatment package is challenging because there are so many considerations: the criteria one uses to make the selection, the outcomes of interest, their measures, and analysis, how one should think about interactions (to be clear, all the action is in the interactions), not to mention the atmospherics of the selection process (who leads the discussion, how the data are presented, how discrepancies are resolved), and in our case, and how one keeps the selection meeting(s) on track (our findings were so surprising that we kept tripping in rabbit holes). None of these challenges, however, outweigh the fun of MOST.

What advice do you have for other behavioral scientists considering the MOST framework for their research?

Linda Collins and her team at Penn State have done an amazing job of disseminating MOST! I refer to their materials frequently. We’ve sent colleagues to their training courses, and they’re very open to collaboration and advice. I also learn more rapidly by listening and I’ve loved watching their talks on YouTube, so, I’d recommend contacting them.

For background information and additional resources on optimization of behavioral and biobehavioral interventions, visit The Penn State Methodology Center.

Leading the Narrative: How Do Researchers and Clinicians Discuss Gun Violence?

Katy Maher, PhD; Arlen C. Moller, PhD; and Sheela Raja, PhD ; Violence and Trauma SIG

Gun violence is a central topic of conversation today and is featured in our president’s message to members in this issue of Outlook.  It is increasingly discussed on multiple platforms from political round tables, social media, television, coffee shops, and around the dinner table with family and friends. As the nation’s leading group of professionals dedicated to improving health and quality of life through behavioral science, we are increasingly called upon to discuss these issues. While writing this, three major mass shootings occurred within a single week, two within a thirteen-hour timespan, and a Chicago hospital went on diversion after several multi-shooting incidents.

At the Society of Behavioral Medicine’s 2019 Annual Meeting, we were challenged to “Lead the Narrative” and engage in public discourse about health.  Members of the Violence and Trauma SIG are conducting research and practicing at the intersection of trauma and health every day, often on the “front lines.” As behavioral health scientists, we know traumatic events, such as these, often have adverse influences on both physical and mental health. For this piece, three Violence and Trauma SIG members share their unique perspectives and experiences helping to lead the narrative on gun violence.

Dr. Katy Maher, Assistant Professor, Clinical Psychologist at a Level 1 Trauma Center

My "front line" was, three hours prior to writing this, sitting with a teenager in his hospital room of a level 1 trauma center as he processed anger around being shot and vivid nightmares. As a clinician who works with gun violence most days of the week, I am passionate about spreading evidence-based research and interventions to my colleagues and trainees, as well as our interdisciplinary team. For those interested in trauma research, I often refer to The International Society for Traumatic Stress Studies, a society ‘dedicated to sharing information about the effects of trauma’ and often attend their national conference (International Society for Traumatic Stress Studies, n.d.). I also refer colleagues and peers to the Psychological First Aid Manual for basic tools of how to respond to acute trauma, such as relaxation or social connections (Brymer et al., 2006). For children, I often recommend the National Child Traumatic Stress Network, whose mission is to raise the standard of care and improve access to services for traumatized children, their families and communities throughout the United States’ and  has a variety of handouts such as "For Teens Coping after Mass Violence" or "Parent Guidelines for Helping Youth after Mass Violence Attack" (National Child Trauma Stress Network, n.d.). The US Department of Veterans Affairs National Center for PTSD also provides wonderful resources that educate individuals on what PTSD is and types of clinical interventions (U.S. Department of Veterans Affairs, 2019). By sharing these resources with others, I help spread accurate and evidence-based public health information.

Dr. Sheela Raja, Clinical Psychologist, Associate Professor, and Chair of SBM Violence and Trauma SIG

I lead the narrative by embracing the opportunity to educate people about gun violence. We are in the middle of a public health crisis and we urgently need to disseminate what we know to various media outlets—in simple ways that people can connect with. For example, if someone is already depressed, a gun in the home increases the chance of a lethal suicide attempt. A gun in the home increases the chances that women will be murdered in interpersonal violence and unsecured firearms are responsible for many accidental deaths and injuries of children (Children’s Hospital of Philadelphia Research Institute, 2019). We cannot become emotionally numb as a populace; as researchers and clinicians, we must advocate and educate. Our Violence and Trauma SIG has co-authored policy briefs on this topic and I hope it’s just the beginning of what we can do.

Dr. Arlen Moller, Associate Professor and Director of Undergraduate Psychology Programs

I’ve been trying to help lead the narrative on gun violence by creating and teaching an undergraduate course on Gun Violence, Psychology, and Public Health, and by freely sharing my course materials (syllabus, slides, and assignments) with others. This course has been very well-received by students, partly I think because I have really encouraged students to come to their own conclusions about the best evidence-based strategies available for reducing gun violence (Dimmer, 2018). We review a wide range of different types of gun violence and a wide range of potential solutions. Students are graded on their ability to cite and accurately summarize high quality evidence. Another feature of the course involves using behavioral science strategies to communicate more effectively at both the individual- and mass communication levels. Interested colleagues can find materials in references (Moller, 2018). SBM members who are open to learning online should review the free MOOC offered by Johns Hopkins University Center for Gun Violence and Policy (Johns Hopkins University, n.d.). This course focuses on a public health perspective and takes approximately 18 hours to complete.


In sum, we echo Past-President Sherry Pagato’s message from last year that: “In an era where fake news and misinformation are spreading like wildfire, it is more imperative than ever that we communicate our science and public health messaging loudly and clearly.” We hope to grow the Violence and Trauma SIG more over the next year to amplify this message, and further lead the narrative on gun violence by leveraging and disseminating evidence-based behavioral science.

Tracey Revenson Named New Editor-in-Chief of Annals of Behavioral Medicine

SBM Staff

Hunter College Professor and longtime Society of Behavioral Medicine (SBM) member Tracey A. Revenson, PhD, has been named the new editor-in-chief of SBM journal, Annals of Behavioral Medicine (ABM).

Dr. Revenson already has a number of initiatives planned. She’d like to publish target articles and commentaries about new theories and advances in the field, invite brief reports that address ethical issues in behavioral medicine, and make the journal more welcoming to qualitative research and mixed method studies. “Some don’t see mixed methods as a critical part of behavioral medicine,” she said. “Yet, they are an important component of any behavioral medicine scientist’s toolkit.”

Dr. Revenson would also like to expand the journal’s audience so it’s more accessible, widely read, and highly cited by professionals outside of SBM’s membership. “We need to connect with health professionals who are on the front lines, journalists who report science, and ordinary people whose lives our research is meant to improve.…I would like to expand opportunities in the journal to use our science to address significant public health concerns such as health equity, alter the focus of interventions from biomarkers to more upstream social determinants, and address emerging health challenges such as climate change.”

Dr. Revenson’s research focuses on coping processes among individuals, couples, and families facing serious physical illnesses such as rheumatoid arthritis and cancer as well as the influence of gender and race/ethnicity on psychosocial adaptation. She has conducted basic research, observational studies, and brief behavioral interventions for these populations.

Dr. Revenson is currently assembling her editorial team. “I’ve already had a major win,” she said. “John Ruiz, PhD, has agreed to serve as the senior associate editor. Dr. Ruiz’s work examines psychosocial influences on cardiovascular disease risk with an emphasis on biobehavioral pathways, and he brings a focus on underserved populations and associated risk and resilience mechanisms.”

Dr. Revenson, an SBM fellow, began serving ABM as an associate editor from 2009-2014, and continued her service as senior associate editor from 2014-2018. Before her work on ABM, Dr. Revenson served as founding editor-in-chief of Women’s Health: Research on Gender, Behavior, and Policy, and as an associate editor of the Journal of Behavioral Medicine. She has co-authored or co-edited 13 books, including the Handbook of Health Psychology (2019). Dr. Revenson currently sits on the Editorial Board of Health Psychology, and is co-editor-in-chief of the International Journal of Behavioral Medicine. She will step down from this role before she officially becomes ABM editor-in-chief on January 1, 2020.

She will spend October to December working with outgoing Editor-in-Chief Dr. Kevin S. Masters, PhD. Dr. Masters has successfully led the journal since 2015. “Among other things, Kevin steered the journal through the transition to a new publisher and an accelerating number of manuscripts each year,” Dr. Revenson said. “He evaluated manuscripts with efficiency and diplomacy, not dispassionately, but with a cultivated interest in what he was reading.”

Dr. Revenson considers it an honor to lead the journal, but leadership will only be part of the equation. “As editor-in-chief, I see my role as a leader, decision-maker, and communicator. The editor must create and energize a team of associate editors, editorial board members, and peer reviewers who have a diverse set of research interests and values.”

When asked how she intends to keep ABM competitive and one of the top behavioral medicine journals, her answer was simple: “By publishing the best science.” She added, “And this depends on both seasoned scholars and early-career investigators submitting their best work to the journal and agreeing to review manuscripts. It takes a village!”

Five Important Points about Multimorbidity Behavioral Scientists Should Know

Tammy Stump, Multimorbidities SIG Chair

More than 50% of adults in the United States suffer from multimorbidity - the co-occurrence of two or more chronic conditions.1 In a recent issue of Health Psychology, researchers, including several members of the Multimorbidities SIG, focused on the issue of multimorbidities in health psychology and behavioral medicine. Their articles highlight several points about multimorbidity that warrant broad consideration by behavioral medicine researchers:

1. Depression is a risk factor for multimorbidity. Depression is a common diagnosis among those with multiple chronic physical conditions. New epidemiological data among Australian women showed that developing elevated depressive symptoms led to a four-fold increase in the odds of subsequently developing multimorbidity.2 Similarly, Birk et al. (2019)* found that depression prospectively predicted the development of ischemic heart disease and diabetes.3

2. Health behavior guidelines may need to be tailored for multimorbidity. Behavior change efforts among those with multimorbidity may require a greater degree of individual monitoring and tailoring than is necessary for healthy populations. In the case of exercise, Dekker, Buurman, and van der Leeden (2019)* recommend the following principles for encouraging exercise among those with multimorbidity: 1) Rigorously assess health status prior to exercise initiation, 2) Make adaptations to ensure safety, 3) Use behavior change strategies to encourage adherence, and 4) Employ advanced clinical reasoning skills to make recommendations for the individual patient.4

3. A broad range of measures of multimorbidity are available. Due to the high prevalence of multimorbidity, epidemiological and intervention studies should routinely assess multimorbidity. Nicholson, Almirall, and Fortin (2019) summarized measures of multimorbidity - broadly divided into list measures, which generate a count of number of chronic conditions, and weighted measures, in which the multimorbidity index score is weighted based on both the presence of conditions and their severity. Nicholson et al. encourage researchers to form an operational definition of multimorbidity that is most suitable for their research question in order to guide measurement selection.5

4. Individuals with multimorbidity are often excluded from clinical trials. Through a review of 600 behavioral health interventions, Stoll et al. (2019)* reveal that multimorbidity is not only rarely evaluated as an intervention moderator, it is often used as an exclusion criterion (as was the case in 68.3% of the interventions reviewed). Thus, there is a limited evidence base supporting the use of behavioral interventions, including simultaneously or sequential interventions, to address health behaviors among those with multimorbidity.6

5. Current healthcare systems often fail to promote health behavior change for those with multimorbidities. Considering the specific case of multimorbidities involving cancer and cardiovascular disease, Spring et al. (2019)* discussed the systems level factors that may lead to this population failing to receive behavioral health promotion recommendations or advice. To address the challenge of multiple health providers – each with limited time and limited expertise in health behavior change – Spring et al. propose greater integration of behavioral data in electronic health record as well as the increased use of paraprofessional health promotionists.7

*Denotes article with at least one author from the Multimorbidities SIG



  1. King, D. E., Xiang, J., & Pilkerton, C. S. (2018). Multimorbidity Trends in United States Adults, 1988–2014. The Journal of the American Board of Family Medicine, 31, 503-513.
  2. Xu, X., Mishra, G. D., & Jones, M. (2019). Depressive symptoms and the development and progression of physical multimorbidity in a national cohort of Australian women. Health Psychology, 38, 812-821.
  3. Birk, J. L., Kronish, I. M., Moise, N., Falzon, L., Yoon, S., & Davidson, K. W. (2019). Depression and multimorbidity: Considering temporal characteristics of the associations between depression and multiple chronic diseases. Health Psychology, 38, 802-811.
  4. Dekker, J., Buurman, B.M. and van der Leeden, M., 2019. Exercise in people with comorbidity or multimorbidity. Health Psychology, 38, 822-830.
  5. Nicholson, K., Almirall, J., & Fortin, M. (2019). The measurement of multimorbidity. Health Psychology, 38, 783-790.
  6. Stoll, C. R., Izadi, S., Fowler, S., Philpott-Streiff, S., Green, P., Suls, J., ... & Colditz, G. A. (2019). Multimorbidity in randomized controlled trials of behavioral interventions: A systematic review. Health Psychology, 38, 831-839.
  7. Spring, B., Stump, T. K., Penedo, F., Robinson, J. (2019) Toward a health-promoting system for cancer survivors: Patient and provider multiple behavior change. Health Psychology, 38, 840-850.

Going Global: The International Society of Behavioral Medicine Charts Steps for the Future

Lila J. Finney Rutten, PhD, MPH; SBM Member Delegate and Joost Dekker, PhD; ISBM Member-At-Large

The Society of Behavioral Medicine (SBM) is a member of the International Society of Behavioral Medicine (ISBM), a federation of 26 national societies with a shared focus on behavioral science and behavioral medicine. ISBM promotes behavioral science and research as well as education through a variety of activities including: promotion and coordination of communication and interaction among various behavioral medicine professional organizations and health professionals; promotion of international collaborative research activities; development of guidelines and standards for the implementation of behavioral medicine; and dissemination of scientific information to multidisciplinary audiences.1

 International Society of Behavioral Medicine Taskforce

While the crucial role of behavior in determining health outcomes has been long recognized2 and some societies like SBM are flourishing, ISBM and some of its member societies have observed challenges currently facing behavioral medicine professional societies such as declining membership and decreased engagement of members. Furthermore, behavioral medicine appears to suffer from lack of clarity around definition and scope.3-11 Many member societies of ISBM also lack strong ties to relevant professional societies, such as disease-focused societies, wherein behavioral science could have significant impact.12

To better understand and inform efforts to address these challenges, ISBM convened a Taskforce in February 2019. All ISBM member societies (including SBM), ISBM’s early career network, and four behavioral medicine collaborative groups were invited to nominate a representative to serve on the Taskforce. The primary objectives of the Taskforce are as follows:

  • Objective 1. Develop a proposal to update the definition of behavioral medicine, its defining characteristics and its main tasks and goals.
  • Objective 2. Develop a proposal to guide the future organization of ISBM.

The taskforce aims to clarify the primary goals and characteristics of behavioral medicine and to explicate a plan to guide the activities and priorities of ISBM to align with and support these goals.

Participate in the International Society of Behavioral Medicine

International Congress of Behavioral Medicine. ISBM hosts the International Congress of Behavioral Medicine. This scientific meeting is an excellent opportunity to connect with colleagues around the world with shared research interests. The quality of the research presented is very high and exchange and collaboration with colleagues from around the globe can be a very rewarding experience. The 16th International Congress of Behavioral Medicine, Interdisciplinary Behavioral Medicine: Systems, Networks and Interventions, will take place in Glasgow, Scotland August 19-22, 2020. Abstract submissions are currently invited with a deadline for submission of Friday November 15, 2019. Further details on the call for abstracts, program tracks, and meeting registration are available here.

Special Interest Groups and Committees: Active engagement in ISBM may include participation in interests groups and committees. For example, ISBM hosts the Diabetes Collaboration and INSPIRE, an early career and student network. ISBM also hosts several committees to support the organizational structure, function, and priorities of the society.

Dissemination: The official journal of ISBM is the International Journal of Behavioral Medicine which provides an important venue for publishing findings in behavioral medicine internationally. ISBM also publishes and distributes a newsletter to disseminate findings from behavioral research and to highlight activities of ISBM and its individual and organizational membership. ISBM is also actively involved in development, implementation, and sponsorship of behavioral medicine seminars in partnership with health organizations across the world.

There are many opportunities to get involved in ISBM. As a member organization of ISBM, SBM and our membership can leverage these important opportunities to engage in global efforts to build the evidence base in behavioral science and to improve population health.



  1. International Society of Behavioral Medicine Charter. www.isbm.info/about-isbm/charter/, 2019.
  2. Healthier Lives through Behavioral and Social Sciences Research. 2006, Office of Behavioral and Social Sciences Research: Bethesda, MD.
  3. Dekker, J., A. Stauder, and F.J. Penedo, Proposal for an Update of the Definition and Scope of Behavioral Medicine. Int J Behav Med, 2017. 24(1): p. 1-4.
  4. Dekker, J., A. Stauder, and F.J. Penedo, Defining the Field of Behavioral Medicine: A Collaborative Endeavor. Int J Behav Med, 2017. 24(1): p. 21-24.
  5. International Congress of Behavioral Medicine. Meeting: Revising the definition of behavioral medicine: perspectives from ‘western’ and ‘non-western’ countries. 2018; Available from: https://issuu.com/zentidos/docs/icbm2018_program_book?e=5521120/65519331.
  6. Johnston, M. and D. Johnston, What Is Behavioural Medicine? Commentary on Definition Proposed by Dekker, Stauder and Penedo. Int J Behav Med, 2017. 24(1): p. 8-11.
  7. Kawakami, N., Reflections on the Proposed Definition and Scope of Behavioral Medicine. Int J Behav Med, 2017. 24(1): p. 18-20.
  8. Lau, J.T., Commentary: Proposal for an Update of the Definition and Scope of Behavioral Medicine. Int J Behav Med, 2017. 24(1): p. 12-15.
  9. Schwartz, G.E. and S.M. Weiss, Behavioral medicine revisited: an amended definition. J. Behav. Med, 1978. 1(3): p. 249-251.
  10. Sommer, R., Discipline and field of study: a search for clarification. Journal of Environmental Psychology, 2000. 20(1): p. 1-4.
  11. Weiss, S.M., Proposal for an Update of the Definition and Scope of Behavioral Medicine: Commentary. Int J Behav Med, 2017. 24(1): p. 5-7.
  12. Nater, U.M., Behavioral Medicine and Related Disciplines. Int J Behav Med, 2017. 24(1): p. 16-17.

Why We Need a CVD SIG

Carly Goldstein, PhD ; Matthew Whited, PhD; Elena Salmoirago-Blotcher, MD, PhD; Andrew Busch, PhD; Emily Gathright, PhD; and Allison Gaffey, PhD; CVD SIG-in-formation leadership

As cardiovascular disease (CVD) is the leading cause of death among adults worldwide, we believe it is overdue for the Society of Behavioral Medicine to have a Special Interest Group (SIG) dedicated to CVD. Many of us who are strongly committed to CVD research belong to multiple SIGs that focus on CVD risk factors, but not on CVD itself. Risk factors, such as diet and exercise, are clearly relevant to CVD, but they are also relevant to the primary and secondary prevention of many other conditions. Without a CVD SIG, secondary prevention of CVD is especially likely to be neglected, as this work does not currently have a clear “home” within SBM. Without a CVD SIG, we miss an opportunity to gather many extraordinary professionals and dedicate a space to collaborate and share CVD research and clinical expertise so that we can inform policy, design research, and better serve CVD patients as well as individuals at high-risk for CVD.

So about a year ago we launched a CVD SIG-in-formation. Our SIG-in-formation will collaborate with the existing SIGs who have done so much for our patients and organizations. Leading in accordance with their example, we hope to organize content at the SBM Annual Meeting that applies to CVD researchers and providers as well as to those who serve patients and communities who are most vulnerable. A more targeted focus on CVD within our organization will strongly contribute to fight for health equity considering, for example, that nearly half of non-Hispanic black adults have some form of CVD. We are proud to be a member of an organization aggressively striving for health equity, and are excited to use this new SIG to bolster our efforts. The complexity of adequate CVD self-management requires special attention within behavioral medicine so that we can meet patients', families', communities', and health systems' needs.

The current CVD SIG-in-formation leadership consists of Dr. Matthew Whited (Chair), Dr. Elena Salmoirago-Blotcher (Co-Chair), Dr. Carly Goldstein (Membership Director), Dr. Andrew Busch (SBM Meeting Activity Coordinator), Dr. Emily Gathright (Communications Director), and Dr. Allison Gaffey (Trainee Member). As a SIG-in-formation we are strongly focused on growing our SIG membership to demonstrate the high the level of interest in CVD research existing among SBM members. If you are interested in joining the conversation, please join our listserv by emailing Andrew Schmidt (aschmidt@sbm.org).

SBM Names Dr. Leslie Johnson as the 2019 Health and Behavior International Collaborative Award Recipient

SBM Staff

The Society of Behavioral Medicine (SBM) is proud to announce Dr. Leslie Johnson as the winner of the 2019 Health and Behavior International Collaborative Award. Dr. Johnson, also an SBM member, is currently a postdoctoral fellow at Emory University. She plans to use the award to visit the University of Melbourne, Australia, where she will work with researchers to determine predictors for diabetes-related anxiety and depression in patients at high risk for developing Type 2 diabetes mellitus (T2DM) taking part in the Kerala, India Diabetes Prevention Program. She also will estimate the prevalence and persistence of these disorders in patients at high risk for developing T2DM. Additionally, she will identify causes of diabetes-related anxiety among patients with T2DM in the INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) trial in India.

T2DM is a leading cause of disease-related deaths globally, with India having the largest absolute number of adults (over 70 million) with diabetes in the world. Symptoms of depression and/or anxiety comorbid with T2MD have been well documented, with recent evidence showing that depression and/or anxiety increase the risk of progressing from prediabetes to diabetes. Dr. Johnson will use hierarchical regression to determine which factors (i.e., demographic data, lipid profile, body mass index) are most commonly associated with the persistence of each condition. She also will complement this with qualitative approaches to identify culturally specific triggers for anxiety in this patient population. Dr. Johnson hopes her findings will help improve diabetes management interventions and assist physicians in India and around the world.  She believes this funded research will lead to better identification and treatment of patients with symptoms of anxiety before it leads to poor health outcomes.

The Health and Behavior International Collaborative Award is jointly sponsored by SBM, the International Society of Behavioral Medicine (ISBM), the International Behavioural Trials Network, the Society for Health Psychology (SfHP), and the American Psychosomatic Society (APS).

Congratulations also to the other 2019 HBIC Award winners: Thomas Kraynak (APS winner); SBM member Tess Langfield (IBTN winner); Suzanne Tanya Nethan, BDS, MDS, (ISBM winner); and SBM member Chloe Huelsnitz (SfHP winner).

Applications Coming Soon: SBM Diversity Institute for Emerging Leaders at SBM 2020

Courtney Bonner, PhD; Steering Committee Chair, Diversity Institute for Emerging Leaders, Education, Training, and Career Development (ETCD) Council member and Amy G. Huebschmann, MD, MS; ETCD Council Chair

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 a new training opportunity for early-career members: the SBM Diversity Institute for Emerging Leaders will equip participants to incorporate principles of diversity and inclusion into the development of strong leadership skills. The leadership development of early-career professionals and the principles of diversity and inclusion are priorities for the Society of Behavioral Medicine (SBM). Therefore, SBM is launching the first annual Diversity Institute for Emerging Leaders during the 2020 SBM Annual Meeting.

Institute Overview

The purpose of the SBM Diversity Institute for Emerging Leaders is to help early-career SBM members develop into effective, thoughtful leaders by fostering leadership skills and a deep understanding of the principles of diversity and inclusion. At the conclusion of 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 (e.g., lab, department). Throughout the year participants will continually assess their leadership development and deepen their understanding of diversity and inclusion through quarterly learning opportunities and regular small group sessions with peers and mentors who are passionate about health equity in behavioral medicine.

  • The Institute is a year-long endeavor, limited to 25 selected individuals.
  • We allow applicants to define their early-career status themselves, but we envision this Institute being most appropriate for those who are completing their post-doctoral research or who have completed their terminal degree within the last 5 years.
  • Applicants must have paid their 2020 SBM member dues by the time they apply.
  • The Institute kicks off with an intense, one-day workshop that takes place before the 2020 SBM Annual Meeting, on Wednesday, April 1, 2020.
  • The Institute provides mentoring and opportunities to network with peers throughout the year.
  • Participants will be responsible for their travel and lodging.
  • The 2020 SBM Annual Meeting registration fee will be waived for accepted institute participants.
  • Applicants representing diverse backgrounds, as defined by SBM, are encouraged to apply.


The ETCD council is very proud to have co-developed this Institute with members of the SBM Diversity Leadership Working Group, and the leadership of the Health Equity SIG. Lastly, we would like to thank the leadership of the SBM Mid-career Leadership Institute for guiding the development of this Institute, including Dr. Marian Fitzgibbon, and SBM administrative staff.

Applications will be available here in early October, and can be submitted to SBM Program Manager Andrew Schmidt at aschmidt@sbm.org.

Enriching Communication Skills for Health Professions in Oncofertility (ECHO) Online Training Program

Gwendolyn Quinn, PhD and Susan Vadaparampil, PhD 

Are you a psychologist, social worker, nurse, or advanced practice provider who works with Adolescent and Young Adult (AYA) cancer patients (ages 15-45)? Enriching Communication Skills for Health Professionals in Oncofertility (ECHO) is a web-based training program focused on building communication skills to address the needs of reproductive health issues for your AYA cancer patients.

This program is available at no cost. You will receive free educational materials, training facilitated by a national team of experts, and upon completion of the program a certificate of completion as well as continuing education credits.

Reproductive health is a key issue for Adolescent and Young Adult (AYA) oncology patients and survivors. Guidelines from professional organizations such as the American Society of Reproductive Medicine, American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network all recommend healthcare providers discuss the risk of infertility and fertility preservation guidelines, refer to reproductive specialists as needed, and document discussions, as well as attend to other aspects of reproductive health such as sexual functioning and contraception. Additionally, in 2013, ASCO published updated clinical practice guidelines for fertility preservation in AYA cancer patients. The revised guidelines extended the responsibility for discussion and referral for fertility preservation beyond the medical oncologist to explicitly include other clinician specialties and allied health care professionals (AHP) in the oncology care setting. This recommendation supports the widely adopted multidisciplinary approach used in many cancer care settings.

To address guidelines from professional organizations, the ECHO training program 1) expanded training to include not only nurses but also psychologists, social workers, and advanced practice providers and 2) covers topics beyond infertility and fertility preservation to include romantic partnering, friendships, body image, sexual functioning, sexual identity and orientation, contraception, and psychosexual adjustment. To date, we have trained 313 AHPs from over 45 states in the US and have 2 more trainings scheduled for January-March of 2020 and 2021. We have continued to receive positive feedback from participants about the training.

Prior to ECHO, Educating Nurses about Reproductive Issues in Cancer Healthcare (ENRICH) was a web-based training program developed in 2011 to assist oncology nurses with timely communication and relevant information regarding risk of infertility, and fertility preservation to AYA patients and survivors. This program was funded by a 5-year R25 Cancer Education Training Grant from the National Cancer Institute (NCI). A total of 233 nurses completed the training; participant knowledge scores and confidence in communication skills regarding fertility increased. Participants also reported increases in fertility related discussions and referrals, and higher rates of documentation after completing the training program.

For additional information or questions, please contact us at (813) 745-6213 or ECHO@Moffitt.org. All interested applicants should visit www.echo.rhoinstitute.org to complete their application online no later than November 22nd, 2019.

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 online articles are listed below.

SBM members who have paid their 2019 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

Behavior Change Techniques and Their Mechanisms of Action: A Synthesis of Links Described in Published Intervention Literature

Rachel N Carey, Lauren E Connell, Marie Johnston,  Alexander J Rothman,  Marijn de Bruin, Michael P Kelly, Susan Michie

Despite advances in behavioral science, there is no widely shared understanding of the “mechanisms of action” (MoAs) through which individual behavior change techniques (BCTs) have their effects. Cumulative progress in the development, evaluation, and synthesis of behavioral interventions could be improved by identifying the MoAs through which BCTs are believed to bring about change.
This study aimed to identify the links between BCTs and MoAs described by authors of a corpus of published literature.
Hypothesized links between BCTs and MoAs were extracted by two coders from 277 behavior change intervention articles. Binomial tests were conducted to provide an indication of the relative frequency of each link.
Of 77 BCTs coded, 70 were linked to at least one MoA. Of 26 MoAs, all but one were linked to at least one BCT. We identified 2,636 BCT–MoA links in total (mean number of links per article = 9.56, SD = 13.80). The most frequently linked MoAs were “Beliefs about Capabilities” and “Intention.” Binomial test results identified up to five MoAs linked to each of the BCTs (M = 1.71, range: 1–5) and up to eight BCTs for each of the MoAs (M = 3.63, range: 1–8).
The BCT–MoA links described by intervention authors and identified in this extensive review present intervention developers and reviewers with a first level of systematically collated evidence. These findings provide a resource for the development of theory-based interventions, and for theoretical understanding of intervention evaluations. The extent to which these links are empirically supported requires systematic investigation.

Psychological and Biological Pathways Linking Perceived Neighborhood Characteristics and Body Mass Index

Diana A Chirinos, Luz M Garcini, Annina Seiler, Kyle W Murdock, Kristen Peek, Raymond P Stowe, Christopher Fagundes

Perceived neighborhood characteristics are linked to obesity, however, the mechanisms linking these two factors remain unknown.
This study aimed to examine associations between perceived neighborhood characteristics and body mass index (BMI), establish whether indirect pathways through psychological distress and inflammation are important, and determine whether these associations vary by race/ethnicity.
Participants were 1,112 adults enrolled in the Texas City Stress and Health Study. Perceived neighborhood characteristics were measured using the Perceived Neighborhood Scale. Psychological distress was measured with the Center for Epidemiological Studies Depression Scale, Perceived Stress Scale and mental health subscale of the Short Form Health Survey-36. Markers of inflammation included C-reactive protein, interleukin-6, and tumor necrosis factor receptor-1. Associations were examined with Structural Equation Modeling.
A model linking neighborhood characteristics with BMI through direct and indirect (i.e., psychological distress and inflammation) paths demonstrated good fit with the data. Less favorable perceived neighborhood characteristics were associated with greater psychological distress (B = −0.87, β = −0.31, p < .001) and inflammation (B = −0.02, β = −0.10, p = .035). Psychological distress and inflammation were also significantly associated with BMI (Bdistress = 0.06, β = 0.08, p = .006; Binflammation = 4.65, β = 0.41, p < .001). Indirect paths from neighborhood characteristics to BMI via psychological distress (B = −0.05, β = −0.03, p = .004) and inflammation (B = −0.08, β = −0.04, p = .045) were significant. In multiple group analysis, a model with parameters constrained equal across race/ethnicity showed adequate fit suggesting associations were comparable across groups.
Our study extends the literature by demonstrating the importance of neighborhood perceptions as correlates of BMI across race/ethnicity, and highlights the role of psychological and physiological pathways.

Executive Functioning as a Predictor of Weight Loss and Physical Activity Outcomes

Meghan L Butryn, Mary K Martinelli, Jocelyn E Remmert, Savannah R Roberts, Fengqing Zhang,  Evan M Forman, Stephanie M Manasse

Executive functioning, which is fundamental for carrying out goal-directed behaviors, may be an underappreciated predictor of outcomes in lifestyle modification programs for adults with obesity.
This study tested the hypotheses that higher levels of baseline executive functioning would predict greater weight loss and physical activity after 6 months of behavioral treatment.
Participants (N = 320) were recruited from the community and provided with 16 treatment sessions. Executive functioning was measured with the tower task component of the Delis-Kaplan Executive Function System (D-KEFS). At months 0 and 6, weight was measured in the clinic and physical activity was measured with tri-axial accelerometers.
Baseline D-KEFS achievement score, rule violations, and completion time significantly predicted weight loss at 6 months. For example, among participants without any rule violations (n = 162), weight loss averaged 11.0%, while those with rule violations (n = 158) averaged 8.7% weight loss. Rule violations also significantly predicted physical activity at 6 months. Among participants without any rule violations, physical activity at 6 months averaged 169.8 min/week, versus 127.2 min/week among those with rule violations.
Particular aspects of executive functioning may predict the relative ease or difficulty of changing eating and exercise-related behaviors, albeit with small effect sizes. This study is the first to our knowledge to detect a predictive relationship between components of executive functioning and objectively measured physical activity in adult lifestyle modification, and one of the first to predict weight loss in adults using an objective measure of executive functioning.


Translational Behavioral Medicine

Exercise effects on quality of life, mood, and self-worth in overweight children: the SMART randomized controlled trial

Kaile M Ross, Emma C Gilchrist, Stephen P Melek, Patrick D Gordon, Sandra L Ruland, Benjamin F Miller

Overweight children are at risk for poor quality of life (QOL), depression, self-worth, and behavior problems. Exercise trials with children have shown improved mood and self-worth. Few studies utilized an attention control condition, QOL outcomes, or a follow-up evaluation after the intervention ends. The purpose is to test effects of an exercise program versus sedentary program on psychological factors in overweight children. One hundred seventy-five overweight children (87% black, 61% female, age 9.7 ± 0.9 years, 73% obese) were randomized to an 8 month aerobic exercise or sedentary after-school program. Depressive symptoms, anger expression, self-worth, and QOL were measured at baseline and post-test. Depressive symptoms and QOL were also measured at follow-up. Intent-to-treat mixed models evaluated intervention effects, including sex differences. At post-test, QOL, depression, and self-worth improved; no group by time or sex by group by time interaction was detected for QOL or self-worth. Boys’ depressive symptoms improved more and anger control decreased in the sedentary intervention relative to the exercise intervention at post-test. At follow-up, depressive symptoms in boys in the sedentary group decreased more than other groups. Exercise provided benefits to QOL, depressive symptoms, and self-worth comparable to a sedentary program. Sedentary programs with games and artistic activities, interaction with adults and peers, and behavioral structure may be more beneficial to boys’ mood than exercise. Some benefits of exercise in prior studies are probably attributable to program elements such as attention from adults.

Trending on Pinterest: an examination of pins about skin tanning

Smita C Banerjee, Vivian M Rodríguez, Kathryn Greene, Jennifer L Hay

Rates of melanoma and nonmelanoma skin cancers are on the rise in the USA with data revealing disproportionate increase in female young adults. The popularity of intentional skin tanning among U.S. adolescents is attributed to several factors, including prioritization of physical appearance, media images of tanned celebrities, ease of availability of artificial tanning facilities, and more recently, the prevalence and celebration of tanned skin on social media. Pinterest, as the third most popular social media platform, was searched for “pins” about skin tanning. The resultant “pins” were examined to understand the extent and characteristics of skin tanning portrayed on Pinterest. We analyzed pins on Pinterest about skin tanning (n = 501) through a quantitative content analysis. Overall, results indicated an overwhelmingly protanning characteristic of pins about skin tanning on Pinterest, with over 85% of pins promoting tanning behavior. The pins were generally characterized by the portrayal of a female subject (61%) and provided positive reinforcement for tanning (49%). Use of tanning for enhancing appearance was the main positive outcome expectancy portrayed in the pins (35%), and nudity or exposure of skin on arms (32%) and legs (31%) was evident in about a third of pins. With overwhelmingly positive pins promoting tanning, use of female subjects, exhibiting nudity, and appearance enhancement, there seems be to a consistent targeting of female users to accept tanning as a socially acceptable and popular behavior. The findings indicate a need for developing sun protection messages and the leveraging of social media for dissemination of skin cancer prevention and detection messages.

The “House of Quality for Behavioral Science”—a user-centered tool to design behavioral interventions

Sarah L Mullane, Dana R Epstein, Matthew P Buman

Within the behavioral field, a plethora of conceptual frameworks and tools have been developed to improve transition from efficacy to effectiveness trials; however, they are limited in their ability to support new, iterative intervention design decision-making methodologies beyond traditional randomized controlled trial design. Emerging theories suggest that researchers should employ engineering based user-centered design (UCD) methods to support more iterative intervention design decision-making in the behavioral field. We present, an adaptation of a UCD tool used in the engineering field—the Quality Function Deployment “House of Quality” correlation matrix, to support iterative intervention design decision-making and documentation for multicomponent behavioral interventions and factorial trial designs. We provide a detailed description of the adapted tool—“House of Quality for Behavioral Science”, and a step-by-step use-case scenario to demonstrate the early identification of intervention flaws and prioritization of requirements. Four intervention design flaws were identified via the tool application. Completion of the relationship correlation matrix increased requirement ranking variance for the researcher (σ2 = 0.47 to 7.19) and participant (σ2 = 0.56 to 3.89) perspective. Requirement prioritization (ranking) was facilitated by factoring in the strength of the correlation between each perspective and corresponding importance. A correlational matrix tool such as the “House of Quality for Behavioral Science” may provide a structured, UCD approach that balances researcher and participant needs and identifies design flaws for pragmatic behavioral intervention design. This tool may support iterative design decision-making for multicomponent and factorial trial designs.

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.

Jasjit Ahluwalia, MD, MPH, MS
The Centers for Disease Control and Prevention recently appointed Dr. Ahluwalia to the federal Interagency Committee on Smoking and Health.

Monica Baskin, PhD
Dr. Baskin was selected for the 2019 Odessa Woolfolk Community Service Award by the University of Alabama at Birmingham.

Jamie Bodenlos, PhD
Dr. Bodenlos received the Florence Denmark Faculty Advisor award from Psi Chi honor society.

Amy Bucher, PhD
Dr. Bucher was selected for the PharmaVOICE 100 in its "Change Agents" category.

Michael Diefenbach, PhD
The American Cancer Society named Dr. Diefenbach its 2019 Humanitarian Honoree.

Kory Floyd, PhD
Dr. Floyd was recently elected a fellow of the International Communication Association.

Megan Hosey, PhD
Dr. Hosey was selected for an NHLBI Loan Repayment Program award for her research on research on anxiety management in patients with acute respiratory failure.

James F. Sallis, PhD
A recent article in PLOS Biology identified Dr. Sallis as being among the top 0.01% of scientists based on citation metrics.

Doug Tynan, PhD
The American Board of Professional Psychology honored Dr. Tynan with its Distinguished Service to the Profession Award.

Elizabeth Unni, PhD
Dr. Unni was recently appointed chair of the Social, Behavioral, and Administrative Sciences at the Touro College of Pharmacy in NY.

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.

Angela D. Bryan, PhD
A recent article in Nature Outlook highlighted Dr. Bryan's research on cannabis and exercise.

Mark Lumley, PhD
Dr. Lumley was interviewed for an NPR story on emotional awareness and expression therapy (EAET) for pain management.

Jacob D. Meyer, PhD
Dr. Meyer was recently interviewed for an article in The New York Times about his research on the effects of exercise on depression and attempting to uncover the mechanisms of exercise’s antidepressant effects.

Michael Stefanek, PhD
The University of Mississippi Medical School published a profile of Dr. Stefanek upon his appointment as head of its Cancer Center and Research Institute's Cancer Control, Epidemiology and Disparities Program.