Monica Baskin, PhD, SBM President
Monica Baskin, PhD
Like many of you, I have never been more excited to count down the final seconds of the year than I was on December 31, 2020. Last year brought challenges on so many fronts as our nation was confronted with multiple crises (COVID-19, systemic racism, political uncertainty) at once. There is no doubt that the physical, mental, economic, social and emotional toll of these issues will be felt for years to come. However, at the start of 2021, I find myself more hopeful about the days to come and increasingly convinced that behavioral medicine has a pivotal role to play in the positive outcomes to follow.
Since the start of the coronavirus pandemic, our members have been on the front lines of patient care, behavioral research, public health communications, and advocacy for programs and research to advance better health. Resources on behavioral medicine during the time of COVID-19 are available on our website including recent articles on managing stressors in healthcare settings, keeping kids physically active during the pandemic, and the 10 commandments of working in academia during a pandemic. In addition, several members have proposed methods from our proven science to increase social distancing intention and behavior and vaccination uptake. Articles in this issue of Outlook also reflect on pressing questions and concerns about the rollout of vaccinations during the current surge in COVID-19 cases.
With respect to systemic racism and racial injustice, I am heartened by the dedication and commitment of our members who are calling out racism and its negative impact on the mental, behavioral and physical health of blacks and other racial/ethnic groups that have been targets of violent and traumatic events. Since my statement last summer reflecting the highly publicized deaths of three unarmed Black people, eight unarmed Black and Hispanic people have been killed by police according to the Washington Post Fatal Force database. Now more than ever, we need to move from statements to sustainable actions to reduce unnecessary violence. As such, efforts by our Health Policy Council and Health Equity SIG to remain vigilant in calling for increased funding for anti-racist research and bringing attention to structural factors that perpetuate and/or maintain systemic racism. This work requires a critical eye on the practices and policies within our own organization and the larger society.
Finally, we are (hopefully) near the end of a protracted political season full of divisive rhetoric and recent violence. And, like each election cycle before this one, this election was the most important election of our lives. The federal election outcomes will likely impact behavioral medicine in multiple ways as described in this issue. As I look forward, I am encouraged that the new administration is set to be more diverse than ever before with the first woman and woman of color as vice president and a record 141 women (including 51 women of color), and the highest number of LGBTQ+ members (total of 11) in the 117th Congress. In addition, proposed members of the incoming presidential cabinet more closely represent the full demographics of our country. So, whether your candidates won or lost, I hope that you can appreciate and celebrate the historic engagement of our country in the democratic process. The 2020 election reached a record high of 160 million voters (20 million more than in 2016), despite a pandemic. More people than ever before were included in a process that let their voices be heard. Likewise, I conclude this message with some encouragement for you to be on the lookout for your upcoming SBM election voting form. We have another amazing group of leaders looking to serve our society on the Board of Directors in the years to come. Let’s see if we can make 2021 a record year for SBM voting. I am looking forward to the best year possible for SBM and our larger society.
Editor's Note: Opportunities for Behavioral Medicine Impact in 2021 and Beyond
Crystal Lumpkins, PhD; Editor, Outlook
Crystal Lumpkins, PhD
Happy New Year! With the start of 2021 and recent elections, it seems befitting to begin the year with a special themed section in Outlook that reflects the current political climate of our nation and what may lie ahead. Not every issue of Outlook will highlight policy and or COVID-19 however with the surge in cases, the rollout of vaccinations and other issues that will continue to evolve, there is sure to be one or two articles that will include these issues and hit home for SBM membership.
The recent 2020 Presidential and Senatorial election races and most recent run-off election for two US Senate seats in Georgia, will have significant impact on a wide range of Behavioral Health issues and therefore health policy and behavior outcome. In this issue, SBM members share their perspectives on what impact the elections may have on Behavioral Medicine and Behavioral Science. Members also will discuss vaccinophobia in the midst of a series of COVID-19 vaccine roll outs where nearly 5 million have received the first of two doses. Questions remain however about decision making and who, why and how individuals will decide to get the vaccine or not. Chronicled here also in this issue of Outlook is the significance of galvanizing organizations to build capability and capacity to address the obesity epidemic. COVID-19 has also further exacerbated the obesity epidemic among children and their families causing the gap to further widen and increase risk. Further, members also write about the intentional inclusion of diversity as a necessary ingredient for a strong health technology workforce and why this will facilitate digital innovation. Untapped opportunities in Clinical Research are also outlined for Behavioral Scientists and Psychologists in addition to the ins and outs of starting a Clinical Practice. Finally, we’d like to congratulate our newly-formed Multiple Health Behavior Change and Multi-Morbidities (MHBCM). Here’s to a fruitful collaborative and productive first year! In the spirit of the New Year we’d also like to encourage you to support SBM during its Proven Science, Better Health giving campaign. You may go here for further details.
Behavioral Medicine in 2021 and Beyond: Members’ Perspectives on the Impact of the 2020 Election
Scherezade K. Mama, DrPH✉ and Loneke T. Blackman Carr, PhD, RD✉; SBM Membership Council
Christian J. Cerrada, PhD; Dalnim Cho, PhD; and Brie Turner-McGrievy, PhD, MS, RD, FTOS
The recent presidential and senatorial election outcomes and U.S. Supreme Court justice confirmation may significantly impact a wide range of behavioral health issues. We asked SBM Members and Champions Christian J. Cerrada, PhD, Senior Associate, Digital Health Outcomes, Evidation Health; Dalnim Cho, PhD, Instructor, Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center; and Brie Turner-McGrievy, PhD, MS, RD, FTOS, Associate Professor and Deputy Director, TecHealth Center, Arnold School of Public Health, University of South Carolina, about how they believe the future of behavioral medicine and research will be impacted by our current political climate and the recent election.
How have the presidential and senatorial elections impacted your current work in behavioral medicine?
Dr. Turner-McGrievy: In my specific area [behavioral nutrition intervention research], there has been a push for new funding mechanisms and innovative approaches to fund nutrition science research. Those efforts seem to have stagnated in the last few years. … My hope is that there will be more stability and predictability in the NIH administration, with less focus on politicization, and that will allow for the consideration of new funding approaches and opportunities.
How do you envision the outcomes of the presidential and senatorial elections impacting your research in 2021 and beyond?
Dr. Cho: I hope the new president and his leadership team will invest in behavioral medicine and set aside a greater portion of the budget for it.
Dr. Cerrada: Policies pertaining to data privacy and public perception around it will shape how we collect and protect person-generated health data, such as those from wearable activity trackers, for both research and program development purposes.
Over the next four years, describe the role you see behavioral scientists and SBM playing in reducing the burden of COVID-19, addressing structural racism and health disparities, climate change, etc.
Dr. Cerrada: As a behavioral scientist in industry, I believe we play a key role as thought leaders to our partners around social determinants of health and their implications on the design and evaluation of health products. Especially in industry, we must serve as champions for developing tools that are effective, person-centered, rigorously-tested, and, importantly, equitable.
Dr. Cho: Covid-19 revealed the importance of behavioral medicine. … Contradicting messages from our leaders and a lack of transparency raised concerns about trust. … Trust, culture, altruism, and message framing and their impacts on vaccine uptake fall within our [behavioral scientists’ and SBM’s] expertise. It will be critical to have a behavioral scientist on the leadership team to address these issues and restore trust.
Dr. Turner-McGrievy: SBM should serve as the voice for how behavioral science impacts all of these things. For example, for climate change, behavioral scientists play a role in conducting research on ways to change behaviors that impact the environment, such as encouraging active transport or eating a more plant-based diet. Behavioral scientists also play a role in conveying these findings to policy makers, who can help encourage programs that make those behavior changes the easier or default choice. SBM needs to play an active role in highlighting the importance of the work of their members, not only to make the public aware of the fantastic research going on, but to also push back on the damage done by the previous administration and to advocate for meaningful policy change.
Vaccinophobia in The Times of Covid-19: Current Status and Future Direction
Rowida Mohamed, MSc✉ and Yves Paul Mbous, MEng✉; Health Decision Making SIG
Vaccinophobia has been a potential threat to the accomplishments of vaccination programs in the US over the past decades. Currently, the pressures to accelerate the development of COVID-19 vaccines have raised concerns about adequate safety and effectiveness testing, but also highlighted perceptions of the vaccines as “experimental.” 1 In a recent survey, half of the respondents preferred to delay vaccination, whereas 20% claimed that they would refuse altogether to vaccinate either themselves or their children against COVID 19. 2 These results suggest a low vaccination acceptability status-quo, impeding an adequate vaccination rate required for achieving herd immunity against this virus when the vaccine become available. Meanwhile, the dominant messages, such as stay-at-home and shelter-in-place to help curb the spread of COVID-19, have led to a notable decrease in immunization services uptake. For example, childhood immunization rates have dropped by 73% since the beginning of the pandemic.3 Now, as social distancing requirements are gradually relaxed, the US could experience outbreaks of vaccine-preventable diseases if routine vaccinations are not re-initiated.
Shifting the minds of those hesitant to get vaccinated is challenging. It requires in-depth knowledge of the target population and long-term investment in multifaceted interventions. To understand vaccination decision-making behaviors, The WHO recommends using the “COM‑B model” (Capability, Opportunity, Motivation—Behavior).4 According to this model, vaccine decision-making is influenced by personal-level factors (capability and motivation), and environmental-level factors (opportunity). In the dearth of robust evidence to guide COVID19 vaccine interventions, the “COM‑B model” can be used to generate ideas as to where research should be directed. Future research should aim to better disseminate knowledge on the benefits of vaccines in order to enhance individuals’ capabilities. First, routine vaccines from influenza to measles provide partial protection against COVID-19, suggesting the significance of maintaining routine immunization during the pandemic to benefit from their spillover effect.5 Second, a growing body of evidence shows that COVID-19 pathogenesis expands beyond the lungs to impact the cardiovascular system; more than three-quarters of surviving COVID-19 patients suffered from heart muscle complications.6 Informing the public that vaccine efficacy is not limited to preventing infection but can also mitigate the severity of the disease is essential. It is also crucial to revise the lessons learned from the success of earlier immunization programs to motivate people to get vaccinated. For example, during the influenza pandemic in 20009, the H1N1 vaccine demonstrated high effectiveness and safety despite the widespread skeptical perceptions, at the time, due to its relatively rapid development. 7 Additionally, reassuring those who may be hesitant to go for vaccination visits about the safety of the vaccine delivery systems might improve access to immunization services. Finally, vaccinating is a prosocial act. In other words, people get vaccinated to benefit others rather than themselves. It, therefore, seems valuable to assess the interplay between the vaccination decision factors and the inclination for prosocial vaccination.
The success of any vaccination program depends on the proportion of the population that gets vaccinated. Unless social and behavioral researchers develop and evaluate interventions supporting vaccine decision-making soon, subsequent vaccination campaigns will be insufficient to achieve adequate vaccine coverage, which is necessary to curtail the infection and to allow a return to routine social activities.
- Lurie N, Saville M, Hatchett R, Halton J. Developing covid-19 vaccines at pandemic speed. N Engl J Med. 2020;382(21):1969-1973. doi:10.1056/NEJMp2005630
- CBS News Eye on Trends: The latest from the Election & Survey Unit. https://www.cbsnews.com/live-news/cbsnews-eye-on-trends/. Accessed August 25, 2020.
- Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020. MMWR Morb Mortal Wkly Rep 69. 2020. doi:10.15585/mmwr.mm6919e2
- WHO/Europe | Publications - TIP Tailoring Immunization Programmes (2019). https://www.euro.who.int/en/publications/abstracts/tip-tailoring-immunization-programmes-2019. Accessed August 25, 2020.
- Salman S, Salem ML. Routine childhood immunization may protect against COVID-19. Med Hypotheses. 2020;140:109689. doi:10.1016/j.mehy.2020.109689
- Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered from Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020. doi:10.1001/jamacardio.2020.3557
- Lansbury LE, Smith S, Beyer W, et al. Effectiveness of 2009 pandemic influenza A(H1N1) vaccines: A systematic review and meta-analysis. Vaccine. 2017;35(16):1996-2006. doi:10.1016/j.vaccine.2017.02.059
Diversity is a Critical Ingredient for Innovation: Promoting Greater Racial/Ethnic Representation in Digital Health
Charles R. Jonassaint, PhD✉; Margo Edmunds, PhD, FAMIA; Abdul Shaikh, PhD, MHSc; Health Equity SIG
Promoting diversity in the digital health workforce and in technology innovation is particularly important for behavioral medicine, given the rapidly increasing generation of personal health data and its role in persisting health disparities. Remote monitoring, wearable devices for self-care, clinical management, and research are just some of the use cases that have contributed to this rise and will be important when reaching (and teaching) diverse populations.1
In early 2020, the Black Lives Matters movement spurred many health care and tech sector organizations to initiate efforts to embrace and advance a more ethnically diverse workforce. The movement increased public discourse about systemic racism and built support for recruiting from and increasing equity among racial groups that have been traditionally underrepresented and marginalized.2-4 Even with the renewed surge of social guilt and majority groups’ fear of being perceived as racist, efforts for improving diversity continue to reflect the implicit biases of white culture, with microaggressions and other forms of discrimination. In academics and medicine, underrepresented minorities (URMs) still lag in promotion rates and salaries,5,6 and racial diversity in scientific collaborations have decreased over time.7 According to the recent Diversity in High Tech report by the US Equal Employment Opportunity Commission, the tech industry continues to overrepresent whites and Asians, and minority-owned companies are less likely to receive venture funding than white-owned companies.
We continue to see evidence that programs to promote diversity, equity, and inclusion are either ineffective or may stagnate over time.6 8This may be in part because racial and ethnic representation may not be prioritized over having hires that “fit in with the team,” and lack of a strong belief that racial representation and other forms of diversity actually add value.9 In fact, some champions of diversity may fundamentally believe that increasing the number of URMs in health-related fields sometimes requires sacrificing to the quality of the workforce. But the opposite is true: greater ethnic and racial diversity in the biomedical sciences and public health enterprise enhances innovation and improves our ability to deliver high-quality health care.10,11 Efforts to improve URM representation in digital health will fall short without a widespread recognition that workforce diversity of race (and all types) will produce outcomes for all.
World-changing insights, excellence, and scientific advancement come when people of diverse backgrounds and experiences work together.12 Compared to racially and culturally homogeneous groups, heterogeneous groups produce higher quality ideas, less “groupthink, 13 and a greater range of solutions to problems.14 Diverse companies perform better on economic indicators such as market share, sales revenue, and increased profits.15 A study of more than 9 million academic papers found a link between greater racial/ethnic diversity and scientific impact, as measured by the number of published citations.7
Diversity in digital health innovation is particularly critical because the lack of diverse perspectives in technology design can be dangerous. Technology developed without a diversity lens introduces errors such as racial biases in health care algorithms that subject Black patients to substandard care16; wearable sensors failing to accurately measure heart rate and energy expenditure in darker skin tones 17; facial recognition software that misidentifies Black people, leading to wrongful arrests; and internet search engine algorithms whose inherent racial biases perpetuate racist ideologies and social misrepresentations.18 19
To enhance the pipeline of underrepresented minorities (URM) into digital health, professional organizations such as SBM need to help promote the evidence that diversity improves the quality of our science, technology, and medicine for all people, not just disparities populations. We need both philosophical and financial commitment from leadership in digital health, behavioral medicine, and the biomedical enterprises to prioritize diverse excellence and invest in an unwavering belief that we are not excellent unless we are diverse.20,21 Taking action to advance diversity in the digital health workforce is not just the right thing to do, it is necessary for meaningful progress in behavioral medicine.
- Edmunds M, Hass C, Holve E. Consumer Informatics and Digital Health : Solutions for Health and Health Care. In: 1st ed. Cham: Springer International Publishing : Imprint: Springer,; 2019.
- American Association of Medical Colleges. https://www.aamc.org. Accessed Aug 9, 2020.
- Lett LA, Murdock HM, Orji WU, Aysola J, Sebro R. Trends in Racial/Ethnic Representation Among US Medical Students. JAMA Netw Open. 2019;2(9):e1910490.
- Bonham VL, Citrin T, Modell SM, Franklin TH, Bleicher EW, Fleck LM. Community-based dialogue: engaging communities of color in the United states' genetics policy conversation. Journal of health politics, policy and law. 2009;34(3):325-359.
- Parker S, Clayton-Pedersen A, Moreno J, Teraguchi D, Smith DG. The revolving door for underrepresented minority faculty in higher education. 2006.
- Whittaker JA, Montgomery BL. Cultivating institutional transformation and sustainable STEM diversity in higher education through integrative faculty development. Innovative Higher Education. 2014;39(4):263-275.
- AlShebli BK, Rahwan T, Woon WL. The preeminence of ethnic diversity in scientific collaboration. Nature Communications. 2018;9(1):5163.
- Castro J, Fenstermaker S, Mohr J, Guckenheimer D. Institutional contexts for faculty leadership in diversity: a University of California-Santa Barbara case study. In: Brown-Glaude W, ed. Doing diversity in higher education: faculty leaders share challenges and strategies. New Brunswick, NJ:: Rutgers University Press; 2009:209–230.
- Crowley AL, Damp J, Sulistio MS, et al. Perceptions on Diversity in Cardiology: A Survey of Cardiology Fellowship Training Program Directors. J Am Heart Assoc. 2020;9(17):e017196.
- Cohen JJ, Gabriel BA, Terrell C. The case for diversity in the health care workforce. Health affairs (Project Hope). 2002;21(5):90-102.
- Valantine HA, Collins FS. National Institutes of Health addresses the science of diversity. Proc Natl Acad Sci U S A. 2015;112(40):12240-12242.
- Johansson F. The Medici Effect, with a new preface and discussion guide: what elephants and epidemics can teach us about innovation. Harvard Business Review Press; 2017.
- Lauretta McLeod P, Lobel SA. The effects of ethnic diversity on idea generation in small groups. Paper presented at: Academy of Management Proceedings1992.
- Watson WE, Kumar K, Michaelsen LK. Cultural diversity's impact on interaction process and performance: Comparing homogeneous and diverse task groups. Acad Manage J. 1993;36(3):590-602.
- Herring C. Does diversity pay?: Race, gender, and the business case for diversity. Am Sociol Rev. 2009;74(2):208-224.
- Obermeyer Z, Powers B, Vogeli C, Mullainathan S. Dissecting racial bias in an algorithm used to manage the health of populations. Science. 2019;366(6464):447-453.
- Shcherbina A, Mattsson CM, Waggott D, et al. Accuracy in wrist-worn, sensor-based measurements of heart rate and energy expenditure in a diverse cohort. Journal of personalized medicine. 2017;7(2):3.
- Noble SU. Algorithms of oppression: How search engines reinforce racism. nyu Press; 2018.
- Quick Facts: United States. United States Census Bureau. https://www.census.gov/quickfacts/fact/table/US. Published 2019. Accessed Aug 9, 2020.
- Flores G, Mendoza FS, DeBaun MR, et al. Keys to academic success for under-represented minority young investigators: recommendations from the Research in Academic Pediatrics Initiative on Diversity (RAPID) National Advisory Committee. Int J Equity Health. 2019;18(1):93.
- Duncan GA, Lockett A, Villegas LR, et al. National Heart, Lung, and Blood Institute Workshop Summary: Enhancing Opportunities for Training and Retention of a Diverse Biomedical Workforce. Ann Am Thorac Soc. 2016;13(4):562-567.
Taking Behavioral Medicine to Capitol Hill: An Interview with Dr. Reginald Tucker-Seeley
Rachel C. Shelton, ScD, MPH✉; SBM Member Delegate
Reginald Tucker-Seeley, MA, ScM, ScD
Dr. Reginald Tucker-Seeley, MA, ScM, ScD, is the inaugural Edward L. Schneider Chair in Gerontology and Assistant Professor in the Leonard Davis School of Gerontology at the University of Southern California (USC). He completed master and doctoral degrees in public health (social and behavioral sciences) at the Harvard T.H. Chan School of Public Health (HSPH) and a postdoctoral fellowship in cancer prevention and control at HSPH and the Dana-Farber Cancer Institute (DFCI). His research has focused primarily on social determinants of health across the life course and on individual-level socioeconomic determinants of health. Dr. Tucker-Seeley has a longstanding interest in the impact of health and social policy on racial/ethnic minorities and across socioeconomic groups. He has experience working on local and state-level health disparities policies, and in the measuring and reporting of health disparities at the state level. Dr. Tucker-Seeley has been a member of SBM since 2008 and has served as the Chair of the Aging SIG, member of the Health Policy Committee, and Co-Chair for multiple sessions at SBM Annual Scientific Meetings and Scientific Sessions. Dr. Tucker-Seeley was recently in the 2017-2018 cohort of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellowship Program.
Tell me why you chose to apply to the RWJF Health Policy Fellowship Program?
I used to teach a course at the Harvard T.H. Chan School of Public Health called “Measuring and Reporting Health Disparities.” In that course, I used my experience in state level policy, having worked on the Commission for Health Advocacy and Equity in Rhode Island, to develop a case study that took students through the process of having to write a state level health disparities report that I included in that course (note: the case study is available for educators here: https://store.hbr.org/product/the-rhode-island-commission-of-health-advocacy-and-equity-developing-a-report-on-health-disparities-part-a/PH9015). I remember in an evaluation of the course, a student wrote, “this is a great course, but there's nothing on the federal level.” Well, that was because I knew very little about health disparities policy at the Federal level. So I started looking for opportunities that would give me exposure to health disparities policy at the Federal level. I found two fellowship opportunities that seemed most appropriate. One was the White House Fellowship, and another was the Robert Wood Johnson Foundation Health Policy Fellowship. I then reached out to a couple of mentors to discuss and was fortunate to be connected to folks who had been accepted to both programs. After hearing about the RWJF Health Policy Fellowship program’s three-month orientation, with training on how federal health policy gets made, I knew that that program was exactly what I was looking for. I really approached it as a way to think about what are some of the tools that I could learn and train students to better engage in health disparities policy, from a federal perspective.
So can you do the fellowship while you're in a full time faculty position?
Yes, interestingly, the fellowship functions like a grant. And so the grant goes to your institution, and it's two years of funding with one year in residency in Washington, DC. While the program is funded by RWJF, it is managed by the National Academy of Medicine (NAM). For those first three months of orientation, the fellowship cohort is housed at the NAM offices in Washington, DC. During that time the cohort meets with leaders across a range of health policy topics learning how federal health policy gets made and how the branches of the federal government work. Next, each fellow interviews for a fellowship placement in either the executive or legislative branch where the fellow will work for eight to 12 months.
What do you think surprised you the most about the fellowship in terms of your expectations?
Yeah, so I think oftentimes at the start of these kinds of programs, people assume that they're going to take whatever their area of expertise is and advise policy makers (legislative or executive branch offices) only on that topic; however, it is important to note that legislative and executive branch offices have their own priorities and agendas. And, with federal politics, you know, things can change at the drop of a hat. So I think as a fellow working in that context, you really have to pull out all of the skills you learned in graduate school related to reading large amounts of material and synthesizing that material really quickly. I think the part that is new, is learning how to then to write succinctly about that synthesis. We as academics are pretty good at synthesizing, but many of us struggle with doing so succinctly. That was something that that I definitely struggled with initially in the fellowship program and in my placement.
And how did you decide on your placement?
Right before accepting the RWJF Health Policy Fellowship, I was recruited to the Leonard Davis School of Gerontology at the University of Southern California (USC). So, my first year on the faculty at USC was spent in Washington, DC. I knew very little about California, and I wanted a placement that would give me an opportunity to learn more about the state where I had just moved my family. Fortunately, Senator Dianne Feinstein’s office was accepting health policy fellows. I submitted my resume and was interviewed by Senator Feinstein's health policy staff. Although she wasn’t on the two primary committees with jurisdiction over healthcare (Health, Education, Labor and Pensions or Finance), she is the senior senator from the largest state with a long history in the Senate and her office staff looked like California; that is, it was racially/ethnically diverse. When I met with her Legislative Director during the interview process, who is an African American man [you don’t see many folks who look like me in leadership positions in the Senate], I knew that I wanted the placement in that office.
What was that like? What was your favorite part? And what was unexpected?
I’m not sure if this was my favorite part, but what was surprising was watching the Senator and her staff manage so many different topics. In our weekly staff meetings, the Senator would go from talking about defense topics to security topics to health and health care topics. It was truly impressive to watch that process!
I would say my favorite part was meeting with constituents. About 25% of my job as a fellow was meeting with folks that wanted to inform/discuss with the Senator a specific health/healthcare related issue. So for those of you that have participated in, a “Congressional Hill Day” where you meet with a congressional staff member, I was that staff member! Hearing about health/health care related issues from California constituents was a great introduction to my new state home and also provided me with insight into how issues are managed in a Senate office.
I think one of my least favorite aspects was the pace. The phrase “drinking from a firehose” is often used to describe what working in Congress feels like and I completely agree with that description! It often felt like time moved fast and slow at the same time in DC. For example, there are so many issues that move in and out of federal policy maker attention and the pace of that process can sometimes feel overwhelming; and managing that process while trying to move one’s policy priorities forward can feel like pushing an elephant up a flight of stairs.
What was a day in the life like?
It could be a bit unpredictable. In some congressional offices, the health policy fellow might be the primary “health” staff member. I knew I didn’t want that experience. I wanted the opportunity to work and watch! That is, I wanted the opportunity to watch how ideas made their way to legislation in a Senate office. I was fortunate to work in an office with a “health policy team” so many of the tasks were divided among multiple people. For me, each day generally started with meetings with constituents. The day could also consist of writing talking points for the Senator on a health/healthcare related topic, working with the health policy team on writing a memo to an Executive branch or Congress member office on the behalf of the Senator on a health/healthcare related topic, and by meeting with/talking to potential co-sponsors of legislation to move the legislative health policy agenda of the office forward.
During my time in her office, Senator Feinstein was on the Senate Cancer Coalition and she was very interested in racial and ethnic diversity in clinical trials. The health policy team worked on writing a letter related to that topic to either HHS or FDA to improve racial/ethnic diversity in clinical trials participation. The memo we wrote to NIH is available here.
I also helped to supervise some of the summer interns. One of the tasks that the summer interns had to do was to write a policy memo and present it to the staff as if they were presenting it to the Senator. I incorporated that task into my Aging and Social Policy course here at USC.
How has this shaped either your personal research or your perception of research?
One of the biggest lessons learned from this experience, was that it helped me to situate what I do (my research agenda) within the larger Federal health policy agenda and the larger Federal policy agenda generally. I think within our own research communities we may rarely think or talk about how our research area fits with the agenda of a policy maker. Working on Capitol Hill helped me to realize that just because a topic is very important to me (e.g. health disparities policy), policy makers may not necessarily be interested in that topic at all! So, I have been thinking a lot about how to encourage a policy maker to be interested in a topic and how to communicate those topics. Prior to the fellowship, I don't think I'd really thought a lot about how do I situate what I do with the priorities of a policy maker. We (academics) always have that very trite statement at the end of research papers: “policymakers should do something about….” After the fellowship, I think I have a greater appreciation of what it takes for policy makers to “do something” in the context of everything else they are managing.
The fellowship also encouraged me to ask more policy relevant research questions. Specifically, I think a lot more now about how my research question(s) or how could my research findings impact people's lives today? Or how can my research question change the process in which people who have historically been left out of the process be included in that process? So for example, I am engaging in more policy scan related projects and starting to look at the kind of legislation that has been introduced or even passed that's relevant to the things that I do. For example, I have a small project now funded by an internal grant at USC looking at legislation at the Federal level and in a couple of states that focused on vulnerable populations related to the impact of COVID-19.
Another thing I realized during my time working on Capitol Hill was that it generally felt like the “Whitest” place I have ever worked, both in terms of who gained access and who was there. This impacts the topics for legislation that gets introduced and passed. The fellowship experience further strengthened my interest in health disparities policy and highlighted the need for me to do whatever I can to ensure that many more racial/ethnic minority voices are in that environment.
How can we actually get policy makers to value things that are on our agenda, whether that's equity related or other topics?
Well, I'll use the “Capitol Hill day” as an example. I think sometimes academics might assume that the “Hill day” visit is the end of the process. But, actually, the “Hill day” should be considered the beginning of the next stage of the process. That is, it is starting a conversation that has to continue. And so whether it's you or someone else within your organization that continues the process, attention has to be paid to continuing that conversation because there are so many other people/topics trying to get the attention of the policy maker and their staff. To go back to the “drinking from a fire hose” analogy that the staff is managing, consider your topic/issue as one of the many water droplets that the staff member is attempting to drink.
Anything else you want to share about your experience or recommendations you have for people thinking about this?
I recognize that if you don’t already live in the DC, Maryland, Virginia (DMV) area that moving to Washington, DC for the year can be disruptive, but to any mid-career SBM member who can fit a health policy fellowship experience into their lives, do it! I don’t think there is any other opportunity like the RWJF Health Policy Fellowship to show you how the legislative process works and that gives insight into how you can later use your research to influence that process.
The last thing I want to make sure I mention is that we always hear that Congress isn’t doing anything about “insert your topic of interest.” I wholeheartedly disagree! I met some of the smartest and hardest working people serving in the United States Congress working simultaneously on a myriad of issues to make our country better.
Obesity in the COVID-19 Pandemic and Beyond: Exacerbation of Health Disparities Among Racial/Ethnic Minority Families
Marissa Kobayashi, MHS✉; Lindsay Stager, MA✉; and Melanie K. Bean, PhD✉; Child and Family Health SIG
Obesity is a major public health issue with alarming trends suggesting that the COVID-19 pandemic is exacerbating this crisis and widening health disparities among at-risk, low-income, ethnic minority families. Recent estimates suggest that 16.6% of children and 31.8% of adults have overweight and 18.5% and 42.4% have obesity. Moreover, 5.6% of children and 9.2% of adults have severe obesity, defined as body mass index (BMI) ≥120% of the 95th percentile and BMI ≥40kg/m2, respectively.1,2 Families from racial and ethnic minority backgrounds, specifically Hispanic/Latinx and Black/African American adults and children, have disproportionately higher rates of obesity.2 These inequities are especially concerning given the detrimental psychological (e.g., depression) and physical health sequelae (i.e., type 2 diabetes, hypertension) of obesity, and corresponding disparities in obesity-related comorbidities.3 The current COVID-19 pandemic is further compounding both obesity risk and existing racial and ethnic health disparities. Specifically: 1) obesity has emerged as a significant risk factor for COVID-19 complications; 2) COVID-19 sequelae are associated with increases in obesogenic behaviors; and 3) alarming increases in food insecurity, paradoxically associated with obesity, have been observed,4 with rates being disproportionately higher in ethnic minority households.5 Coordinated public health efforts are needed to reduce the deleterious impact of COVID-19 on obesity risk, with particular efforts needed among the most vulnerable families.
Obesity and obesity-related comorbidities are associated with increased risk of COVID-19 morbidity and mortality for both children and adults.6,7 Among children hospitalized for COVID-19, obesity is the most prevalent underlying condition.8 Similarly, adult obesity is frequently observed among those admitted to intensive care for COVID-19, with more severe obesity corresponding to more COVID-19 severity.9 Furthermore, the burden of COVID-19 has disproportionately fallen on individuals from lower income and racial and ethnic minority backgrounds due in part to greater exposure from employment (e.g., essential workers) and more frequent habitation in multigenerational households.10,11 Specifically, Black and Hispanic adults and children have significantly greater rates of cases, hospitalizations, and deaths when compared to their white counterparts.10 These disparities highlight systemic inequities, including those corresponding to higher rates of obesity, identifying the need for urgent action to reduce these trends and reverse other COVID-19 impacted obesogenic behaviors.
The pandemic has significantly disrupted many facets of family life and adversely impacted obesogenic behaviors. Stay-at-home mandates and the associated closures of schools, businesses, and other activities have disrupted routines and led to declines in child and adult physical activity,12,13 disruptions to sleep patterns, and increased screen time, all of which increase the risk of weight gain.13,14 Moreover, significant changes to eating patterns have been observed, with less dietary restraint,15 greater use of controlling feeding practices,4 decreased consumption of fruits and vegetables,16 and increased snacking and stress eating.14 Changes in the home food environment have become more salient with purchasing patterns associated with the pandemic suggesting greater prevalence of processed food in the home.4 Moreover, there are grave increases in food insecurity, with nearly 40% of Black and Hispanic households with children experiencing food insecurity.5 Taken together, these behavioral patterns are concerning, given their association with obesity, raising concern for long-standing obesity-related sequalae due to this pandemic. Thus, public health interventions and policies to address these behavioral trends are imperative, particularly for those most at risk due to these systemic disparities.
Given the increase in obesogenic behaviors, food insecurity and the COVID-19 health risks associated with obesity, timely intervention is critical. Innovative adaptations to evidence-based obesity interventions and targeted public health policies and legislative initiatives are urgently needed to address these widening health disparities. COVID-19 has exposed deep health inequities. These public health challenges will require commitment and coordination across multiple systems to avoid irreparable consequences to families’ health.
- Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2020). Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, 360.
- Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2017). Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief, 288.
- Smith, J. D., Fu, E., & Kobayashi, M. A. (2020). Prevention and Management of Childhood Obesity and its Psychological and Health Comorbidities. Annual review of clinical psychology, 16, 351-378.
- Adams, E. L., Caccavale, L. J., Smith, D., & Bean, M. K. (2020). Food insecurity, the home food environment, and parent feeding practices in the era of COVID‐19. Obesity, 28(11), 2056-2063.
- Schanzenbach, D., Pitts, A. (2020). Food insecurity in the census household pulse survey data tables. Northwestern University Institute for Policy Research. Retrieved from: https://www.ipr.northwestern.edu/documents/reports/ipr-rapid-research-reports-pulse-hh-data-1-june-2020.pdf
- Centers for Disease Control and Prevention. (2020). “Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/evidence-table.html
- Hussain, A., Mahawar, K., Xia, Z., Yang, W., & Shamsi, E. H. (2020). Obesity and mortality of COVID-19. Meta-analysis. Obesity research & clinical practice,14(4), 295-300.
- Kim, L., Whitaker, M., O’Halloran, A., Kambhampati, A., Chai, S. J., Reingold, A., ... & Anderson, E. J. (2020). Hospitalization rates and characteristics of children aged< 18 years hospitalized with laboratory-confirmed COVID-19—COVID-NET, 14 states, March 1–July 25, 2020. Morbidity and mortality weekly report, 69(32), 1081.
- Simonnet, A., Chetboun, M., Poissy, J., Raverdy, V., Noulette, J., Duhamel, A., ... & LICORN and the Lille COVID‐19 and Obesity study group. (2020). High prevalence of obesity in severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) requiring invasive mechanical ventilation. Obesity. Doi: 10.1002/oby.22831
- Centers for Disease Control and Prevention. (2020). COVID-19 Hospitalization and Death by Race/Ethnicity. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html.
- Substance Abuse and Mental Health Services Administration. (2020). Double jeopardy: COVID-19 and behavioral health disparities for black and Latino communities in the U.S. Retrieved from https://www.samhsa.gov/sites/default/files/covid19-behavioral-health-disparities-black-latino-communities.pdf
- Duncan, G. E., Avery, A. R., Seto, E., & Tsang, S. (2020). Perceived change in physical activity levels and mental health during COVID-19: Findings among adult twin pairs. PloS one, 15(8), e0237695.
- Dunton, G., Do, B., & Wang, S. (2020). Early Effects of the COVID-19 Pandemic on Physical Activity and Sedentary Behavior in US Children. BMC Public Health, 20, 1351.
- Zachary, Z., Brianna, F., Brianna, L., Garrett, P., Jade, W., Alyssa, D., & Mikayla, K. (2020). Self-quarantine and Weight Gain Related Risk Factors During the COVID-19 Pandemic. Obesity Research & Clinical Practice, 14(3), 210-216. doi:10.1016/j.orcp.2020.05.004
- Di Renzo, L., Gualtieri, P., Pivari, F., Soldati, L., Attinà, A., Cinelli, G., ... & Esposito, E. (2020). Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. Journal of Translational Medicine, 18(1), 1-15.
- Sidor, A., & Rzymski, P. (2020). Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland. Nutrients, 12(6), 1657.
Advancing Obesity Solutions across Multiple Sectors: An Interview with Dr. Nicolaas P. Pronk
Cypress Lynx, MPH✉; Obesity and Eating Disorders SIG
Nicolaas P. Pronk, PhD
The Obesity & Eating Disorders Special Interest Group (OED SIG) is excited to share an interview with the Chair of the Roundtable on Obesity Solutions. The Roundtable is a convening activity of the National Academies of Science, Engineering, and Medicine that brings together member organizations from multiple sectors to address the obesity epidemic. Through meetings, public workshops, publications, and innovation collaboratives, the Roundtable explores the science, evidence, evaluation, and innovation efforts that advance progress in reducing the impact of obesity, as well as applies effective equity strategies to address obesity-related disparities. SBM is a member organization, represented by Dr. Melissa Napolitano, SBM Fellow.
What is your role on the Roundtable?
My role as Chair is to ensure that our efforts meaningfully engage all member organizations and that our work is informed by evidence of what we know is effective.
The Roundtable is comprised of different members and often collaborates with professionals from diverse sectors. How does this diversity advance the Roundtable mission?
It would be nearly impossible to pursue this mission and vision without a diverse membership and variety of voices during our deliberations. Therefore, we organize in a manner that invites everyone to share their perspectives and ensure that we gather diverse points of view. Armed with such insights, the Roundtable membership can then move forward in a constructive and productive way.
What are today’s biggest challenges in obesity research, treatment, and prevention?
Challenges to address obesity are multifold, but we need both prevention and treatment. We know that the macro-environment (the economic situation of people, the food supply, the built environment, and more) and micro-environment (human biology, genetics and genomics, and behavior) play important roles. However, one of the most challenging issues relates to the interactions and intersections of all those variables and factors and how, when, and where they come together in any given individual or population. How can we use the available best evidence and current knowledge and apply it, adapt it, and adopt it locally to benefit people and communities?
What future opportunities do you see for the Roundtable, other stakeholders, and the OED SIG to advance and scale obesity solutions? Has the COVID-19 pandemic and the focused efforts on social justice influenced the Roundtable’s thinking about your future efforts?
The Roundtable represents a potential mechanism through which to inform and engage multiple stakeholders on important obesity-related issues. We help our membership identify policy opportunities and influence our member organizations to mobilize resources across multiple stakeholders to build capacity and capability around obesity solutions. The COVID-19 crisis has emphasized that this work is urgently needed, and the recent social justice efforts reinforce the importance of keeping equity at the top of our minds.
What advice do you have for OED SIG members who would like to learn more or get involved?
We always welcome additional member organizations at the Roundtable and its innovation collaboratives – please reach out if your organization or institution is interested in joining. To learn more, please visit: https://www.nationalacademies.org/our-work/roundtable-on-obesity-solutions.
The ‘Best Decision’ Ever Made – Words of Wisdom From a Clinical Psychologist in Private Practice
Eric Zhou, PhD✉; Jessee Dietch, PhD; Michael Mead, PhD; and Laura Nicholson, MA; Sleep SIG
There are many available career paths for behavioral scientists which were eloquently discussed during a recent SBM webinar titled “Career Paths Beyond the Academic Track.” For clinical psychologists, one such path is private practice. While all graduates of American Psychological Association-accredited clinical psychology programs receive considerable clinical training, the path to a part- or full-time career in private practice is one that is shrouded in mystery for recent (and not so recent) graduates.
We have the distinct pleasure of connecting with Dr. Virginia Runko, a clinical psychologist in Washington DC to learn more about her career path in behavioral sleep medicine (BSM) at her private practice, “DC Psychology and Sleep Services.”
Please introduce yourself, including your training background.
I’m a clinical psychologist and BSM specialist & diplomate. I earned my PhD in Clinical Health Psychology from the University of Miami and I completed a postdoc in BSM from Johns Hopkins. I’ve done research as part of my training but my passion has always been clinical work. On a personal note, I have a lovely family consisting of my supportive husband, my independent and confident 4-year-old daughter, and my sweetie pie 2.5-year-old son.
How long have you been in private practice?
I worked at a group mental health private practice, consisting of therapists and psychiatrists, for 5 years before opening my own private practice about a year and a half ago. My practice is called DC Psychology and Sleep Services which reflects my specialty in BSM but also the more general psychotherapy services I provide. Most of my patients initially come seeking CBT-I but many continue for more long-term therapy to address stress, relationships, mood, etc.
What motivated you to start your private practice?
By going out on my own, I could have complete autonomy, flexibility, and the opportunity to make more money. And after 5 years at the group practice, I learned a lot about the business and administrative aspects of running a practice so I felt confident I could tackle it.
What type of person do you think would be happiest pursuing a private practice career?
Someone who likes the nuts and bolts of running a business as well as the clinical work. I’ve found a lot of the business aspects fun! Also, someone who prefers to be their own boss would definitely be happy in private practice.
What words of wisdom would you share with a psychologist who is thinking of starting their own private practice?
Do your research. That is, talk to others who have started their own practices and attend talks about starting a practice. On one hand, you want to be prepared for what you’re getting into. On the other hand, you might realize it’s not as scary as you think once you get some reassurance from others that it can be done!
What are your highlights of working in private practice?
Having complete control over all decisions, from my schedule, how I design my marketing materials, to what office I want to work in. Also, since I’m a one-woman operation now, I like the boutique feel of my practice and I like that I’m able to personally be involved with the patient from the very first contact. I value that and I think patients value that.
What are your challenges of working in private practice?
Being a one-woman operation, the buck stops with me. This doesn’t lead to problems most days but there have certainly been times when I might get a flurry of inquiries and I can’t just end my day after I’m done seeing patients - I need to respond to everything in a timely fashion since no one else will. Related to this, since you do it all in solo private practice, having strong executive function skills is a big plus. If you’re not especially organized or you tend to let things slip through the cracks, private practice could be challenging. Also, others have said private practice, especially solo ones, can be isolating. I haven’t found that to be the case, perhaps since I share a suite with other psychologists and I’m in frequent contact with several mental health colleagues.
Have there been any surprises about your experience in private practice?
Everyone I spoke to before starting my practice said it’s been the best decision they’ve made so I shouldn’t be surprised yet I am still surprised that it truly has gone as well as it has and that I love it as much as I do! Another surprise is that I’m considering expanding my practice so soon after going out on my own. I, probably like many, think “one day” I’ll consider this or that, so when “one day” arrives so soon, it’s surprising.
Do you have opportunities to engage in research as a private practitioner?
Yes. I don’t seek engagement in research but somehow opportunities find me so I’m confident that if you’re actively looking to get involved with research, there is a way.
Interested in Behavioral Medicine and Palliative Care? A ‘How-To’ for Getting Started
Katherine Ramos, PhD✉; Laura Porter, PhD✉; Mike Hoerger, PhD; Kimberly Hiroto, PhD; and Sean O’Mahony, MD; Palliative Care SIG
Psychologists and other behavioral scientists are becoming increasingly interested in pursuing clinical and research opportunities in the growing field of Palliative Care. The focus of palliative care is to improve the quality of life of persons living with serious life-limiting illness, and for their families. This year, SBM approved the formation of the Palliative Care Special Interest Group (SIG) to support SBM members working in this area.
The SIG recently convened a panel of clinicians and researchers (early to senior in their respective careers) who presented a webinar on palliative care training and research opportunities. Speakers identified several cross-cutting themes for how to get started. Those themes include:
- Seek mentoring early and often. If local mentors are unavailable, reach out and secure distant mentors. For researchers, one tip includes using the NIH reporter search engine and use keywords to find investigators in your area of focus. Don’t be afraid of “cold emailing” investigators. Investigators with R01s may have opportunities for postdoctoral fellowships or diversity supplements.
- Become connected with palliative care-focused organizations. In addition to the SBM Palliative Care SIG, the National Palliative Care Research Center (NPCRC), Palliative Care Research Cooperative (PCRC), Hospice and Palliative Nurses Association (HPNA), Social Work Hospice and Palliative Network (SWHPN), and American Academy of Hospice and Palliative Medicine (AAHPM) provide important opportunities for networking, training, and leadership experiences.
- If you are early career, consider a clinical internship or fellowship in palliative care such as the Coleman Palliative Medicine Training Program (CPMTP) or the VA Health Care System Interprofessional Palliative Care Fellowship Program offered in 6 VA facilities (e.g., Palo Alto, CA; West LA, CA; Portland, OR; San Antonio, TX; Milwaukee, WI and Bronx, NY) . The VA also offers additional Palliative Care training for psychologists in clinical internship rotations and in fellowship. Leverage existing collaborative interprofessional training programs to build local interprofessional training programs to support professional development, informal mentorship, and resiliency. Consider pooling resources to build local and statewide mentored learning communities (e.g. the new Michigan Interdisciplinary PC Training Network).
- Increase multidisciplinary collaborations. Palliative care is a team sport. Collaborating with others outside your specialty will expand your knowledge and may generate novel ideas for research and clinical practice. Consider reaching out to palliative care physicians and social workers; ask to shadow them in clinic or attend their grand rounds or team meetings.
- Have a vision, strategize and goal-set around the career you desire. Outline 1-year, 3-year, and 5-year career goals. Identifying a clinician or researcher whose career you like and mirroring their path is one way to get started. As you continue to strategize your long-term plans, be sure to keep track of your metrics for success (e.g., number of clinical demonstration projects, publication record, grant funding, leadership involvement). Be open to modifying these plans as changes in the health care environment occur: adversity may become an opportunity.
- Play to your strengths. Consider your training background and specialty and how your past experiences may yield a high value to your approach to palliative care work. Examples include:
- If you are a clinical or counseling psychologist, consider offering your expertise in psychological assessments as a service to palliative care clinics. You could also develop theory-informed psychological interventions and/or train other palliative care providers in existing evidenced-based interventions.
- If you are trained in geriatrics, leverage this expertise to address the special needs of older adults in palliative care settings (e.g., integrating geriatric assessment tools in clinic, targeting patient and caregiver education and support across the dementia continuum).
- If you are a health economist, consider your role in assessing and evaluating economic outcomes of palliative care services.
Whichever training or opportunity path you choose in palliative care, you stand to benefit from enjoying a highly rewarding and personally meaningful career.
Please feel free to reach out for more question, and if you're interested in joining the Palliative Care SIG, contact us!
Introducing the Multiple Health Behavior Change and Multi-Morbidities (MHBCM) SIG
Brad Appelhans, PhD✉; Peter Giacobbi, PhD✉; and Tammy Stump, PhD✉; Multiple Health Behavior Change and Multi-Morbidities SIG
We are pleased to announce that the MHBCM SIG recently received formal approval from the SBM board. The SIGs that merged to create MHBCM have a rich history in SBM and brought a large pool of members and intellectual interests.
The Multiple Health Behavior Change (MHBC) SIG was formed around empirical evidence and the clinical reality that multiple health behaviors contribute more to the risks of chronic disease than single behaviors. MHBC interventions address two or more health behaviors either sequentially or simultaneously. The MHBC SIG was formed to encourage and support multidisciplinary research and knowledge translation using an integrated approach.
The Transdisease Processes SIG formed around a common interest in the roles of neurocognitive and decision-making processes in a variety of health outcomes. For example, delay discounting, different domains of executive function, emotion regulation, impulsivity, and reward processing are implicated in addiction, obesity and cardiometabolic disease, and other conditions. Our SIG aimed to bring together researchers studying these processes across disease states, both to consolidate our knowledge of how these constructs influence health and to improve our measurement capabilities.
The Multi-Morbidities SIG addressed the growing challenge of individuals exhibiting multiple chronic health conditions, including the combinations of two or more physical health conditions as well as the co-occurrence of both mental and physical health conditions. The presence of multiple health conditions presents psychosocial and behavioral demands that are often not addressed by existing interventions. This SIG aimed to raise awareness of these issues to promote assessment of multi-morbidity as well as efforts to prevent and control multi-morbidity using evidence-based techniques.
During 2019, our SIGs came to realize that these areas had substantial overlap and that a combined SIG would help leverage our strengths and create new opportunities for professional networking.
The mission of the MHBCM SIG is to 1) contribute to the development of a science of multiple health behavior change for health promotion and disease management, and 2) advance approaches to understanding and promoting health among those with multiple physical health conditions. When health risk behaviors co-occur, and/or a patient has multi-morbidities, they have an increased risk of poor health outcomes. Intervening in these contexts presents a unique set of challenges, such as whether to intervene simultaneously vs. sequentially to impact multiple behaviors or conditions and selecting and analyzing multiple outcome variables. Our group addresses the theoretical, methodological, intervention, statistical and funding issues related to targeting multiple health behaviors for change and promoting health among those with multi-morbidities. Our cross-disciplinary group is designed to enhance the professional development of its members by fostering networking, mentorship, career development, and scientific discussion.
We are grateful to all who provided input throughout this SIG merger. As you renew your SBM membership, please consider signing up for the MHBCM SIG if you aren't already a member.
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 2020 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.
- Go to the Members Only section of the SBM website.
- Log in with your username and password.
- Click on the Journals link.
- 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 email@example.com or (414) 918-3156.
Annals of Behavioral Medicine
Martin S Hagger, BA (Hons), PhD, Stephanie R Smith, BPsych (Hons), Jacob J Keech, BPsych (Hons), PhD, Susette A Moyers, BA (Hons), MA, Kyra Hamilton, BPsych (Hons), PhD
Social distancing is a key behavior to minimize COVID-19 infections. Identification of potentially modifiable determinants of social distancing behavior may provide essential evidence to inform social distancing behavioral interventions.
The current study applied an integrated social cognition model to identify the determinants of social distancing behavior, and the processes involved, in the context of the COVID-19 pandemic.
In a prospective correlational survey study, samples of Australian (N = 365) and U.S. (N = 440) residents completed online self-report measures of social cognition constructs (attitude, subjective norm, moral norm, anticipated regret, and perceived behavioral control [PBC]), intention, action planning, habit, and past behavior with respect to social distancing behavior at an initial occasion. Follow-up measures of habit and social distancing behavior were taken 1 week later.
Structural equation models indicated that subjective norm, moral norm, and PBC were consistent predictors of intention in both samples. Intention, action planning, and habit at follow-up were consistent predictors of social distancing behavior in both samples. Action planning did not have consistent effects mediating or moderating the intention–behavior relationship. Inclusion of past behavior in the model attenuated effects among constructs, although the effects of the determinants of intention and behavior remained.
Current findings highlight the importance of subjective norm, moral obligation, and PBC as determinants of social distancing intention and intention and habit as behavioral determinants. Future research on long-range predictors of social distancing behavior and reciprocal effects in the integrated model is warranted.
Eric Hekler, PhD, Jasmin A Tiro, PhD, Christine M Hunter, PhD, Camille Nebeker, EdD, MS
In 2015, Collins and Varmus articulated a vision for precision medicine emphasizing molecular characterization of illness to identify actionable biomarkers to support individualized treatment. Researchers have argued for a broader conceptualization, precision health. Precision health is an ambitious conceptualization of health, which includes dynamic linkages between research and practice as well as medicine, population health, and public health. The goal is a unified approach to match a full range of promotion, prevention, diagnostic, and treatment interventions to fundamental and actionable determinants of health; to not just address symptoms, but to directly target genetic, biological, environmental, and social and behavioral determinants of health.
The purpose of this paper is to elucidate the role of social and behavioral sciences within precision health.
Recent technologies, research frameworks, and methods are enabling new approaches to measure, intervene, and conduct social and behavioral science research. These approaches support three opportunities in precision health that the social and behavioral sciences could colead including: (a) developing interventions that continuously “tune” to each person’s evolving needs; (b) enhancing and accelerating links between research and practice; and (c) studying mechanisms of change in real-world contexts. There are three challenges for precision health: (a) methods of knowledge organization and curation; (b) ethical conduct of research; and (c) equitable implementation of precision health.
Precision health requires active coleadership from social and behavioral scientists. Prior work and evidence firmly demonstrate why the social and behavioral sciences should colead with regard to three opportunity and three challenge areas.
Lauren Connell Bohlen, PhD, Susan Michie, DPhil, Marijn de Bruin, PhD, Alexander J Rothman, PhD, Michael P Kelly, PhD, Hilary N K Groarke, MSc, Rachel N Carey, PhD, Joanna Hale, PhD, Marie Johnston, PhD
Behavioral interventions typically include multiple behavior change techniques (BCTs). The theory informing the selection of BCTs for an intervention may be stated explicitly or remain unreported, thus impeding the identification of links between theory and behavior change outcomes.
This study aimed to identify groups of BCTs commonly occurring together in behavior change interventions and examine whether behavior change theories underlying these groups could be identified.
The study involved three phases: (a) a factor analysis to identify groups of co-occurring BCTs from 277 behavior change intervention reports; (b) examining expert consensus (n = 25) about links between BCT groups and behavioral theories; (c) a comparison of the expert-linked theories with theories explicitly mentioned by authors of the 277 intervention reports.
Five groups of co-occurring BCTs (range: 3–13 BCTs per group) were identified through factor analysis. Experts agreed on five links (≥80% of experts), comprising three BCT groups and five behavior change theories. Four of the five BCT group–theory links agreed by experts were also stated by study authors in intervention reports using similar groups of BCTs.
It is possible to identify groups of BCTs frequently used together in interventions. Experts made shared inferences about behavior change theory underlying these BCT groups, suggesting that it may be possible to propose a theoretical basis for interventions where authors do not explicitly put forward a theory. These results advance our understanding of theory use in multicomponent interventions and build the evidence base for further understanding theory-based intervention development and evaluation.
Translational Behavioral Medicine
David X Marquez, Susan Aguiñaga, Priscilla M Vásquez, David E Conroy, Kirk I Erickson, Charles Hillman, Chelsea M Stillman, Rachel M Ballard, Bonny Bloodgood Sheppard, Steven J Petruzzello, Abby C King, Kenneth E Powell
Maintaining or improving quality of life (QoL) and well-being is a universal goal across the lifespan. Being physically active has been suggested as one way to enhance QoL and well-being. In this systematic review, conducted in part for the 2018 U.S. Health and Human Services Physical Activity Guidelines for Americans Scientific Advisory Committee Report, we examined the relationship between physical activity (PA) and QoL and well-being experienced by the general population across the lifespan and by persons with psychiatric and neurologic conditions. Systematic reviews, meta-analyses, and pooled analyses from 2006 to 2018 were used for the evidence base. Strong evidence (predominantly from randomized controlled trials [RCTs]) demonstrated that, for adults aged 18–65 years and older adults (primarily 65 years and older), PA improves QoL and well-being when compared with minimal or no-treatment controls. Moderate evidence indicated that PA improves QoL and well-being in individuals with schizophrenia and Parkinson’s disease, and limited evidence indicated that PA improves QoL and well-being for youth and for adults with major clinical depression or bipolar disorder. Insufficient evidence existed for individuals with dementia because of a small number of studies with mixed results. Future high-quality research designs should include RCTs involving longer interventions testing different modes and intensities of PA in diverse populations of healthy people and individuals with cognitive (e.g., dementia) and mental health conditions (e.g., schizophrenia) to precisely characterize the effects of different forms of PA on aspects of QoL and well-being.
Eric K Layland, Joseph A Carter, Nicholas S Perry, Jorge Cienfuegos-Szalay, Kimberly M Nelson, Courtney Peasant Bonner, H Jonathon Rendina
Stigma against sexual and gender minorities is a major driver of health disparities. Psychological and behavioral interventions that do not address the stigma experienced by sexual and gender minorities may be less efficacious. We conducted a systematic review of existing psychological and behavioral health interventions for sexual and gender minorities to investigate how interventions target sexual and gender minority stigma and consider how stigma could affect intervention efficacy. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Eligible studies were peer reviewed and published in English between January 2003 and July 2019 and reported empirical results of behavioral or psychological interventions implemented among sexual and gender minorities. All interventions addressed stigma. We identified 37 eligible interventions. Most interventions targeted sexual minority men. Interventions were frequently developed or adapted for implementation among sexual and gender minorities and addressed multiple levels and types of stigma. Interventions most frequently targeted proximal stressors, including internalized and anticipated stigma. HIV and mental health were the most commonly targeted health outcomes. A limited number of studies investigated the moderating or mediating effects of stigma on intervention efficacy. The application of an intersectional framework was frequently absent and rarely amounted to addressing sources of stigma beyond sexual and gender minority identities. A growing number of interventions address sexual and gender minority stigma in an effort to prevent deleterious health effects. Future research is needed to assess whether stigma modifies the effectiveness of existing psychological and behavioral interventions among sexual and gender minorities. Further, the application of intersectional frameworks is needed to more comprehensively intervene on multiple, intersecting sources of stigma faced by the diverse sexual and gender minority community.
William T Riley, Dana Greene-Schloesser, Dara R Blachman-Demner, Michael Spittel
The 10th anniversary of Translational Behavioral Medicine, commemorated by this special issue, coincides with the 25th anniversary of the Office of Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health (NIH). OBSSR was enacted by Congress in 1993 and established 2 years later in July 1995 to identify projects of behavioral and social sciences research that should be conducted or supported by the national research institutes and develop such projects in cooperation with such institutes and to coordinate research conducted or supported by the agencies of the NIH . Over the past 25 years, OBSSR has worked diligently to fulfill Congress’s charge. Strategically located within the NIH Office of the Director’s Division of Program Coordination, Planning, and Strategic Initiatives (DPCPSI), OBSSR is well positioned to facilitate collaboration across the NIH by convening NIH staff and extramural investigators, conducting workshops, developing trans-NIH initiatives, and providing cofunding of meritorious grant applications. In this commentary, we highlight some of the key projects led by OBSSR, in collaboration with our colleagues at the various NIH institutes and centers, to advance behavioral and social sciences research conducted or supported by the NIH. We also consider the opportunities and challenges of OBSSR and the behavioral and social sciences in the next 25 years.
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 firstname.lastname@example.org.
Steven N. Blair, PED
Clarivate recently recognized Dr. Blair as a highly cited researcher for 2020.
Richard J. Contrada, PhD
The Society for Health Psychology (APA Division 38) recognized Dr. Contrada with its 2020 Excellence in Health Psychology Mentoring Award.
Casey L. Daniel, PhD, MPH
Dr. Daniel received the 2020 Outstanding Young Alumni Award from Birmingham-Southern College and was named a 2020 Rising Star by the University of Alabama at Birmingham National Alumni Society.
Perry N. Halkitis, PhD, MS, MPH
Dr. Halkitis was selected for the 2020 Hyacinth Award, granted by the Hyacinth Foundation in recognition of those who have been an advocate and champion for individuals living with HIV.
Abby C. King, PhD
Dr. King was honored with the 2020-2021 Alva Myrdal Guest Professorship Award at Mälardalen University, Sweden.
Carla Miller, PhD, RD
Dr. Miller received the Faculty Research Award, recognizing individuals with significant contributions to the field of research, from the College of Education & Human Ecology at The Ohio State University.
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 email@example.com.
Jasjit S. Ahluwalia, MD, MPH, MS
Brown University profiled a recent publication by Dr. Ahluwalia in a piece entitled "Pod e-cigarettes less harmful than regular cigarettes, new study finds."
Cynthia Castro Sweet, PhD; Gina Merchant, PhD; and Dori Steinberg, PhD, MS, RD
Forbes Magazine listed Drs. Castro Sweet, Merchant, and Steinberg among its 10 Behavioral Scientists You Should Know.