Outlook: Newsletter of the Society of Behavioral Medicine

Spring 2020

President's Message

Michael Diefenbach, PhD, SBM President

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

Dear Colleagues:

I hope you and your families are well during this time of uncertainty. My heart is going out to all of you who are feeling unwell or have family members who are sick, in quarantine or are sheltering in place. I’m speaking to you from the epicenter of the pandemic, New York City where thousands have been impacted. We are a resilient nation and am hopeful that we will get through these challenging times. We are also a resilient society. It is not a time for slowing down our pursuit of scientific inquiry and productivity but to take this opportunity to share our science creatively.

Last week is when we would have held our Annual Meeting in San Francisco. It feels much longer now than the 4 weeks since the declaration of a global pandemic by the World Health Organization, and a public emergency by the US Government. All of this made it impossible to hold a meeting. You know that we did not make this decision lightly, but these events and the health of our members, the community of San Francisco and your own community was, and still is, our biggest concern.

Putting a conference together is a year-long process, we usually start in May right after the meeting to gear up for another year. So, you can imagine that canceling a meeting is not simple either. The society entered into several contracts: with the hotel, the A/V company, for catering, and so on. The process of cancelling them is governed by various terms, actions and official pronouncements. Given the reality that we are unable to hold our meeting in person, we turn to two other priorities: First, to present our program and science in an alternative way, and second, to ensure that the society can function in future years. Speaking of the financial future, everybody who registered to attend the meeting will get their registration refunded over the coming weeks.

Our annual meeting is my favorite scientific event of the year, and I can’t tell you how much I miss seeing you, listening to our science and learning from you and our keynote and master lecture presenters. The Program Committee, under Alison Phillips’ leadership, and I have thought about ways to bring some of the exciting activities we had planned to you. Here is what we have planned so far:

  • First, if you haven’t done so, please download the SBM annual meeting conference app in your app store. The app is called “SBM Events” and here you will eventually find all abstracts of accepted papers, panel discussions, symposia, and posters.
  • Second, in the coming weeks everybody who has an accepted paper and/or poster submission will be invited to submit a PDF of their paper/poster to SBM. The poster will be accessible through the online planner and the conference app. I recommend reserving some time to peruse the papers and posters, just as you would have done during the annual meeting. You might also want to contact your colleague and have a virtual dialogue about their and your work. It might lead to new collaborations.
  • Just as every year, all abstracts will be published in a special issue of our Journal Annals of Behavioral Medicine
  • Tracey Revenson, the new editor of Annals also has confirmed that she will reserve space for a write-up of all the keynote and master lectures in one of the upcoming issues that will be published over the summer.
  • individual SIGs will organize virtual business meetings over the next weeks. So please check your emails to know what’s going on with them.
  • Finally, and very importantly, please attend  our SBM wide virtual business meeting, which is scheduled for April 27th at 4:00pm Eastern Time. All members are invited, and you will hear presentations about SBM’s activities over the past year, its membership status and most importantly you will hear from incoming President Dr. Monica Baskin about her plans for the year. Be sure to mark your calendar for that.

I’m sure there will be other developments in the coming weeks and we will communicate them as they happen via email, our website, and our social media channels.

I know these are difficult times and it might not always be easy to keep your spirits up. But we as behavioral scientists can draw on our collective strengths to stay engaged. After all we have a strong community of friends and colleagues. During this time of forced physical isolation, let’s make sure that we connect virtually. Reach out to each other, communicate and share ideas. Hopefully you have some time to catch up on writing that manuscript that you have put off, and to think about the next research project. I urge you to not forget our conference theme this year of “Accelerating our Science” and in the spirit of provocative questions to think out of the box and to push our science forward.

I wish you good health and all the best. Take care.


Tired of Behavioral Medicine Being the “Best Kept Secret”?

Lisa Klesges, PhD, Past-President and Development Committee Chair; Michael Diefenbach, PhD, President; and Monica Baskin, PhD, President-Elect

Society of Behavioral Medicine (SBM) members told us they’re tired of behavioral medicine being the “best kept secret” for evidence-based decision making. They told us that they wanted to see our science and our society as the “go-to-place” for solutions of today’s behavioral medicine challenges in public health, health care and industry. They were also very vocal in wanting to increase our influence on public policy. We share this vision and we are taking steps to make this a reality.

SBM has important goals to increase our outreach efforts to policy makers, communicate our science to the public and industry, and to expand our leadership development offerings for members at all career stages. But achieving these ambitious goals requires more funding than we currently have. A fundraising campaign is on the horizon, and we hope you will join us to make this next chapter in SBM’s history a success.

The SBM Board of Directors has thought about such a campaign for a while and in late 2018, the board commissioned a fundraising feasibility study. We talked to more than 50 stakeholders and tested fundraising campaign ideas. We learned that people think very highly of SBM (92% of those interviewed rated us positively), and that they support our outreach, communication and education efforts. A large majority of participants (75%) also agreed that now is the right time to move forward with expanded fundraising activities.

This was encouraging, but we also learned about members’ concerns. Participants worried about SBM’s lack of a culture of member giving, and they had questions about taking donations from industry.

To that end, we are in the process of developing plans to inspire members to give for shared goals, to educate them about our future strategies and the stewardship of entrusted funds to date. SBM is a 501(c)(3) nonprofit organization, and it is crucial that our members know and trust that their donations will contribute to SBM’s mission to advance the science and the reach of behavioral medicine. We are finalizing policies to guide our acceptance of major gifts from both individuals and companies that align with our mission and values as a nonprofit organization.

You will be hearing a lot more from us about these effort in the coming months. Please stay tuned. And, in the meantime, if you want to get involved, please email SBM Development Coordinator Eli Rehorst at erehorst@sbm.org. We would love to have you help us achieve our ambitious goals.

We are looking forward to joining together to move behavioral medicine from the best kept secret to the best-known solution for today’s health challenges.


What is Dissemination & Implementation Science?: An Introduction and Key Resources in the Field

Rachel C. Shelton, ScD, MPH; SBM Member Delegate


It has been well-documented that there is a tremendous gap between research (e.g. what we know works in terms of evidence-based programs, interventions, practices, policies, guidelines) and practice (e.g. what is actually routinely delivered in real-world community and clinical settings). There have been numerous examples that have documented the efficacy or effectiveness of an ‘innovation’ (e.g. evidence-based practices or programs or EBIs) does not lead to or guarantee its uptake in widespread, routine use.  It has been estimated that it takes an average of 17 years for 14% of original (i.e., discovery) research to be translated and integrated into clinical practice among physicians, and it is likely even longer in community-based and lower-resource settings. NIH and other funding agencies globally have recognized the need for research to advance understanding of how to actively enhance the adoption, implementation, reach, and impact of scientific discoveries and interventions in real-world settings.

Dissemination and implementation (D&I) research is the scientific study of methods and strategies to promote the adoption and integration of proven evidence-based treatments, programs and practices into routine use in diverse real-world settings and populations. D&I science has grown rapidly as a field over the past 10-15 years, with a substantial increase in implementation science related submissions and publications, increasing D&I funding, and numerous opportunities for D&I training and job opportunities. The Society of Behavioral Medicine is home to many scientists and practitioners who have helped rigorously develop, evaluate, and build the evidence-base base for numerous programs and practices. As such, D&I research is a natural partner and extension of behavioral science, and an opportunity to consider how we can more actively facilitate the adoption and use of behavioral science innovations, practices, and interventions.

As a field, D&I science has had a focus on and made advancements in: 1) understanding multi-level aspects of context (e.g. policy, organizational, provider/implementer, individual factors) that influence the adoption and use of EBIs across diverse real-world settings, often guided by conceptual frameworks like the Diffusion of Innovations and the Consolidated Framework for Implementation Research; 2) development of a recognized set of D&I study designs (e.g. stepped wedge designs; mixed-methods) and D&I outcomes as a key focus for study (e.g. adoption, fidelity, sustainability, cost, acceptability), often guided by evaluation frameworks like the RE-AIM Framework; and 3) identification and testing of implementation strategies to actively facilitate the implementation of EBIs within specific clinical and community settings, often guided by the ERIC taxonomy.  Bi-directional learning and engagement with stakeholders is a central, foundational part of D&I science, to ensure that researchers are designing with dissemination and ultimately sustainability in mind from the start, and are inclusive of stakeholder perspectives of what is feasible and appropriate to ultimately enhance fit and relevance of solutions. While there has been great progress made as a field, important gaps and opportunities remain, including understanding the impact of planned adaptions for new settings and populations, and the right balance of fidelity and adaptation as EBIs are delivered across new and diverse real-world settings and populations. Further, there are many important but understudied areas that warrant further empirical investigation, including sustainability, scale-up, de-implementation, health equity, and D&I science applied to evidence-based policies.

There are numerous resources for those interested in learning more about the field. There are excellent databases that identify evidence-based program/practices (e.g. RTIPs database through NCI), recent textbooks that cover the core foundations in the field (‘Dissemination and Implementation Research in Health: Translating Science to Practice’; Brownson, Colditz, Proctor 2018), numerous journals that focus on this area (e.g. Implementation Science, Translational Behavioral Medicine, Implementation Science Communications, Implementation Research & Practice), multiple conferences (e.g. Society for Implementation Research Collaboration or SIRC; conference on the science of D&I Research in Health hosted by Academy Health and NIH), regular newsletters that highlight the latest research and funding/training opportunities, including from NCI (https://cancercontrol.cancer.gov/IS/index.html) and UNC Consortium for Implementation Science (http://news.consortiumforis.org/newsletter/), and multiple training opportunities (https://sites.wustl.edu/mtdirc/resources/links/), including Training Institute for Dissemination and Implementation Research in Health (TIDIRC) materials now made Open Access (https://cancercontrol.cancer.gov/IS/training-education/tidirc/openaccess.html). There are numerous postdocs and job opportunities that are rapidly growing in the field as well (https://impsciuw.org/implementation-science/connect/global-job-board/). Additionally, SBM has a growing number of members who are D&I scientists, and we encourage you to explore opportunities to learn from rigorous examples of D&I research at our upcoming Annual Meeting.

For more introductory information and an orientation to key domains and resources in the field, we recommend the following articles:

  • Koh, Lee, Brotzman, Shelton. 2018. An orientation for new researchers to key domains, processes, and resources in implementation science. Trans Beh Med.
  • Bauer, Mark S., et al. 2015. "An introduction to implementation science for the non-specialist." BMC psychology 3.1:32.  
  • Shelton, R.C., Lee M, Brotzman L, Wolfenden L, Nathan N, Wainberg M. 2020. What is Dissemination and Implementation Science?: An Introduction and opportunities to advance behavioral medicine and public health globally. International Journal of Behavioral Medicine.
  • Implementation Science at a Glance, National Cancer Institute (https://cancercontrol.cancer.gov/IS/docs/NCI-ISaaG-Workbook.pdf)

Implementation Science & Behavioral Health: An Interview with Dr. Leah Zullig

Allison A. Lewinski, PhD, MPH; Population Health Sciences SIG member


Leah Zullig, PhD

Implementation science is a rapidly growing and evolving area of research in the US and abroad. The main goal of implementation science is to increase the uptake, timeliness of uptake, and spread of evidence-based interventions and practices. My research interest is in health services and nursing research, specifically in developing and implementing sustainable interventions to improve health outcomes. As an early career investigator, I aim to develop meaningful interventions that are relevant, appropriate, and can be implemented in real-world clinical settings with interdisciplinary collaborators. For that reason, I chose to interview Leah Zullig, PhD to gain insight into this emerging area of research as well as obtain advice for researchers just starting out.
 

Who is Leah Zullig, PhD?

I am a health services researcher and implementation scientist. I examine cancer care delivery and quality, promoting cancer survivorship and chronic disease self-management. I am an investigator at the Durham Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham Veterans Affairs Medical Center, and an Associate Professor in the Duke Department of Population Health Sciences. I lead and collaborate on implementation science research both nationally and internationally.
 

What is an implementation scientist?

As an implementation scientist, I partner with individuals in a variety of academic, industry, healthcare, and community settings to apply rigorous research methods to implement and sustain effective interventions. This work often involves engaging with healthcare system leaders, clinicians, pharmacists, patients and others to understand the context in which we’re working and how to implement something with an eye toward not disrupting existing clinical workflows. I also guide and support individuals in considering how they can best support implementation, evaluate evidence-based programs, proactively plan for adapting evidence-based interventions, and consider when an intervention should be removed from practice.
 

How did you get into implementation science?

During my doctoral training I worked as a project coordinator in a health services research group at the Durham VA. In this role, I oversaw evidence-based interventions that were tested in a health care system and successfully improved health outcomes but were still not implemented into clinical practice. This nagged at me. Later, during my career development award, I focused on training about how to reduce the gap between research and clinical practice. When I became aware of the field of implementation science I was immediately excited. This emerging field of implementation science really addressed what I wanted to do—implement interventions that were sensitive to context and had a real-time impact on clinical practice and the health system.
 

What makes you excited about implementation science?

First, I have found the implementation science community to balance scientific rigor and exciting methodology with a welcoming, collegial, and collaborative spirit. Second, implementation science is multi-disciplinary. It is energizing to work with people from different disciplines, academic or industry roles, clinical backgrounds, communities, and environments. I also get to meet and work with researchers or stakeholders who have developed all types of innovative, evidence-based interventions. It’s rewarding to watch individuals adapt their interventions to be more successful. I also really value that the work that we do as implementation scientists has the potential to improve population health. That real-world impact is important.
 

What types of skills are key to succeeding in implementation science?

Implementation science is a team sport, and an implementation scientist may serve as a PI or a co-investigator on projects. Based on my experience, I would say that successful implementation scientists have two complementary skill sets:

  1. Technical skills: Operational knowledge of implementation science frameworks; familiarity with the historical underpinnings of implementation science; appreciation for stakeholder engagement; and respect for intervention fidelity while balancing adaptation is crucial.
  2. Communication and leadership skills: Ability to manage and work within a multidisciplinary team; respect for other viewpoints, roles, perspectives; desire to incorporate stakeholders in projects; humility; and being open to learning from other individuals who have different experiences.
     

What advice would you give to someone who wants to learn more about implementation science?

There are many formal training and mentoring opportunities to learn about implementation science. Such trainings are a fantastic opportunity because they can connect you with cutting-edge knowledge as well as mentoring in the field.
 

Any final thoughts?

This is an exciting time to be in implementation science. The field is expanding, and the demand is great. I am constantly learning something new with each research project I that complete!


How to Find the "Right" Postdoctoral Fellowship

Ekin Secinti, MS; Student SIG President

We interviewed Dr. Anthony E. Crimarco (Postdoctoral Fellow in Cardiovascular Disease Prevention at Stanford Prevention Research Center), Dr. Megan M. Miller (Postdoctoral Fellow at Indiana University-Purdue University Indianapolis and Riley Children’s Hospital), and Dr. Joseph Winger (American Cancer Society Postdoctoral Fellow at Duke University Medical Center) about how they were able to find the “right” postdoc!
 

Describe your postdoc.

Dr. Crimarco: My specific responsibilities include the analysis of dietary data, writing manuscripts, and occasionally lecturing material to study participants or master’s and undergraduate students.

Dr. Miller: My position consists mostly of analyzing data and writing manuscripts and grants. A small percentage of my time (1/2 days per week) is spent doing clinical work.

Dr. Winger: My typical day includes study-related duties (e.g., recruiting participants, data management), working on manuscripts for publication, attending meetings with my mentoring team, and writing grant proposals. I also attend various structured trainings (e.g., statistics workshops) throughout the year.
 

How did you find this postdoc?

Dr. Crimarco: I actually came across it from an email through SBM’s listserv (it’s free to sign up and a useful resource for doctoral students that are job hunting).

Dr. Miller: After discussing my research trajectory, Dr. Hirsh offered me the opportunity to work with him at the postdoc level to finish several projects I had begun as a graduate student. I was lucky enough to have my postdoc set up prior to beginning an internship.

Dr. Winger: I was encouraged to apply for this fellowship by my mentors. You can learn more about it on the American Cancer Society website.
 

What excites you most about this postdoc?

Dr. Crimarco: I love the autonomy and the ability to work with all of the faculty. What makes this postdoc unique compared to other ones is that we have the freedom to not only work in our advisor’s labs, but to also collaborate with all other faculty members and fellow postdocs. This allows me to explore new areas of research, while still continuing to become an expert in my original field of research.

Dr. Miller: The large amount of time I can devote to research.

Dr. Winger: I love serving as a principal investigator on work that I’m passionate about. It’s also great to participate in trainings that are directly aligned with my interests.
 

What is your biggest challenge?

Dr. Crimarco: I would say the biggest challenge is finding the right amount of work load. Because Postdocs can work with anyone here, sometimes we take on too much projects at once. It’s also possible to do “too little” if one does not make an effort to get involved in enough projects. So it’s important to be a self-starter and to have realistic expectations for how much work you would like to accomplish each semester. It’s also okay to “say no” sometimes.

Dr. Miller: The unstructured schedule of my position can feel too unstructured at times. I sometimes worry I am not making efficient use of my time and it can be hard to figure out which paper/project to prioritize.

Dr. Winger: My biggest challenge, initially at least, was knowing how to best structure my days and put my time and energy on my own work. When I started this fellowship, it was the first time in 6 years that my schedule was almost entirely up to me. So it was a bit disorienting for the first year. I found myself spending too much time on things other than my own line of research and first-authored publications. I’ve grown in this area immensely. It helps to check in with myself every time I receive a request. I’ll ask myself questions like, how long will preparing for this talk take? Do I actually have time to review a manuscript this week?
 

Any advice for others?

Dr. Crimarco: Start the job search process early -a year ahead of your intended starting date. Search for Postdocs from a variety of websites (e.g., Academic Keys, the American Society of Nutrition, the Chronicle of Higher Education, and Indeed.com). Practice some mock interviews with your professors and colleagues. Reach out to former postdocs for advice. Inquire about Postdocs or employment opportunities. If there is a particular professor whose research that you like, send them an email and introduce yourself. Truthfully a lot of postdoc opportunities are due to timing. Every once in a while it’s good to check in to see what type of grants have been awarded and what opportunities may come from these grants.

Dr. Miller: Define what you value in life, both career-wise and personally. Look for a postdoc position that will allow you to stay in line with those values (as much as possible) and maximize both.

Dr. Winger: I’d recommend finding a position where there are data available for you to analyze. I’m thankful to be in a lab with a long history of funded studies – with plenty of data for secondary analyses. A primary goal for research postdocs is to publish papers, so do your best to ensure that’s possible.


Intensive Longitudinal Data in Behavioral Medicine: A Q&A with Dr. Genevieve Dunton

Dani Arigo, PhD, LP; Behavioral Informatics and Technology (BIT) SIG Chair


Genevieve Dunton, PhD, MPH

Dr. Genevieve Dunton is an Associate Professor of Preventive Medicine and Psychology at the University of Southern California (USC). She has been instrumental in promoting the utility of intensive assessment (i.e., multiple assessments of the same person over short time frames) for advancing behavior change science and the use of sensor technology to capture behavior and its determinants in real time. She recently published influential papers on these topics in JAMA and Translational Behavioral Medicine.

 

You’ve been an advocate for using intensive longitudinal data (ILD) to study “micro-temporal processes.” What is this approach and what can it do for behavioral medicine?

Micro-temporal processes are sequences of events, exposures, or experiences underlying human behavior that unfold across acute timescales such as minutes or hours. I’ve been a big advocate for studying these processes because they can tell us so much more about when, where, and how people behave than by looking at change across traditional timescales (i.e., months and years). Understanding micro-temporal processes can be particularly important for studying health behaviors that need to be repeated in order to have health benefits (such as physical activity and healthy eating). Sustaining these behaviors can be challenging due to variations in how people feel, who they interact with, and the environments they encounter. When factors that influence that behavior vary over short time periods and across settings, maintaining consistent behavior can be difficult. Intensive longitudinal data (ILD) methods are critical for capturing micro-temporal processes because they collect many measurements (hundreds or thousands) over time, often at frequencies of seconds or minutes. ILD can help us learn important things about health behaviors such as their temporal specificity (e.g., Does the influence of a factor on behavior vary over time?), situational specificity (e.g., What specific environments influence specific behaviors?) and person specificity (e.g., What unique sets of factors are predictive of behavior for a given individual?). ILD offer an enormous opportunity to fine tune, enhance, and in some cases even scrap existing theories that guide behavioral medicine intervention(s?). Further, ILD can form the basis for the development and evaluation intensively adaptive interventions that incorporate real-time feedback into decision rules about what type of intervention is needed for whom, at what time, and in what situation.
 

What types of technology have you used to capture ILD?

In my Real-time Eating Activity and Children’s Health (REACH) lab at USC, we’ve used smartphones, accelerometers, external GPS devices, ultraviolet dosimeters, Bluetooth-enabled asthma inhalers, and wearable air pollution monitors. In one of our ongoing studies, Dr. Stephen Intille and I are combining assessments from smartphones and smartwatches to try to get the? most complete picture of micro-temporal processes underlying maintenance and relapse of physical activity, sitting time, and sleep over 12 months. We’re collecting continuous passive ILD from including acceleration, GPS, noise, light, voice and SMS messages, and app use. We are also intermittently collecting active forms of ILD through real-time self-reported Ecological Momentary Assessment (EMA) surveys of feelings, motivation, and cognitions. An innovative feature of this study is the use of micro-EMA through the smartwatch interface. Micro-EMA allows us to deploy brief questions to participants very frequently (up to 6 times per hour) with limited burden.
 

You and your colleagues also developed new statistical methods and software to analyze ILD. What makes this approach to analysis novel?

We’re very excited about our new MixWILD software! MixWILD stands for “Mixed Effects Modeling With Intensive Longitudinal Data.” Funded by grants from NHLBI and NCI, Dr. Don Hedeker and I have been able to develop this user-friendly (and free!) product for the analysis of mixed models. What’s unique about MixWILD is that it can be used to examine how subject-level means, variances, and slopes of time-varying variables may predict subject-level behavioral outcomes. ILD can be aggregated into conceptually and theoretically relevant indicators at higher-level units of analysis (e.g., week, month, year, person), including means (e.g., how unhappy is a subject, on average, across occasions?), variances (e.g., how erratic is a subject’s mood across occasions?), and slopes (e.g., is a subject’s mood related to feelings of energy across occasions?). MixWILD uses a two-stage modeling approach to test how these subject-level means, variances, and slope predict subject-level outcome. For example, MixWILD can help us to determine whether fluctuations in mood influence smoking or moderate the impact of a smoking cessation intervention. MixWILD has a user-friendly graphical interface with drop-down menus, so it is super easy for the non-expert. It also can be used to test regular multilevel linear and logistic regression models if you don’t want to worry about any of the fancy stuff described above.
 

What new or underused technologies and methods might help us make the biggest strides toward understanding micro-temporal processes?

A big challenge that we face in mHealth is low user engagement. Individuals download apps and are enthusiastic users for a while, but engagement drops off steeply after a few months. We face the same challenges when collecting ILD. We need to continue to push ourselves to innovate to optimize engagement. Doing so may mean harnessing new technologies and machine learning methods to passively assess constructs such as affective and physical feeling states that we could only previously collect through active input methods. This includes facial expression recognition algorithms, eye-tracking sensors, and predictive modeling of heart rate variability and galvanic skin response. We also need to think creatively about how to integrate features of gamification, entertainment, humor, social connection, and relaxation into our health behavior change and data collection applications to make them more engaging.
 

You also invest in the next generation of behavioral medicine professionals beyond mentoring your own trainees. What are some of the most common questions you get?

This is one of my most favorite parts of what I do. As a trainee, I benefitted immensely from attending mentoring sessions with experts during SBM annual meetings. After I came back from sabbatical last summer, I started hosting “Ask Me Anything” sessions. I post available times on Twitter and anyone who is interested can sign up for a slot using Calbird. We then do a 15-min one-on-one video call using Zoom. I can’t tell you how inspiring and fulfilling this experience is for me. We talk about a variety of topics including the job market, post-docs, and grant-writing. We also talk about problems with specific theories and technologies, challenges, and hang-ups that we face. I most commonly get questions about my own professional path, and I explain how haphazardly I got to where I am now. I also get questions about how behavioral medicine professionals can get more structured training on EMA. I wish there were more EMA courses or workshops available right now. It makes me think about trying to put together an online non-credit course that anyone could take.
 

How have your involvement in SBM and your use of social media platforms such as Twitter contributed to your career success or satisfaction (or both)?

I started my Twitter account in 2013 and ended up taking a break for a while, to focus on other priorities. When I came back, I was shocked at how much it had taken off as a platform to communicate with other professionals in behavioral medicine. Today, I cannot imagine how out of the loop I would be if were not on Twitter. I am constantly hearing about policy updates, new reports and guidelines, meetings, and hot-off-the-press papers. I also get to hear commentary from other professionals on the relevance, meaning, and importance of these advancements. There is no other outlet for sharing candid opinions about scientific issues in real time (given the slow pace of published commentaries and the infrequency of face-to-face scientific meetings). Lastly, Twitter helps me meet and connect with early stage professionals who may be a great fit with my lab. So, my take home message is if you’re not on Twitter, you probably should be!
 

What other advice do you have for early-career professionals, particularly as it relates to the use of technology to advance behavior change science and practice?

My biggest piece of advice is to start to reach out and work with people in other disciplines as soon as you can. It might mean going to talks in other departments or attending conferences outside of your field, which I did as a graduate student. As a post-doc, I was introduced to wonderful colleagues in computer science, whom I’ve now worked with for 12 years. Five years ago, I started collaborating with environmental epidemiologists. In each of these interdisciplinary situations, there were many times that I felt uncomfortable because I had no idea what they were talking about, and I thought they would not be interested in what an applied behavioral scientist had to say. In order to make true progress in what we are doing, we need to get ourselves out of our comfort zones quickly.
 

Contact Dr. Dunton at dunton@usc.edu and find her on Twitter at @GenevieveDunton.


On Developing Interorganizational Collaborations: A Dispatch from the Cancer SIG Health Partnerships Committee

Tammy A. Schuler, PhD; Cancer SIG Member

I am a clinical psychologist trained heavily in psycho-oncology research. However, my first position out of postdoc was something more non-traditional: Director of Outreach and Partnerships for the Association for Behavioral and Cognitive Therapies (ABCT). The “Partnerships” piece of this job meant that I needed to collaborate with other staff and leadership to determine what relationships ABCT should develop with other organizations and why. I spent nearly five eye-opening years learning how to do this. Incidentally, working for a professional organization’s central office was a wonderful experience and I highly recommend it. 

My position was a new role at ABCT and there were very few people out there with a position like mine. Thus, there was no definitive set of guidelines telling me what to do and nobody that could give me all the details. I eventually developed an understanding around how to develop and manage partnerships but developing this skillset will forever be a work in progress! I apply this learning now as Chair of the Health Partnerships Committee for the Cancer SIG and as the new Cancer Liaison for the Scientific and Professional Liaison Committee.

Here are some of the points that I think are important to consider when developing interorganizational collaborations:

  1. Ensure that traditionally underrepresented groups with a stake in an organizational goal or activity are involved in feasibility discussions, and subsequently, the planning and execution of the activity -- from the beginning and never as an afterthought. I cannot emphasize enough how important this is and that’s why I’m listing it as the first item.
     
  2. The organization you are representing will always have a stronger and more impactful voice when collaborating with other organizations. Remember this. Speaking in unison is one way to help the needle move to address the needs of the populations we are trying to help.
     
  3. The range of actions your organization can take in the context of partnerships is considerable: joint conferences, lobbying, interorganizational position papers, community outreach, interfacing with other scientists, and more.
     
  4. To determine what the goals and priorities of your organization are?(so that you know what kinds of partnerships you should cultivate), review your organization’s mission statement and current/historical strategic plans. Speak with the Board of Directors, staff, committee chairs, and other leadership. It’s worth noting that the Board of Directors and other voluntary leadership roles usually rotate out of their roles on a mandatory schedule, so the institutional memory of staff and minutes taken at meetings can prove invaluable to fill in the gaps and provide information on what has or has not worked in the past and why.
     
  5. Your organization’s strategic plan may need an update if an important goal comes to light that is not covered in the strategic plan. Spoiler alert: there probably is something important missing.
     
  6. Many people will have strong opinions on the actions that an organization should take, and they usually have very good reasons for their requests.Listen and learn something but choose your next steps wisely.
     
  7. It’s great to partner with other professional organizations, but also consider community groups, funding agencies and foundations, universities, patient advocacy groups, and others.
     
  8. Students and trainees are frequently some of the most organized people and the best liaisons there are. Include them in your efforts.

An Interview with Dr. Jacquelyn Campbell on Mentoring and Mentorship

Veronica P.S. Njie-Carr, PhD, RN, ACNS-BC, FWACN; Alicia A. Dahl, PhD, M.S.; & Victoria Grunberg, M.S.; Women's Health SIG Co-Chairs


Jacquelyn Campbell, PhD, MSN, RN

Dr. Jacquelyn Campbell is a Professor and Anna D. Wolf Chair in the School of Nursing at Johns Hopkins University and is the National Program Director for the Robert Wood Johnson Foundation Nurse Faculty Scholars. She is a world –renowned academic scientist and leader in research and advocacy in the field of domestic violence and intimate partner violence (https://nursing.jhu.edu/faculty_research/faculty/faculty-directory/jacquelyn-campbell). She is a master at mentoring and mentorship and epitomizes the essence of a mentor for scientists under her tutelage. Her ability to be inclusive in preparing the next generation of scientists is phenomenal. The Women’s Health SIG co-chairs interviewed Dr. Campbell to learn more about her mentoring qualities.
 

You are acclaimed for your mentorship abilities, a role model, and inspiration to hundreds, if not thousands globally. Please tell us how you do it.

My mentoring philosophy helps me mentor many people. Much of what I do is mentor people who will go on and mentor others. And that’s one of the kinds of formal and informal agreements I make with mentees – pay it forward.

Often times when I get requests to mentor someone, especially if it is a global request …somewhere around the world - I do see it as an opportunity and hopefully that's part of what I role model for others - is that mentoring is a wonderful opportunity to help empower someone else to go where they want to go in nursing and in scholarship. Plus, it gives me great joy and fulfillment to be able to mentor people, particularly, those that are committed as I am to providing assistance and empower those who face far more challenges than I have. I help secure what I call a mentoring network. So it is not just one person who is mentoring them. So that's how I do it.
 

Mentors have different values about mentoring and mentorship. Tell us about your philosophy of mentoring and mentorship.

Number one is the notion that mentorship is a partnership. I may have achieved certain things in life that my mentees have not. But that does not mean that they are not a full partner. It is a collaboration - that we work together - finding out what they need from me, and that I am building on their strengths and capabilities they already have in many ways. That mentorship is helping mentees recognize those strengths and capabilities and build on them. Also, have a network of mentors. The mentee has me in one particular area, but there are other people that I can connect them with that would be helpful in other areas where they either get additional skills or make additional contacts, or be mentored in different ways. For instance, if the mentee is a nurse, that nursing piece I'm really good at, but someone else might need mentorship in the combination of nursing and public health, or they need other mentorship around the public health pieces or if it's someone who's in social work, I get some help in that content area.

It is a collaborative process plus empowerment. I know that's a buzzword, but the notion that I'm helping them discover and have space in their existing talents, strengths, and capabilities is also a mentorship approach. It is much more of a partnership versus me, telling somebody what they should be doing. I'd love to have a few people that want to be just like me, but I'm not looking for that. I am looking for people I can provide some guidance where they want and help them where they want to go where they want to be. My philosophy is that people can outgrow me as a mentor. They may move on and that's fabulous. I don't feel like people have to be wedded to me. I am pleased to be a small part of their journey.
 

You provide quality mentorship amidst your multiple competing priorities, how do you find ways to be efficient?

The notion that it is a mentorship team is important. I do not encourage anybody to be totally relying on me for everything. For example, if someone wants a letter of support, I ask them to do their homework finding out whatever the selection criteria are. Then they will draft the letter of support, the kinds of things that needs a lot of time. It provides mentees the opportunity to know the impact of their work and how it might make a difference. It helps build confidence in what they're doing when they have to write it down and they get comfortable writing about themselves. Letters of support are important. If I agree to do it, I do it right. Just yesterday, I was working on a couple of American Academy of Nursing recommendation letters. I spent almost all day on two letters. Other people would say that's way too much time to spend on something like that. But I know how incredibly important those letters are. Part of what I do to be efficient is I only support things that I can make time to do. But I try limiting those things somewhat to be efficient. I spend time providing publication opportunities. Oftentimes I get invitations to do many things. So I can say, “I’ll be delighted,” but I would need so and so, for example, coauthor with me, otherwise I do not have time to do it. In our field, those are important for people to get into the habit of doing – publications and grant writing. I realize it's incredibly important that more junior people get on publications. I'm not very good at saying, no, especially to mentees, but I do try to limit the number of things I take on, but mentorship is one of my biggest priorities.
 

You clearly have reached the peak of your profession as an academic scientist, yet you remain resolute in your support and mentorship of trainees and faculty. What is your inspiration?

Well, I think in part I was well mentored. My other inspiration is that I find nurses especially to be amazingly wonderful people. I also find that people who do research in my area – behavioral health interventions, especially for those working in violence and trauma, are wonderful. I really admire what these people are committed to do and I feel privileged to be a small part of their journey and what they are trying to accomplish. People are addressing the problems that we have as a country - as a world, because there's so much violence and trauma, unfortunately. So that's my inspiration - working with other people that want to do that. I really like people, you know, people are mostly fabulous!


Advice on Obtaining NIH Funding for Sexual and Gender Minority Health Research: Interview with Dr. Karen Parker

 H. Jonathon Rendina, PhD, MPH; HIV and Sexual Health SIG Chair


Karen Parker, PhD, MSW

Dr. Karen Parker is the Director of the Sexual & Gender Minority Research Office within the NIH Office of the Director. Dr. Parker holds an MSW and PhD in Social Work and was formerly Acting Branch Chief of the Office of Science Planning and Assessment and Women’s Health Officer within the National Cancer Institute. We asked her to provide her thoughts on funding opportunities at NIH for sexual and gender minority health research.
 

What are the emerging topics in SGM research right now?

Sexual and gender minority health research is a nascent and growing field of scientific inquiry. While I am happy to say that research in this space continues to expand, there are still many unanswered questions relating to the health of SGM individuals across various chronic health conditions, especially when considering the intersections of sexual orientation and gender identity with other identities and their impact on health outcomes. Moreover, there is a dearth of research within certain subpopulations among sexual and gender minorities, including research on bisexual and bi+ individuals and transgender and gender non-conforming populations. Other emerging topics in this field include life course considerations and social determinants of SGM health.
 

What advice would you give to someone that is starting out in the field of SGM health research?

We need more researchers in this field that are committed to expanding our understanding of the unique health concerns and issues of SGM populations. My advice to someone starting out in this field is to never feel discouraged in pursuing your research passions. This field requires individuals that are tenacious in their scientific endeavors. We sometimes hear of investigators who don’t feel supported by their mentors or institutions when pursuing research within SGM populations. To those investigators, I say “stick it out.” Existing literature is consistent in demonstrating that SGM populations encounter significant health disparities in comparison to other groups and that more research is needed to better assess and understand those disparities. We need you!
 

What are important factors that contribute to success in obtaining funding?

For those of you interested in obtaining funding, I would strongly recommend that you first develop a network of scientific mentors and collaborators within the field, especially with those who have successfully been funded for their work. I’d recommend using NIH tools to develop these networks, including RePORTER. Using NIH RePORTER, you can search for previously funded and active projects relating to SGM health research. You can then look up information about the principal investigator, as well as the NIH Program Officer associated with that project. I cannot stress enough how helpful it is to reach out to a Program Officer if you are interested in applying for a grant. They are an invaluable tool in helping to navigate the application process.


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.

  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

Moving in Sync: Hourly Physical Activity and Sedentary Behavior are Synchronized in Couples

Theresa Pauly, Jan Keller, Nina Knoll, Victoria I Michalowski, Diana Hilda Hohl, Maureen C Ashe, Denis Gerstorf, Kenneth M Madden, Christiane A Hoppmann

Background
Overall time spent in moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior are both correlated in couples. Knowledge about the nature and psychosocial correlates of such dyadic covariation could inform important avenues for physical activity promotion.
Purpose
The present study investigates hour-by-hour covariation between partners (i.e., synchrony) in MVPA and sedentary behavior as partners engage in their daily lives and links it with person-level MVPA/sedentary behavior, temporal characteristics, and relationship variables.
Methods
We used 7-day accelerometer data from two couple studies (Study 1, n = 306 couples, aged 18–80 years; Study 2, n = 108 couples, aged 60–87 years) to estimate dyadic covariation in hourly MVPA and sedentary behavior between partners. Data were analyzed using coordinated multilevel modeling.
Results
In both studies, hourly MVPA and sedentary behavior exhibited similarly sized dyadic covariation between partners in the low-to-medium range of effects. Higher MVPA synchrony between partners was linked with higher individual weekly MVPA and higher individual weekly sedentary levels, whereas higher sedentary synchrony between partners was associated with higher individual weekly MVPA but lower individual weekly sedentary levels. MVPA and sedentary synchrony were higher in the morning and evening, more pronounced on weekends, and associated with more time spent together, longer relationship duration, and time-varying perceptions of higher partner closeness.
Conclusions
This study demonstrates that MVPA and sedentary behaviors do not occur in a social vacuum. Instead, they are linked with close others such as partners. Thus, capitalizing on social partners may increase the effectiveness of individual-level physical activity interventions.

Socioeconomic Status Moderates the Effects of Health Cognitions on Health Behaviors within Participants: Two Multibehavior Studies

Benjamin Schüz, Cameron Brick, Sarah Wilding, Mark Conner

Background
Socioeconomic differences in health-related behaviors are a major cause of health inequalities. However, the mechanisms (mediation/moderation) by which socioeconomic status (SES) affects health behavior are a topic of ongoing debate.
Purpose
Current research on SES as moderator of the health cognitions–health behavior relation is inconsistent. Previous studies are limited by diverse operationalizations of SES and health behaviors, demographically narrow samples, and between-person designs addressing within-person processes. This paper presents two studies addressing these shortcomings in a within-person multibehavior framework using hierarchical linear models.
Methods
Two online studies, one cross-sectional and one 4 week longitudinal, assessed 1,005 (Study 1; Amazon MTurk; USA only) and 1,273 participants (Study 2; Prolific; international). Self-reports of multiple SES indicators (education, income, occupation status; ZIP code in Study 1), health cognitions (from the theory of planned behavior), and measures of six health behaviors were taken. Multilevel models with cross-level interactions tested whether the within-person relationships between health cognitions and behaviors differed by between-person SES.
Results
Education significantly moderated intention-behavior and attitude-behavior relationships in both studies, with more educated individuals showing stronger positive relationships. In addition, ZIP-level SES (Study 1) moderated attitude-behavior effects such that these relationships were stronger in participants living in areas with higher SES.
Conclusions
Education appears to be an important resource for the translation of intentions and attitudes into behavior. Other SES indicators showed less consistent effects. This has implications for interventions aiming at increasing intentions to change health behaviors, as some interventions might inadvertently increase health inequalities.

Bereaved Family Cancer Caregivers’ Unmet Needs: Measure Development and Validation

Youngmee Kim, Charles S Carver, Rachel S Cannady

Purpose/Background
Accumulating evidence shows that bereaved family caregivers report elevated distress for an extended period, which compromises their quality of life. A first step in the development of programs to enhance bereaved caregivers’ quality of life should be determining the needs they experience to manage the loss, and the needs that are not being satisfied. Thus, this study aimed to develop a new measure to assess unmet needs among bereaved family caregivers.
Method
The 20-item Needs Assessment of Family Caregivers-Bereaved to Cancer measure was developed and validated with bereaved cancer caregivers 5 (n = 159) and 8 (n = 194) years after the initial cancer diagnosis of the index patient, when stress in providing care to the patient was assessed.
Results
Exploratory factor analysis yielded two primary factors: unmet needs for reintegration and unmet needs for managing the loss. Bereaved caregivers who were younger and ethnic minority, and who had greater earlier perceived stress of caregiving, reported their needs were more poorly met (t > 2.33, p < .05). The extent to which bereaved caregivers’ needs to manage the loss were not perceived as being met was a consistent and strong predictor of poor adjustment to bereavement at both 5- and 8-year marks (t > 1.96, p < .05), beyond the effects of a host of demographic and earlier caregiving characteristics.
Conclusion
Findings support the validity of the Needs Assessment of Family Caregivers-Bereaved to Cancer and suggest that interventions to help bereaved caregivers manage the loss by assisting their transition to re-engagement in daily and social activities will benefit caregivers by mitigating bereavement-related distress years after the loss.

 

Translational Behavioral Medicine

Feasibility of implementing mobile technology-delivered mental health treatment in routine adult sickle cell disease care

Charles R Jonassaint, Chaeryon Kang, Kemar V Prussien, Janet Yarboi, Maureen S Sanger, J Deanna Wilson, Laura De Castro, Nirmish Shah, Urmimala Sarkar

Abstract
Sickle cell disease (SCD) is a severe hemoglobinopathy characterized by acute and chronic pain. Sufferers of the disease, most of whom are underrepresented minorities, are at increased risk for mental health disorders. The purpose of this study is to test the acceptability and implementation of a computerized cognitive behavioral therapy (cCBT) intervention, Beating the Blues, to improve depression, anxiety, and pain in patients with SCD. Adults with SCD and significant symptoms of depression (Patient Health Questionnaire [PHQ-9] score ≥ 10) or anxiety (Generalized Anxiety Disorder Scale [GAD-7] score ≥ 10) were eligible to participate and be randomized to either receive eight sessions of cCBT with care coach support or treatment as usual. Participants reported daily pain and mood symptoms using a mobile diary app. Depression, anxiety, and pain symptoms were assessed at 1, 3, and 6 months. Thirty patients were enrolled: 18 to cCBT, and 12 to control. The cCBT intervention was feasible to implement in clinical settings and acceptable to participants. Patients in the cCBT arm reported a marginally greater decrease in depression at 6 months (−3.82, SE = 1.30) than those in the control group (−0.50, SE = 1.60; p = .06). There were no significant effects of treatment on anxiety; however, cCBT was associated with improved daily pain reported via a mobile diary app (p = .014). cCBT, delivered via mobile device, is a feasible strategy to provide mental health care to adults living with SCD. cCBT was acceptable to the target population; was able to be implemented in real-world, nonideal conditions; and has the potential to improve patient-reported outcomes.

Considering religion and spirituality in precision medicine

Karen H K Yeary, Kassandra I Alcaraz, Kimlin Tam Ashing, Chungyi Chiu, Shannon M Christy, Katarina Friberg Felsted, Qian Lu, Crystal Y Lumpkins, Kevin S Masters, Robert L Newton, Jr, Crystal L Park, Megan J Shen, Valerie J Silfee, Betina Yanez, Jean Yi

Abstract
The emerging era of precision medicine (PM) holds great promise for patient care by considering individual, environmental, and lifestyle factors to optimize treatment. Context is centrally important to PM, yet, to date, little attention has been given to the unique context of religion and spirituality (R/S) and their applicability to PM. R/S can support and reinforce health beliefs and behaviors that affect health outcomes. The purpose of this article is to discuss how R/S can be considered in PM at multiple levels of context and recommend strategies for integrating R/S in PM. We conducted a descriptive, integrative literature review of R/S at the individual, institutional, and societal levels, with the aim of focusing on R/S factors with a high level of salience to PM. We discuss the utility of considering R/S in the suitability and uptake of PM prevention and treatment strategies by providing specific examples of how R/S influences health beliefs and practices at each level. We also propose future directions in research and practice to foster greater understanding and integration of R/S to enhance the acceptability and patient responsiveness of PM research approaches and clinical practices. Elucidating the context of R/S and its value to PM can advance efforts toward a more whole-person and patient-centered approach to improve individual and population health.

Behavioral and social scientists’ reflections on genomics: a systematic evaluation within the Society of Behavioral Medicine

Colleen M McBride, Kristi D Graves, Kimberly A Kaphingst, Caitlin G Allen, Catharine Wang, Elva Arredondo, William M P Klein

Abstract
Clinical and public health translation of genomics could be facilitated by expertise from behavioral medicine, yet genomics has not been a significant focus of the Society of Behavioral Medicine (SBM). SBM convened a working group (WG) to lead a systematic exploration of members’ views on: (a) whether SBM should give a higher priority to genomic translation and (b) what efforts, if any, should be made to support this increased engagement. The WG used a stepped process over 2 years that began by gaining input from SBM leadership regarding key issues and suggestions for approach, engaging a cross section of membership to expand and record these discussions, followed by systematic qualitative analyses to inform priority action steps. Discussions with SBM leaders and members suggested that genomics was relevant to SBM, particularly for junior members. SBM members’ expertise in social and behavioral theory, and implementation study designs, were viewed as highly relevant to genomic translation. Participants expressed that behavioral and social scientists should be engaged in translational genomics work, giving special attention to health disparities. Proposed action steps are aligned with a “push–pull” framework of innovation dissemination. “Push” strategies aim to reach potential adopters and included linking members with genomics expertise to those wanting to become involved and raising awareness of evidence-based genomic applications ready for implementation. “Pull” strategies aim to expand demand and included developing partnerships with genomics societies and advocating for funding, study section modifications, and training programs.

 
 

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.

Kimlin Tam Ashing, PhD
Dr. Ashing was appointed chair of the American Association for Cancer Research Jane Cooke Wright Awards Committee and joined as a member of the AACR Breast Cancer Research Review Committee.

Noel T. Brewer, PhD
Dr. Brewer was recently named as a Fellow of the Association for Psychological Science.

Linda E. Carlson, PhD
The International Psycho-Oncology Society selected Dr. Carlson for its 2019 Bernard Fox Memorial Award.

Starlynne Gornail, MHS
The Rocky Mountain Public Health Training Center selected Ms. Gornail for its Student Leaders in Public Health award.

Megan A. Moreno, MD, MPH, MSEd
The Wisconsin Women’s Health Foundation has selected Dr. Moreno as a 2020 Champion in Women’s Health.

Gabriel Robles Alberto, PhD, MSW
Dr. Robles was appointed the Chancellor's Scholar for Inclusive Excellence in Sexual and Gender Minority Health at the Rutgers School of Social Work where he also started a tenure-track position as Assistant Professor in January.

Olayinka Shiyanbola, PhD
Dr. Shiyanbola was recently appointed Associate Professor in the University of Wisconsin-Madison School of Pharmacy.


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.

David B. Allison, PhD
Dr. Allison testified before the U.S. House of Representatives Committee on Science, Space, and Technology at a hearing entitled “Strengthening Transparency or Silencing Science? The Future of Science in EPA Rulemaking.”

Amy Bucher, PhD
The New York Times quoted Dr. Bucher in an article on credit card usage and financial behavior change.

Margaret C. Fahey, MA
The Washington Post featured Ms. Fahey in an article on holiday weight gain.

Becca Krukowski, PhD
Dr. Krukowski penned an article for The Best Times entitled "Three Tips for New Year's Weight Loss."

Alan Teo, MD, MS
Dr. Teo’s work on defining hikikomori was recently profiled in print by Oregon Public Broadcasting and BBC Science Focus and on the air on Oregon Public Broadcasting’s program Think Out Loud, and the BBC World Service’s Weekend program.


CLASSIFIEDS

University of Kansas Medical Center - Postdoctoral Researchers and Doctoral Students, Center for Physical Activity and Weight Management

The Center for Physical Activity and Weight Management supports research, training and clinics for the prevention and treatment of obesity in children and adults. Interests include all components of energy balance, metabolic syndrome, weight management delivery systems, technology, brain function, special populations (those with intellectual and physical disabilities), rural populations, and others. Currently, the Center has 8 funded R01 projects from the National Institutes of Health to investigate exercise and nutrition for prevention and treatment of obesity in adults and children including those with physical and intellectual disabilities. In addition, since 1986 the Center has maintained an ongoing clinical treatment program termed the Weight Control Research Project designed to provide weight loss and weight maintenance for adults. To learn more about the Center (grants and publications, etc.) please go to our website. Our Center is seeking: Post-Doctoral Researchers and Doctoral Students. For further information and/or to apply please go to Job Posting. Questions? Email: kim@ku.edu. EO/AA