The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the nation's medical research agency - making important discoveries that improve health and save lives.
The overarching goal of this Science of Behavior Change (SOBC) project is to utilize an experimental medicine approach to develop an efficient, ecologically valid, within-person approach to measuring and intervening on the deleterious effects of everyday stress on meeting recommended levels of two health behaviors: physical activity and sleep patterns. In Phase 1, we will develop, validate and deliver a stress assay that assesses malleable components of the stress process that drive health behavior decisions and enactment as they unfold, in real-time and in individuals' natural environments. In Phase 2, we will use this assay to evaluate "just-in-time" intervention approaches that target specific stress response components at times and in contexts when they are most malleable and can positively impact health behaviors. In contrast to previous daily stress studies, we will conduct coordinated analyses in 10 intensive longitudinal datasets separating effects of stressor reactivity, recovery and pile-up on health behaviors. By replicating the results across 10 studies we will ensure identification of the most reliable and potent targets for intervention.
This proposed Science of Behavior Change (SOBC) study will translate research on delay discounting to the prevention of Type 2 diabetes (T2D) in persons with prediabetes. A cross-sectional design will be used to test if delay discounting (DD) is a target related to behavioral and medical adherence in persons with prediabetes. Specifically, researchers will examine whether measures of DD, region of interest (ROI) neural activation during DD, and other executive functions are predictive of behavioral and medical adherence among prediabetics.
A recent Cochrane Review of RCTs aimed to increase regimen adherence paints a bleak picture of the current state of the field (Nieuwlaat et al., 2014). The authors summarize the results of 182 RCTs, which aimed to improve regimen adherence through various interventions, noting that most interventions produced little improvements in regimen adherence with small magnitudes of effect; additionally, those that worked were expensive interventions that combined many constituent elements, thereby making it difficult to understand the mechanisms through which they took their effect. The goal of the current study, therefore, is to take an experimental medicine-based approach which first identifies candidate targets related to stress and stress resilience - in particular, temporal discounting, self-efficacy, and executive control - which are likely to affect adherence and other health behaviors; develops interventions to affect these targets and assays to verify target engagement; and tests whether the engagement of these targets affects regimen adherence and other health behaviors.
Corrosive couple conflict—intense conflicts between partners that may involve physical or emotional aggression—and coercive parent-child conflict—escalating conflicts between parents and children that may involve physical or emotional aggression—are a pervasive, powerful, and destructive (but modifiable) poison to a wide range of adult and child health problems. Despite strong research findings and extensive clinical literature, measures that can sensitively, easily assess these patterns of conflict, and interventions that can quickly, precisely reduce these patterns, are both underdeveloped. This project will identify, refine, and develop these tools and seek to establish the resulting impact on health behaviors and adherence to medical regimens.
Self-regulation, or the ability to intentionally manage cognitive and emotional resources to accomplish goals, is crucial to addressing a wide range of health problems influenced by common behaviors, such as excessive eating, lack of physical activity, addiction, and poor adherence to medical regimens. Mindfulness interventions have initial evidence to influence self-regulation, however it is still poorly understand what specific elements of mindfulness interventions are most effective at influencing self-regulation, and if those changes in self-regulation translate into clinically meaningful health behavior changes, such as improved medial regimen adherence. This study proposes to analyze several existing datasets to answer these questions, as well as test the ability of customized mindfulness interventions to alter self-regulation and medical regimen adherence in four ongoing studies.
In this project we propose to understand self-regulation processes and mechanisms underlying evidence-based behavioral interventions for the treatment of obesity and depression, 2 of the top contributors to the burden of disease and disability in the US and globally. The project synergistically integrates human neuroscience and behavioral science to identify which self-regulation targets are engaged by the intervention among which subgroups of the population and how we can harness these target mechanisms to promote greater health behavior change, better weight management and improved mood. In a series of 3 interrelated studies we will identify, validate and refine a set of assays to measure self-regulation targets; and to engage these targets to optimize behavioral treatment of coexisting obesity and depression among adults. Given the widespread relevance of these disorders and the targeted health behaviors (adherence to self-tracking and medications, physical activity, diet), this research will be a prototype for understanding and optimizing behavioral interventions for multiple chronic conditions, with profound potential impacts on population health.
Childhood obesity is a critical and ongoing public health problem, with almost 25% of children overweight by age 4 years and 35% by adolescence. Once established, childhood obesity is difficult to treat and tracks into adulthood. The more years of a lifespan one is obese, the greater risk for obesity-associated comorbidities such as coronary heart disease, type 2 diabetes, hypercholesterolemia, asthma, hypertension, arthritis, and cancer. There is thus an urgent need to prevent and treat childhood obesity, but current prevention and treatment programs focused on diet and physical activity have limited efficacy. We posit that one reason for this is a lack of focus on the basic mechanisms of health behavior change, specifically self-regulation processes that may shape whether changes are adopted. The goal of the ABC Brain Games Study is to develop and test measures of childhood self-regulation targets and to evaluate associations with proximal processes known to be associated with later obesity and other health risks (e.g., obesogenic eating behavior, attention problems). Specifically, we are testing whether four brief interventions focused on improving self-regulation can change children's executive function (EF), food bias, emotion regulation, and future orientation as specific self-regulation targets that may be relevant for multiple health behaviors.
Because the need to alter health-related behavior is ubiquitous across medicine, understanding the extent to which the principles of effective health behavior change (and the mechanisms by which they work) are similar or differ across health conditions and settings is a critically important area of scientific inquiry -- and may inform more efficient, cost-effective, and patient-centered care. This line of research may allow us to make great strides in crafting “precision medicine” approaches for a wide array of populations.
The Resource and Coordinating Center (RCC) aims to provide strategic leadership, efficient coordination, inspired support, and pioneering dissemination of the innovative experimental medicine approaches that SOBC consortium scientists adopt to identify and validate measures, and engage novel behavior change targets.