Care New England Health System

COBRE CENTER FOR NEUROMODULATION (CCN)

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION

OPTIMIZATION OF A BEHAVIORAL INTERVENTION TO INCREASE PHYSICAL ACTIVITY IN OLDER ADULTS LIVING WITH HIV - INCREASING NUMBERS OF PERSONS LIVING WITH HIV (PLWH) ARE LIVING TO OLDER AGES. OLDER PLWH ARE AT INCREASED RISK FOR A WIDE SPECTRUM OF CO-MORBID CONDITIONS SUCH AS CARDIOVASCULAR DISEASE, FRAILTY PHENOTYPE, AND MENTAL HEALTH DISORDERS. PRACTICAL PRIMARY CARE-BASED INTERVENTIONS ARE NEEDED FOR OLDER PLWH THAT TARGET LIFESTYLE FACTORS TO REDUCE COMPLICATIONS OF AGING AND IMPROVE HEALTHSPAN. MOST PLWH ENGAGE IN LESS PHYSICAL ACTIVITY (PA) THAN IS RECOMMENDED BY PUBLIC HEALTH GUIDELINES. THUS, INCREASING PA CAN LEAD TO NUMEROUS MENTAL AND PHYSICAL HEALTH BENEFITS AMONG PLWH. CURRENT STUDIES IN PLWH TYPICALLY FOCUS ON THE IMPACT OF SUPERVISED EXERCISE. HOWEVER, THERE ARE MANY BARRIERS TO THIS TYPE OF PA. LIFESTYLE PHYSICAL ACTIVITY (LPA) PROGRAMS THAT FOCUS ON INTEGRATING PA, ESPECIALLY WALKING, INTO EVERYDAY LIFE, MAY BE MORE SUCCESSFUL IN PRODUCING A SUSTAINED INCREASE IN PA. THE LONG-TERM GOAL OF THIS RESEARCH IS TO DEVELOP AN EFFECTIVE AND EFFICIENT PRIMARY CARE INTERVENTION THAT INCREASES LPA AMONG OLDER PLWH. WE LEVERAGE THE MULTIPHASE OPTIMIZATION STRATEGY (MOST) AS A FRAMEWORK FOR DEVELOPING, OPTIMIZING, AND EVALUATING A MULTICOMPONENT BEHAVIORAL INTERVENTION. MOST IS COMPRISED OF THREE PHASES. FIRST, IN THE PREPARATION PHASE, AN EMPIRICAL AND THEORY-DRIVEN CONCEPTUAL MODEL IS DEVELOPED THAT IDENTIFIES DIFFERENTIABLE INTERVENTION COMPONENTS AND SPECIFIES OPTIMIZATION CRITERIA (I.E., GOAL OF INTERVENTION DEVELOPMENT). WE HAVE COMPLETED THIS PHASE. SECOND, IN THE OPTIMIZATION PHASE, THE IMPACT OF EACH INTERVENTION COMPONENT ON THE DESIRED OUTCOME IS EMPIRICALLY EXAMINED. THE GOAL IS TO DETERMINE WHICH COMPONENTS TO INCLUDE IN A FINAL INTERVENTION PACKAGE THAT IS OPTIMIZED FOR EFFICACY AND EFFICIENCY. THE PROPOSED STUDY REFLECTS THE SECOND PHASE, OR AN OPTIMIZATION TRIAL. FINALLY, IN THE EVALUATION PHASE, THE OPTIMIZED INTERVENTION PACKAGE IS EVALUATED FOR EFFICACY IN A TRADITIONAL RCT; THIS WILL BE THE NEXT STEP IN THIS LINE OF RESEARCH FOLLOWING THE CURRENTLY PROPOSED PROJECT. IN THIS PROJECT, WE WILL TEST THE IMPACT OF THREE SEPARABLE INTERVENTION COMPONENTS ON STEPS PER DAY AFTER 4 MONTHS OF INTERVENTION. WE WILL RECRUIT 208 PLWH OF AGE =50 YEAR CLASSIFIED AS LOW-ACTIVE. ALL PARTICIPANTS RECEIVE COMPONENT ‘0’: BRIEF ADVICE TO EXERCISE AND A FITBIT ACTIVITY TRACKER. WE THEN TEST 3 ADDITIONAL COMPONENTS IN A FACTORIAL DESIGN: 1) PA COACHING— FOCUSED ON GOAL-SETTING AND SELF-MONITORING; 2) COGNITIVE-BEHAVIORAL INTERVENTION FOR PA (CB-PA)—FOCUSED ON IDENTIFYING VALUES AND ADDRESSING INTERNAL BARRIERS TO PA SUCH AS PAIN, DEPRESSION, OR FATIGUE; 3) SOCIAL SUPPORT FOR PA (SS-PA)—A COMPONENT WHICH LEVERAGES THE SOCIAL FUNCTIONALITY OF THE FITBIT APP, PROMOTING SOCIAL SUPPORT AND FRIENDLY COMPETITION. THE PRIMARY OUTCOME WILL BE STEPS PER DAY DURING MONTH 4. THE OBSERVED MAIN AND INTERACTION EFFECTS FOR THE 3 CANDIDATE COMPONENTS WILL GUIDE SELECTION OF COMPONENTS TO BE INCLUDED IN AN OPTIMIZED INTERVENTION THAT WILL BE TESTED IN A FUTURE RCT. WE WILL ALSO EXAMINE POTENTIAL MEDIATORS FOR EACH INTERVENTION COMPONENT, AS WELL AS SECONDARY OUTCOMES INCLUDING PERCEIVED PHYSICAL HEALTH, MENTAL HEALTH, CARDIOVASCULAR DISEASE RISK, AND THE FRAILTY PHENOTYPE.

TAILORED LIFESTYLE INTERVENTION IN OBESE ADULTS WITHIN PRIMARY CARE PRACTICE

TESTING THE EFFICACY OF A TECHNOLOGY-SUPPORTED LIFESTYLE PHYSICAL ACTIVITY INTERVENTION AMONG WOMEN WITH DEPRESSION IN ALCOHOL TREATMENT

OPTIMIZATION AND MULTI-SITE FEASIBILITY OF YOGA FOR CHRONIC PAIN IN PEOPLE IN TREATMENT FOR OPIOID USE DISORDER - CHRONIC PAIN IS A SIGNIFICANT PROBLEM FOR AT LEAST HALF OF ALL PERSONS RECEIVING OPIOID AGONIST THERAPY (OAT) FOR OPIOID USE DISORDER – I.E., BUPRENORPHINE/ NALOXONE (BUP) OR METHADONE MAINTENANCE TREATMENT (MMT). PHARMACOTHERAPEUTIC PAIN MANAGEMENT IS CHALLENGING IN OAT PATIENTS, AND OTHER BEHAVIORAL OPTIONS FOR MANAGING CHRONIC PAIN ARE NEEDED. HATHA YOGA MAY BE A USEFUL ADJUNCTIVE APPROACH FOR DECREASING PAIN- RELATED DISABILITY AND PAIN SEVERITY, AND PREVENTING OPIOID MISUSE DURING OAT. THERE IS EVIDENCE SUPPORTING ITS EFFICACY IN OTHER CHRONIC PAIN POPULATIONS, AND YOGA MAY TARGET CRAVINGS AND OTHER RISK FACTORS FOR OPIOID RELAPSE. WITH NCCIH R34 FUNDING, WE CONDUCTED A PILOT RCT OF A 12-WEEK HATHA YOGA CLASS VS. A HEALTH EDUCATION CLASS (HE; A CONTROL CONDITION) FOR PEOPLE WITH CHRONIC PAIN RECEIVING MMT (N=20) OR BUP (N=20) FOR OPIOID USE DISORDER. THE PRIMARY TARGET OF THE YOGA INTERVENTION WAS DECREASED LIFE INTERFERENCE DUE TO PAIN. IN THIS STUDY, WE MEASURED MULTIPLE INDICES OF FEASIBILITY AND ACCEPTABILITY OF THE MANUALIZED INTERVENTIONS. ALTHOUGH WE MET A PRIORI BENCHMARKS ON MANY OF THESE FEASIBILITY INDICES, WE DID FIND THAT, CONSISTENT WITH LITERATURE ON BEHAVIORAL INTERVENTIONS IN OAT PATIENTS, SOME PARTICIPANTS ATTENDED ONLY VERY FEW CLASSES. THUS, AS A NEXT STEP IN THIS RESEARCH, THE PURPOSE OF THE CURRENT PROJECT IS TO DEVELOP AN OPTIMIZED YOGA INTERVENTION PACKAGE THAT INCLUDES KEY COMPONENTS THAT INCREASE YOGA DOSAGE RECEIVED, DEFINED AS TIME IN CLASS (A FUNCTION OF NUMBER OF CLASSES ATTENDED) PLUS HOME YOGA PRACTICE TIME. WE PLAN TO USE THE MULTIPHASE OPTIMIZATION STRATEGY (MOST) TO DO THIS. WE WILL EVALUATE FOUR INTERVENTION COMPONENTS, ALL OF WHICH WILL BE ADDED TO OUR STANDARD GROUP YOGA CLASSES, TO DETERMINE THEIR IMPACT ON TOTAL YOGA DOSAGE RECEIVED. THESE COMPONENTS ARE: A) TWO ADDED 1:1 MEETINGS WITH THE YOGA TEACHERS; B) PROVISION OF STUDY TEACHER-LED HOME PRACTICE VIDEOS; C) MONETARY INCENTIVES FOR CLASS ATTENDANCE; AND D) TEXT MESSAGES DESIGNED TO INCREASE INTRINSIC MOTIVATION FOR YOGA PRACTICE. AS A SECONDARY GOAL, IN KEEPING WITH THE U01 PROGRAM ANNOUNCEMENT, WE WILL ALSO DEMONSTRATE THAT WE CAN CONDUCT THIS RESEARCH IN TWO SITES DISTINCT FROM EACH OTHER AND FROM OUR PREVIOUS SITE. IN THIS STUDY, AFTER CONDUCTING PILOT WORK (PHASE 1), WE PLAN TO CONDUCT A FULLY-POWERED FACTORIAL EXPERIMENT THAT WILL ALLOW US TO EVALUATE THE IMPACT OF EACH OF THE 4 INTERVENTION COMPONENTS ON YOGA DOSAGE RECEIVED. ALL PARTICIPANTS WILL RECEIVE THE CORE YOGA INTERVENTION, WITH RANDOM ASSIGNMENT TO RECEIVE OR NOT RECEIVE EACH OF THE FOUR INTERVENTION COMPONENTS OUTLINED ABOVE. RESULTS FROM PHASE 2 WILL ALLOW US TO CHOOSE AN EFFICIENT COMBINATION OF INTERVENTION COMPONENTS THAT, TOGETHER WITH STANDARD YOGA CLASSES, MAXIMIZES YOGA DOSAGE. WE WILL ALSO BE ABLE TO EXAMINE MECHANISMS BY WHICH INTERVENTION COMPONENTS ARE HYPOTHESIZED TO WORK. THIS PROJECT WILL PREPARE US FOR THE NEXT STEP IN THIS RESEARCH, I.E., A FULLY-POWERED, MULTI-SITE RCT TESTING THE OPTIMIZED YOGA INTERVENTION (VS. A CONTROL CONDITION), WITH A PRIMARY OUTCOME OF REDUCED PAIN INTERFERENCE.

EVALUATION OF THE "COPING LONG TERM WITH ACTIVE SUICIDE PROGRAM"

DEX/CRH RESPONSE: MOOD/ANXIETY DISORDER ENDOPHENOTYPE?

INITIATING AND MAINTAINING PHYSICAL ACTIVITY IN DEPRESSED INDIVIDUALS

EFFECTIVENESS OF A MULTI-COMPONENT MHEALTH INTERVENTION TO IMPROVE POST-HOSPITAL TRANSITIONS OF CARE FOR PATIENTS WITH SMI - PROJECT SUMMARY/ABSTRACT THE PERIOD IMMEDIATELY FOLLOWING DISCHARGE FROM ACUTE PSYCHIATRIC HOSPITALIZATION IS A TIME FRAUGHT WITH GAPS AND DISCONTINUITIES IN CARE FOR MANY PATIENTS. DESPITE THIS TIME OF ELEVATED RISK, PATIENTS OFTEN LACK SUFFICIENT TRANSITIONAL SUPPORTS AND RELATED RESOURCES FOR RETURNING TO THE COMMUNITY AND RESUMING LONG-TERM OUTPATIENT TREATMENT. THE LONG-TERM GOAL IS TO IMPROVE THE CONTINUITY OF CARE FOR PATIENTS WITH SERIOUS MENTAL ILLNESS (SMI) BY SUPPORTING A SAFER AND MORE EFFICIENT BRIDGE FROM HOSPITAL TO OUTPATIENT CARE. THE OBJECTIVE OF THIS PROPOSAL IS TO TEST THE EFFECTIVENESS OF OUR EMPIRICALLY-SUPPORTED, MULTI-COMPONENT MHEALTH INTERVENTION CALLED TFOCUS IN COMPARISON TO ENHANCED ASSESSMENT AND MONITORING TO ENSURE SAFETY AND AN ADEQUATE STANDARD OF CARE (“SAFE”). TFOCUS WILL BE DEPLOYED DURING THE HIGH-RISK PERIOD DIRECTLY FROM HOSPITAL TO OUTPATIENT CARE AND PROVIDE REAL-TIME ASSESSMENT AND INTERVENTION TO PATIENTS VIA A MOBILE APP, PLUS USER ENGAGEMENT AND CLINICAL STATUS UPDATES TO CLINICIANS VIA A WEB-BASED “DASHBOARD.” TO SPEED THE TRANSLATION OF FINDINGS TO CLINICAL PRACTICE, WE WILL RIGOROUSLY TEST THE EFFECTIVENESS OF TFOCUS IN A FULLY-POWERED HYBRID TYPE 1 EFFECTIVENESS-IMPLEMENTATION TRIAL, WHILE COLLECTING INFORMATION ON IMPLEMENTATION BARRIERS/FACILITATORS TO PROMOTE UPTAKE IN REAL WORLD SETTINGS. THE CENTRAL HYPOTHESIS IS THAT TFOCUS WILL IMPROVE ILLNESS SELF-COPING AND TREATMENT ATTITUDES, WHICH WILL LEAD TO REDUCED: PSYCHIATRIC SYMPTOMS, REHOSPITALIZATIONS, AND SUICIDAL IDEATION/BEHAVIORS. TFOCUS WILL ALSO LEAD TO IMPROVED POST-DISCHARGE TREATMENT ENGAGEMENT AND ILLNESS RECOVERY. THE AIMS OF THIS PROPOSAL ARE: (1) TO CONDUCT A FULLY-POWERED, RCT (N=180) TO TEST THE EFFECTIVENESS OF TREATMENT-AS-USUAL (TAU) + TFOCUS VS TAU + SAFE; (2) TO EXAMINE POTENTIAL MEDIATORS AND MODERATORS OF TREATMENT EFFECTS; AND, (3) TO IDENTIFY PATIENT, STAFF, AND ORGANIZATIONAL/SYSTEM-LEVEL FACTORS THAT MAY FACILITATE/HINDER TFOCUS IMPLEMENTATION. THE PRIMARY OUTCOME WILL BE OVERALL PSYCHIATRIC SYMPTOMS. THE APPROACH IS INNOVATIVE BECAUSE IT IS ONE OF THE FIRST RANDOMIZED CONTROLLED TRIALS CONDUCTED IN THE U.S. SPECIFICALLY EVALUATING AN MHEALTH AFTERCARE SUPPORT PROGRAM FOR PATIENTS WITH SMI DIRECTLY MOVING FROM HOSPITAL TO OUTPATIENT CARE. ALSO, THIS STUDY IS UNIQUE IN THAT IT WILL COLLECT DATA TO GENERATE HYPOTHESES ABOUT IMPLEMENTATION STRATEGIES VIA A MULTI-PRONGED APPROACH INVOLVING KEY STAKEHOLDERS AND ADDITIONAL IMPLEMENTATION ATA. UPON SUCCESSFUL COMPLETION OF THE PROPOSED R01 RESEARCH, THIS STUDY WILL CONTRIBUTE SIGNIFICANT ACTIONABLE DATA THAT WILL LAY THE GROUNDWORK FOR A LARGE-SCALE HYBRID TYPE 3 TRIAL OF TFOCUS IN DIVERSE HOSPITAL SETTINGS.

PREDICTING SUICIDE: A LONGITUDINAL ANALYSIS OF SPEECH PATTERNS IN A HIGH RISK SAMPLE

RACIAL/ETHNIC DISPARITIES IN HEART FAILURE: A CROSS COHORT COLLABORATION - ABSTRACT HEART FAILURE (HF), AND ITS SUBTYPES DEFINED BY PRESERVED (HFPEF), REDUCED (HFREF) OR MID-RANGE (HFMREF) EJECTION FRACTION ARE A MAJOR AND GROWING PUBLIC HEALTH PROBLEM. THE LONG TERM GOAL OF THIS PROJECT IS TO BETTER UNDERSTAND THE HEALTH DISPARITIES REGARDING HF AND DEFINE EFFECTIVE PREVENTIVE MEASURES THAT MAY REDUCE THESE DISPARITIES. WE PROPOSE TO POOL DATA FROM 10 LARGE LONGITUDINAL COHORT STUDIES TO EXAMINE RACE/ETHNIC AND SEX DISPARITIES IN DEVELOPING HF, ITS SUBTYPES, AND ITS PROGNOSIS. THE HARMONIZED DATA WILL INCLUDE OVER 130,028 MEN AND WOMEN WITH OVER 8975 SIMILARLY-ADJUDICATED PROSPECTIVE HF OUTCOMES, REPRESENTING A WIDE SPECTRUM OF AGES, RACE/ETHNICITIES, AND GEOGRAPHIC REGIONS OF THE UNITED STATES. THIS CROSS-COHORT COLLABORATION WILL PROVIDE A UNIQUE OPPORTUNITY TO CONDUCT A COMPREHENSIVE EVALUATION OF SEX AND RACIAL/ETHNIC HEALTH DISPARITIES IN HF. CAUSAL MEDIATION ANALYSIS TECHNIQUES WILL BE USED TO ESTIMATE THE DEGREE TO WHICH SINGLE AND MULTI-FACTOR LIFESTYLE AND CLINICAL INTERVENTIONS COULD POTENTIALLY REDUCE HEALTH DISPARITIES IN HF. IN OUR PHENOMAPPING AIM, WE WILL DEFINE UNIQUE CLINICALLY RELEVANT PHENOTYPES OF HF BASED UPON COHORT DATA THAT IS ALSO COMMONLY PRESENT IN MEDICAL RECORDS FOR ENHANCED GENERALIZABILITY, INCLUDING AGE, RACE/ETHNICITY, SEX, CLINICAL SIGNS, SYMPTOMS, BIOMARKERS, EJECTION FRACTION, PHYSIOLOGIC MEASURES, AND CO-MORBIDITIES; WE WILL ALSO EVALUATE HF PHENOTYPE ASSOCIATIONS WITH CVD AND ALL-CAUSE MORTALITY.

RISK PROFILES AND MECHANISMS OF DISEASE IN MALTREATED CHILDREN

FUNCTIONAL IMAGING OF CORTICO-LIMBIC PREDICTORS OF EMOTION REGULATION, EMOTION REACTIVITY, AND RISK FOR SUICIDAL IDEATION AND BEHAVIOR

ECOLOGICAL ASSESSMENT OF PROXIMAL RISK FACTORS FOR SUICIDE DURING CARE TRANSITIONS - PROJECT SUMMARY/ABSTRACT SUICIDAL IDEATION AND BEHAVIOR ARE GROWING PUBLIC HEALTH PROBLEMS IN THE UNITED STATES. THIS IS PARTICULARLY CONCERNING DURING THE HIGH-RISK PERIOD FOLLOWING DISCHARGE FROM PSYCHIATRIC HOSPITALIZATION WHEN RISK FOR SUICIDE IS AMONG THE HIGHEST RATES OBSERVED. UNFORTUNATELY, OUR CURRENT ABILITY TO PREDICT SUICIDE IS ONLY SLIGHTLY ABOVE CHANCE. THIS POOR PREDICTIVE ABILITY MAY BE DUE TO AN OVERRELIANCE ON DISTAL/CROSS-SECTIONAL SUICIDE RISK FACTORS ALONE, RATHER THAN AN EMPHASIS ON PROXIMAL RISK FACTORS (THE DYNAMIC COGNITIVE, AFFECTIVE, AND BEHAVIORAL EXPERIENCES OCCURRING IN THE DAYS, HOURS, AND MINUTES PRIOR TO SUICIDE). THE PROPOSED STUDY BUILDS UPON OUR TEAM'S EXISTING INFRASTRUCTURE AND EXPERTISE IN DIGITAL PHENOTYPING AND ECOLOGICALLY VALID MODELS OF SUICIDE RISK. WE WILL EXAMINE HOW AFFECTIVE (E.G., NEGATIVE AFFECT) AND CONTEXTUAL (E.G., SOCIAL INTERACTIONS, COGNITIONS, & SLEEP DISRUPTION) PROXIMAL RISK FACTORS INTERACT TO INFLUENCE SUICIDAL IDEATION AND CONFER RISK FOR SUICIDAL BEHAVIOR, PARTICULARLY DURING THE HIGH-RISK PERIOD FOLLOWING HOSPITALIZATION. WE WILL RECRUIT AND FOLLOW-UP WITH 240 PSYCHIATRIC INPATIENTS HOSPITALIZED FOR SUICIDAL IDEATION OR BEHAVIOR OVER A FIVE-YEAR STUDY PERIOD. PARTICIPANTS WILL COMPLETE BASELINE ASSESSMENTS INCLUDING CLINICAL INTERVIEWS, LABORATORY-BASED BEHAVIORAL ASSESSMENTS, AND SELF-REPORTS OF DISTAL RISK FACTORS ASSOCIATED WITH SUICIDE. DURING HOSPITALIZATION, PARTICIPANTS WILL BEGIN COMPLETING ECOLOGICAL MOMENTARY ASSESSMENTS (EMAS) OF AFFECT, COGNITION, BEHAVIOR, AND SOCIAL/ENVIRONMENTAL CONTEXT. FOLLOWING DISCHARGE, PARTICIPANTS WILL CONTINUE EMA MONITORING FOR 4-WEEKS AT BASELINE AND AGAIN FOR TWO 3-WEEK EMA “BURSTS” AT 3- AND 6-MONTH FOLLOW-UP ASSESSMENTS. DURING EACH EMA MONITORING PERIOD, WE WILL COLLECT DIGITAL PHENOTYPING DATA (E.G., SLEEP, LOCATION, ACTIVITY LEVEL/MOVEMENT) USING WEARABLES AND SMARTPHONE SENSORS. WE WILL CONDUCT 3- AND 6-MONTH FOLLOW-UP ASSESSMENTS IN OUR LAB TO RE-ADMINISTER LAB-BASED BEHAVIORAL ASSESSMENTS AND COLLECT OUTCOME DATA INCLUDING SUICIDAL IDEATION, SUICIDAL BEHAVIOR, AND RE-HOSPITALIZATION. THE PROPOSED STUDY AIMS TO IDENTIFY PROXIMAL RISK FACTORS FOR SUICIDE AND USE INTENSIVE LONGITUDINAL METHODS TO CHARACTERIZE THE RELATIONSHIPS AMONG AFFECTIVE AND CONTEXTUAL PROXIMAL RISK FACTORS WHILE ALSO EXAMINING HOW DISTAL RISK FACTORS MODERATE THE RELATIONSHIPS AMONG PROXIMAL RISK FACTORS AND BETWEEN PROXIMAL RISK FACTORS AND SUICIDAL IDEATION AND BEHAVIOR. WE WILL EXAMINE THESE RELATIONSHIPS BOTH BEFORE AND AFTER DISCHARGE FROM PSYCHIATRIC HOSPITALIZATION. THE RESULTS OF THIS STUDY HAVE THE POTENTIAL TO SUBSTANTIALLY ENHANCE OUR UNDERSTANDING OF SUICIDE PHENOMENOLOGY AS IT EXISTS IN THE REAL WORLD, PARTICULARLY ACROSS THE HIGH-RISK PERIOD FOLLOWING PSYCHIATRIC HOSPITALIZATION, WITH THE POTENTIAL TO IMPROVE OUR ABILITY TO PREDICT, PREVENT, AND ULTIMATELY TREAT SUICIDAL THOUGHTS AND BEHAVIORS USING TRADITIONAL AND TECHNOLOGY-ENHANCED INTERVENTIONS.

AEROBIC EXERCISE FOR SMOKERS WITH DEPRESSIVE SYMPTOMATOLOGY

EFFICACY OF A PRENATAL YOGA INTERVENTION FOR ANTENATAL DEPRESSION

REDUCING STIS IN EMERGING ADULTS WHO USE ALCOHOL AND MARIJUANA

EARLY LIFE STRESS: EPIGENETIC REGULATION OF ENDOCRINE AND IMMUNE PATHWAYS

VARENICLINE VERSUS NICOTINE REPLACEMENT FOR METHADONE-MAINTAINED SMOKERS

TRANSLATING COPD GUIDELINES INOT PRIMARY CARE PRACTICE

A LONGITUDINAL EMA STUDY EXAMINING THE ROLE OF MATERNAL MOOD AND PHYSICAL SYMPTOMS ON WOMEN'S CANNABIS USE ACROSS THE PERINATAL PERIOD - ABSTRACT CANNABIS IS THE MOST WIDELY USED DRUG AMONG PREGNANT WOMEN, AND RATES OF USE ARE INCREASING DRAMATICALLY. REASONS FOR THE SHARP INCREASE IN CANNABIS USE (CU) AMONG IN PERINATAL WOMEN ARE NOT CLEAR. CHANGES IN CANNABIS LEGALIZATION, INCREASED ACCESS AND ACCEPTABILITY OF THE DRUG, AND A PERCEPTION OF LOW HEALTH RISK OR THERAPEUTIC BENEFIT ARE POSSIBLE EXPLANATIONS. INCREASED CU FOR MEDICINAL REASONS IN THE GENERAL POPULATION MAY PROMPT WOMEN TO CONSIDER CU FOR PREGNANCY SYMPTOMS, SUCH AS NAUSEA. FURTHER, SYMPTOMS OF ANXIETY AND DEPRESSION ARE COMMON DURING THE PERINATAL PERIOD, AND SOME WOMEN MAY TURN TO CANNABIS IF IT IS PERCEIVED TO BE LESS RISKY, OR MORE ACCEPTABLE, THAN STANDARD PSYCHOPHARMACOLOGIC TREATMENTS. YET ADVERSE OUTCOMES HAVE BEEN DOCUMENTED, INCLUDING HIGHER INCIDENCE OF LOW BIRTH WEIGHT, GREATER NEED FOR NEONATAL INTENSIVE CARE ADMISSION, AND A 3-FOLD RISK OF NEONATAL MORBIDITY. MOTHERS WHO USE CANNABIS PRENATALLY EXPERIENCE HIGHER RATES OF DEPRESSION; AMONG POSTPARTUM USERS, THERE IS ALSO A GREATER RISK FOR DEPRESSION AND AS WELL AS LOWER LIKELIHOOD OF BREASTFEEDING. NOT ALL WOMEN WHO USE CANNABIS PRIOR TO PREGNANCY CONTINUE DURING THE PERINATAL PERIOD. SOME DATA SUGGEST THAT 2/3 OF WOMEN DISCONTINUE CU UPON LEARNING OF PREGNANCY, WITH UP TO 1/3 CONTINUING USE. OUR DATA SHOW THAT MANY WOMEN WHO CONTINUE CU EXPRESS CONFLICTED FEELINGS ABOUT THEIR USE. AMONG THOSE WHO QUIT, RELAPSE IS NOT UNCOMMON, ESPECIALLY AFTER DELIVERY. REASONS FOR CONTINUED CU DURING THE PERINATAL PERIOD, AND MOTIVATIONS FOR CESSATION, ARE RELATIVELY UNKNOWN. IN LIGHT OF THE WIDESPREAD CU DURING THE PERINATAL PERIOD, A CRITICAL NEED EXISTS TO DEVELOP TAILORED INTERVENTIONS, SERVICES, AND EDUCATIONAL MATERIALS, PARTICULARLY ADDRESSING THE NEEDS OF PREGNANT WOMEN WITH HIGH LEVELS OF MOOD AND PHYSICAL SYMPTOMS. HOWEVER, BEFORE INTERVENTIONS AND SERVICES CAN BE DEVELOPED, IT IS CRUCIAL TO ELUCIDATE PREGNANT WOMEN’S MOTIVES FOR CU, PREDICTORS OF USE AND CESSATION, THE EXTENT TO WHICH MOOD AND PHYSICAL SYMPTOMS DRIVE PATTERNS OF USE, AS WELL AS THE SALIENCE OF CONTEXTUAL FACTORS (E.G., ACCESS TO CANNABIS). UTILIZING A FRAMEWORK BASED ON SOCIOECOLOGICAL MODELS OF HEALTH BEHAVIOR, WE PROPOSE TO EXAMINE FACTORS THAT CONTRIBUTE TO WOMEN’S CU BEHAVIOR IN THE PERINATAL PERIOD. IN THIS 5-YEAR STUDY, WE WILL RECRUIT 200 PREGNANT WOMEN WHO REPORT REGULAR CU IMMEDIATELY PRIOR AND/OR DURING PREGNANCY AND FOLLOW THEM FROM THE FIRST TRIMESTER OF PREGNANCY TO 12 WEEKS POSTPARTUM. WE INCLUDE 4, 10-DAY BURSTS OF ECOLOGICAL MOMENTARY ASSESSMENT (EMA) DURING THE PERINATAL PERIOD TO TRACK ASSOCIATIONS BETWEEN MATERNAL MOOD AND PHYSICAL SYMPTOMS, CU, AND CANNABIS CRAVINGS. FURTHER, WE WILL CONDUCT QUALITATIVE INTERVIEWS WITH WOMEN TO ELICIT FEEDBACK REGARDING IDEAL CONTENT AND MODALITY OF FUTURE SERVICES AND INTERVENTIONS. QUANTITATIVE AND QUALITATIVE RESULTS WILL BE INTEGRATED TO YIELD COHESIVE FINDINGS TO GUIDE FUTURE RESEARCH AND SERVICE DEVELOPMENT. TAILORED SUPPORT FOR WOMEN MAY REDUCE DELETERIOUS OUTCOMES ASSOCIATED WITH CU DURING THE PERINATAL PERIOD.

RCT TO IMPROVE POST-HOSPITAL TREATMENT ADHERENCE FOR COMORBID SUBSTANCE USE AND BIPOLAR DISORDERS

CHILDHOOD MALTREATMENT:BIOMARKERS OF RISK AND RESILIENCE

WHISH-2-PREVENT HEART FAILURE STUDY

RESIDENCY TRAINING IN PRIMARY CARE

AA LINKAGE FOR ALCOHOL ABUSING WOMEN LEAVING JAIL

IMPROVING FUNCTIONING IN HIV PATIENTS WITH CHRONIC PAIN AND COMORBID DEPRESSIVE SYMPTOMS

COMPARING BRIEF ALCOHOL INTERVENTIONS FOR HIV-HCV CO-INFECTED PERSONS

LINKING OPIOID DEPENDENT PATIENTS FROM INPATIENT DETOXIFICATION TO PRIMARY CARE

MULTI-METHOD ASSESSMENT OF EMOTION REACTIVITY: TRANSLATIONAL RESEARCH IN SUICIDE

CONTROLLED TRIAL OF DBS FOR OCD

RCT OF A TAILORED WALKING PROGRAM TO REDUCE STRESS AMONG PREGNANT WOMEN

DYNAMIC IMPACTS OF SLEEP DISRUPTION ON ECOLOGICALLY ASSESSED AFFECTIVE, BEHAVIORAL, AND COGNITIVE RISK FACTORS FOR SUICIDE - PROJECT SUMMARY/ABSTRACT SUICIDAL IDEATION AND BEHAVIOR ARE GROWING PUBLIC HEALTH PROBLEMS IN THE UNITED STATES. UNFORTUNATELY, OUR CURRENT ABILITY TO PREDICT SUICIDE IS ONLY SLIGHTLY ABOVE CHANCE, WHICH MAY BE ATTRIBUTABLE TO AN OVERRELIANCE ON DISTAL/CROSS-SECTIONAL RISK FACTORS THAT ARE WEAK PROXIMAL PREDICTORS OF SUICIDE RISK. MODELING THE COMPLEX PROCESS BY WHICH ATYPICAL SLEEP IMPACTS DAILY FUNCTIONING IN CONJUNCTION WITH ESTABLISHED PROXIMAL RISK FACTORS CAN AID IN IDENTIFYING CONTEXTS AND TIME PERIODS OF GREATEST SUICIDAL RISK, MODELED AT THE INDIVIDUAL LEVEL. THE PROPOSED STUDY BUILDS UPON OUR TEAM’S EXTENSIVE EXPERTISE IN SLEEP/WAKE CYCLES, PSYCHOPHYSIOLOGY, DEEP PHENOTYPING, AND MULTI-METHOD, MULTIVARIATE, ECOLOGICALLY VALID MODELS OF SUICIDE VULNERABILITY IN HIGH-RISK PSYCHIATRIC POPULATIONS. WE WILL EXAMINE HOW A HOLISTIC MODEL OF ATYPICAL SLEEP RELATES TO KNOWN TRAIT (BASELINE NEUROCOGNITIVE PERFORMANCE; E.G., GREATER IMPULSIVE TENDENCIES, HIGHER LOSS SENSITIVITY, REDUCED ABILITY TO REGULATE EMOTIONS) AND STATE (TIME-VARYING, OCCURRING HOURS TO DAYS BEFORE SI/SB; E.G., MOMENTARY FLUCTUATIONS IN EMOTIONAL REACTIVITY, IMPULSIVITY; GREATER EMOTIONAL LABILITY; GREATER ISOLATIVE TENDENCIES), RISK FACTORS FOR SUICIDE, AND EXAMINE HOW THESE FACTORS TOGETHER PROXIMALLY INFLUENCE SUICIDAL IDEATION AND CONFER RISK FOR FUTURE SUICIDAL BEHAVIOR. WE WILL RECRUIT 200 PSYCHIATRIC INPATIENTS AT HIGH RISK FOR SUICIDE AND CONDUCT A BASELINE ASSESSMENT OF SLEEP/WAKE FUNCTIONING AND TRAIT RISK FACTORS AND USE LABORATORY-BASED TASKS COUPLED WITH PSYCHOPHYSIOLOGY (I.E., EVENT- RELATED POTENTIALS, HEART RATE VARIABILITY, AND ELECTRODERMAL ACTIVITY) TO PHENOTYPE RISK PROCESSES LINKED TO AROUSAL AND COGNITIVE SYSTEMS. THIS BASELINE ASSESSMENT WILL BE FOLLOWED BY FOUR WEEKS OF EMA AND DIGITAL PHENOTYPING COUPLED WITH SAFTE-DERIVED ACTIGRAPHY TO CHARACTERIZE KEY STATE RISK FACTORS. WE WILL CONDUCT FOLLOW-UP ASSESSMENTS AT 1-, 3-, AND 6-MONTHS POST HOSPITAL DISCHARGE TO DETERMINE HOW OUR PROXIMAL MODEL OF RISK PROSPECTIVELY PREDICTS SI AND SB. THE PROPOSED STUDY AIMS TO CHARACTERIZE PROXIMAL RISK FOR SUICIDE USING INTENSIVE LONGITUDINAL METHODS AND TO IDENTIFY “WINDOWS” OF GREATEST RISK FOR SUICIDE, WHICH MAY VARY FROM PERSON TO PERSON, THAT SERVE AS MARKERS FOR INTENSIVE INTERVENTION. FINALLY, WE WILL LEVERAGE THIS EXTENSIVE DATASET TO DEVELOP A MODEL OF THE SLEEP-SUICIDE RELATIONSHIP EMPHASIZING THE CONTRIBUTION OF TRAIT AND STATE FACTORS. THE RESULTS OF THIS STUDY HAVE THE POTENTIAL TO GREATLY ENHANCE OUR UNDERSTANDING OF THE PHENOMENOLOGY OF SUICIDE RISK AS IT EXISTS IN THE REAL WORLD, WITH THE POTENTIAL TO IMPROVE OUR ABILITY TO PREDICT, PREVENT, AND INTERVENE USING BOTH TRADITIONAL AND TECHNOLOGY-ENHANCED PSYCHOTHERAPIES.

HEMODYNAMIC AND COGNITIVE FUNCTION IN CARDIOVASCULAR DISEASE

TESTING THE EFFICACY OF AN EXERCISE INTERVENTION FOR PATIENTS WITH OCD

LINKAGE OF HOSPITALIZED OPIOID USERS TO BUPRENORPHINE

SEQUENTIAL USE OF FLUOXETINE FOR SMOKERS WITH ELEVATED DEPRESSIVE SYMPTOMS

RCT OF HATHA YOGA FOR PERSISTENT DEPRESSION

ACCOUNTABLE HEALTH COMMUNITIES TRACK 3

TDCS TO DECREASE OPIOID RELAPSE - BUPRENORPHINE HAS EMERGED AS A LEADING TREATMENT FOR OPIOID USE DISORDER (OUD), BUT RECIPIENTS HAVE HIGH EARLY RELAPSE RATES LIKELY DUE TO VARYING DEGREES OF DYSFUNCTION WITHIN CRAVING AND COGNITIVE CONTROL NEURONAL NETWORKS. TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) MAY HAVE PROMISE AS ADJUVANT TREATMENT FOR BUPRENORPHINE INITIATORS BECAUSE CONSIDERABLE WORK ON ADDICTIVE SUBSTANCES SUGGESTS TREATMENT TARGETED AT THE DORSOLATERAL PREFRONTAL CORTEX (DLPFC; REGION INVOLVED IN SELF-REGULATION) MAY REDUCE CRAVING AND DRUG CONSUMPTION. WE WILL MEASURE BEHAVIORAL AND BRAIN RESPONSES FOLLOWING TDCS STIMULATION TO THE DLPFC DELIVERED DURING COGNITIVE CONTROL NETWORK (CCN) PRIMING. PARTICIPANTS IN THEIR FIRST WEEK OF PRESCRIBED BUPRENORPHINE WILL BE ASSESSED TWICE USING FMRI, ONCE PRIOR TO TDCS+CCN PRIMING AND AGAIN AT THE COMPLETION OF 5 SESSIONS OF TDCS+CCN PRIMING (ONE WEEK LATER). TASK-BASED AND RESTING STATE FUNCTIONAL CONNECTIVITY WILL BE USED TO EXAMINE NETWORKS ASSOCIATED WITH CRAVING (CR) AND COGNITIVE CONTROL. IN THE UG3 PHASE (N=60), FMRI WILL PROVIDE VALIDATION OF EXPECTED CHANGES IN THESE NETWORKS FOLLOWING TDCS STIMULATION. GO/NO GO CRITERIA FOR THE UH3 PHASE WILL BE DEMONSTRATION OF GREATER FMRI CHANGE IN ANY NODE OF THE CR OR CCN NETWORKS AND GREATER CHANGE IN SUBJECTIVE CRAVING MEASURED PRIOR TO (OUTSIDE FMRI SCAN) OR DURING AN FMRI CUE REACTIVITY TASK FOLLOWING THE TDCS+CCN PRIMING INTERVENTION COMPARED TO SHAM TDCS+CCN PRIMING. IN THE UH3 PHASE (N=100), WE WILL PERFORM A LARGER RCT (VS. SHAM CONTROL) TO ADDRESS LONG-TERM NEUROBEHAVIORAL OUTCOMES, INCLUDING OPIOID RELAPSE, CRAVING, AND SUSTAINED FMRI CHANGES. BECAUSE TDCS IS SAFE, INEXPENSIVE AND PORTABLE, IF THIS INTERVENTION PROVIDES FMRI VALIDATION OF TARGETED BRAIN EFFECTS AND PRODUCES CLINICAL RESPONSE, IT COULD HAVE GREAT IMPACT AUGMENTING THE CARE OF PERSONS ENTERING BUPRENORPHINE TREATMENT, A POPULATION AT HIGH RISK FOR TREATMENT FAILURE.

BEHAVIORAL AND ECOLOGICAL SUICIDE TRACKING: ATTENTION, INTERPRETATION, AND MEMORY

EVALUATING THE EFFECTIVENESS OF MINDFULNESS-BASED THERAPY FOR SMI IMPLEMENTED IN A COMMUNITY MENTAL HEALTH SETTING - SERIOUS MENTAL ILLNESS (SMI), ENCOMPASSING SCHIZOPHRENIA-SPECTRUM AND MAJOR MOOD DISORDERS, HAS BEEN ESTIMATED TO AFFECT APPROXIMATELY 5.4% OF THE U.S. ADULT POPULATION EACH YEAR. RESEARCH SHOWS LOW RATES OF EVIDENCE-BASED TREATMENT BEING PROVIDED TO PATIENTS WITH SMI. THIS IS UNFORTUNATE, BECAUSE EVIDENCE-BASED PSYCHOLOGICAL THERAPIES HAVE BEEN SHOWN TO BE EFFECTIVE FOR IMPROVING OUTCOMES IN SMI. ONE SUCH EFFICACIOUS PSYCHOLOGICAL INTERVENTION IS MINDFULNESS-BASED THERAPY (MBT), WHICH INTEGRATES MINDFULNESS PRACTICE WITH COGNITIVE-BEHAVIORAL STRATEGIES TO IMPROVE ILLNESS MANAGEMENT. PREVIOUS TRIALS CONDUCTED IN THE UNITED KINGDOM HAVE SHOWN THAT MBT IMPROVES SYMPTOMS AND FUNCTIONING IN COMMUNITY-BASED OUTPATIENTS WITH SMI, INCLUDING IN ROUTINE PRACTICE SETTINGS. IN THE U.S., MOST PATIENTS WITH SMI RECEIVE TREATMENT AT LOCAL COMMUNITY MENTAL HEALTH CENTERS (CMHCS). HOWEVER, PATIENTS IN CMHCS OFTEN CANNOT ACCESS EVIDENCE-BASED THERAPIES LIKE MBT DUE TO THE LACK OF TRAINED STAFF ABLE TO PROVIDE THESE INTERVENTIONS. FURTHER, PREVIOUS STUDIES OF MBT HAVE BEEN CONDUCTED EXCLUSIVELY OUTSIDE THE U.S. IT IS ESSENTIAL TO CONFIRM THAT MBT IS EFFECTIVE WHEN DELIVERED FOR PATIENTS WITH SMI IN THE U.S., AND HOW IT CAN BE SUSTAINABLY IMPLEMENTED IN CMHCS WHERE THIS CLINICAL POPULATION IS COMMONLY TREATED. THUS, WE PROPOSE TO TEST THE EFFECTIVENESS OF MBT FOR SMI AND STUDY ITS IMPLEMENTATION IN A TYPICAL CMHC SETTING. ADDITIONALLY WE WILL SPECIFY A CERTIFIED TRAINING PROGRAM IN MBT FOR FRONTLINE CLINICIANS, GIVEN THE DIFFERENCES BETWEEN U.K. AND U.S. HEALTHCARE SYSTEMS. TO SPEED TRANSLATION TO CLINICAL PRACTICE, WE ALSO WILL COLLECT INFORMATION FROM DIVERSE COMMUNITY PARTNERS ON IMPLEMENTATION BARRIERS AND FACILITATORS TO PROMOTE FUTURE UPTAKE. WE WILL RANDOMIZE 160 PATIENTS WITH SMI (PSYCHOTIC-SPECTRUM AND MAJOR MOOD DISORDERS) TO RECEIVE TREATMENT AS USUAL (TAU) VS TAU PLUS MBT DELIVERED BY FRONTLINE CLINICIANS IN A LARGE, DIVERSE CMHC. WE WILL CONDUCT BLINDED ASSESSMENTS AT BASELINE AND AT 6- (MID), 12- (POST), AND 24- WEEKS (FOLLOW-UP). CONSISTENT WITH AN EXPERIMENTAL THERAPEUTICS APPROACH, WE WILL EXAMINE POTENTIAL MECHANISMS OF ACTION (E.G., MINDFULNESS SKILLS), AS WELL AS COLLECT IMPLEMENTATION-FOCUSED QUANTITATIVE AND QUALITATIVE DATA FROM OUR COMMUNITY PARTNERS (PATIENTS, ADMINISTRATORS, CLINICIANS). IF FOUND TO BE EFFECTIVE AND AIDED BY A CERTIFIED TRAINING PROGRAM AND THE IMPLEMENTATION DATA COLLECTED, MBT COULD BE ADOPTED AS A FUTURE EVIDENCE-BASED PRACTICE AND INTEGRATED INTO THE ROUTINE COMMUNITY CARE OF PATIENTS WITH SMI, THEREBY REDUCING HEALTH DISPARITIES.

MI: EMPOWERING WOMEN TO MAKE CONTRACEPTIVE CHOICES WHILE INCARCERATED

PILOT MULTISITE RANDOMIZED CONTROLLED TRIAL OF YOGA TO REDUCE DEPRESSION INADOLESCENTS - PROJECT SUMMARY EVEN BEFORE THE ONSET OF THE COVID PANDEMIC, ADOLESCENT DEPRESSION HAS BEEN INCREASING, AND HEALTH DISPAR- ITIES AND DISPARITIES IN ACCESS TO TREATMENT HAVE CONTINUED TO WIDEN. THUS, THERE IS A CLEAR NEED FOR INNOVATIVE, ACCESSIBLE TREATMENTS FOR DEPRESSED ADOLESCENTS, INCLUDING TREATMENTS THAT DO NOT RELY ON A LIMITED POOL OF CHILD AND ADOLESCENT HEALTH PROVIDERS. YOGA-BASED INTERVENTIONS (YBIS) HAVE SHOWN PROMISE FOR ADULT DEPRESSION. SEVERAL ATTRACTIVE ASPECTS OF YOGA INCLUDE ITS: 1) AVAILABILITY THROUGHOUT THE U.S.; 2) ACCESSIBILITY VIA ONLINE CLAS- SES; 3) INDEPENDENCE FROM AN OVERBURDENED MENTAL HEALTH CARE SYSTEM; AND 4) GENERALIZABILITY--YOGA STUDENTS STATE THAT THEY USE MINDFULNESS AND BREATHING PRACTICES TO COPE WITH STRESS IN EVERYDAY LIFE. FUNDED BY A NCCIH R34, WE DEVELOPED A YBI FOR DEPRESSED ADOLESCENTS, AND DEMONSTRATED THAT THIS IN-PERSON PROGRAM WAS ACCEPTABLE AND FEASIBLE IN A SMALL SAMPLE (N=11) OF DEPRESSED ADOLESCENTS AS WELL AS IN A PILOT RCT (N=42) OF YBI VS. AN EXISTING EVIDENCE-BASED TREATMENT, GROUP COGNITIVE-BEHAVIORAL THERAPY (GCBT). THE RCT CLASSES WERE INITIALLY IN-PERSON, BUT WE MIGRATED TO SYNCHRONOUS ONLINE CLASSES DUE TO COVID-19. IN THE RCT, PARTICIPANTS WITHIN EACH STUDY ARM SHOWED DECREASED DEPRESSION SYMPTOMS AND INCREASED SELF-COMPASSION OVER TIME. MOST A PRIORI FEASIBILITY AND ACCEPTABILITY TARGETS WERE MET (E.G., RECRUITMENT, RETENTION, EXPECTANCY, SATISFACTION, CREDIBILITY, ATTENDANCE, AND ADHERENCE). HOWEVER, PARTICIPANTS DID NOT ENGAGE IN HOME (OUTSIDE-OF- CLASS) PRACTICE AT THE TARGETED RATE. THUS, IN THE PRESENT PROPOSAL WE HAVE MODIFIED OUR PROTOCOL TO PROVIDE AN OPPORTUNITY FOR TWICE-WEEKLY SUPERVISED YOGA PRACTICE (ONE IN-PERSON CLASS ON THE WEEKEND, AND ONE VIRTUAL CLASS MIDWEEK). OUR PRIOR PILOT TRIAL WAS BASED AT ONLY ONE SITE (PROVIDENCE RI) WITH ONE PRIMARY YBI INSTRUCTOR AND TWO GCBT LEADERS. MULTIPLE SITES AND INSTRUCTORS/LEADERS, AND RECRUITMENT OF A MORE RACIALLY AND ETHNICALLY DIVERSE SAMPLE, WILL BE IMPORTANT TO DEMONSTRATE GENERALIZABILITY AND TO ENHANCE EFFECTIVENESS. WE NOW PRO- POSE TO CONDUCT A TWO-PHASE MULTI-SITE FEASIBILITY TRIAL. PHASE 1 (N=20) WILL FOCUS ON INCREASING ACCESSIBILITY AND FEASIBILITY OF YBI FOR PARTICULAR GROUPS OF ADOLESCENTS. WE WILL CONDUCT INDIVIDUAL INTERVIEWS WITH TEENS WHO WERE LESS REPRESENTED IN OUR PILOT TRIAL (AFRICAN-AMERICAN/BLACK, ASIAN AMERICAN, AND MALE ADOLESCENTS) TO GAIN THEIR FEEDBACK ON YOGA BASED INTERVENTIONS, WITH A FOCUS ON INCREASING ACCESSIBILITY AND FEASIBILITY FOR ADOLESCENTS WITH THESE IDENTITIES. PHASE 2 (N=128) WILL BE A PILOT RCT OF YBI VS. GCBT AT TWO GEOGRAPHICALLY DISTINCT SITES: BOSTON, MA AND COLUMBUS, OH. GIVEN THE RISING PREVALENCE OF ADOLESCENT DEPRESSION AND THE EXISTENCE OF ESTABLISHED, EFFICACIOUS GROUP TREATMENT FOR DEPRESSION (I.E., GROUP CBT), WE DETERMINED THAT A NON-INFERIORITY TRIAL REPRESENTED THE MOST ETHICAL WAY TO PROCEED. WE WILL INCORPORATE LESSONS LEARNED FROM THIS STUDY TO FURTHER REFINE STUDY MATERIALS AND CREATE A TEMPLATE FOR ONBOARDING MULTIPLE FUTURE SITES. THIS PROJECT WILL PREPARE US TO CONDUCT A MULTISITE, ADEQUATELY POWERED, NON-INFERIORITY RCT OF YBI VS. GCBT IN DEPRESSED ADOLESCENTS.

RESIDENCY TRAINING IN PRIMARY CARE

DISTRESS TOLERANCE TREATMENT FOR SMOKING CESSATION

SUSTAINING TOBACCO ABSTINENCE AFTER INCARCERATION

PRIMARY CARE TRAINING AND ENHANCEMENT

ETHNIC HEALTH/MOTIVATING HIV+ LATINOS TO QUIT SMOKING

METHADONE-MAINTAINED SMOKERS SWITCHING TO E-CIGARETTES - ABSTRACT PERSONS WITH OPIOID USE DISORDER (OUD) ENROLLED IN METHADONE MAINTENANCE PROGRAMS CONTINUE TO HAVE SMOKING PREVALENCE RATES OF 80-90% AND HIGH RATES OF TOBACCO-RELATED MORBIDITY AND MORTALITY. MULTIPLE CLINICAL TRIALS OF PHARMACOTHERAPY HAVE DOCUMENTED THAT METHADONE-MAINTAINED SMOKERS (MMS) HAVE VERY LOW SMOKING CESSATION RATES. THESE LOW RATES OF SUCCESSFUL QUITTING AND THE SIGNIFICANT HEALTH CONSEQUENCES OF SMOKING COMBUSTIBLE CIGARETTES (CC), IT IS CRITICAL TO IDENTIFY HARM-REDUCTION STRATEGIES IN THIS AT-RISK POPULATION. ELECTRONIC CIGARETTE (EC) USE HAS GROWN RAPIDLY AND SUBSTITUTING COMBUSTIBLE CIGARETTES WITH EC USE MAY DECREASE HEALTH RISKS IN MMS. WE PROPOSE TO TAKE A FIRST STEP IN EXAMINING THE RISKS AND BENEFITS ASSOCIATED WITH EC USE AMONG MMS. OF PARTICULAR INTEREST WOULD BE THE HEALTH EFFECTS OF ECS AMONG MMS BECAUSE OF MMS’ DIFFICULTY WITH PROLONGED CC QUITTING, THE SEVERITY OF THEIR NICOTINE DEPENDENCE, GREATER TOBACCO DEMAND, AND THE PRECEDENT OF HARM REDUCTION WHEREIN OPIOID USERS SUBSTITUTE A LOWER RISK OPIOID (METHADONE) FOR ILLICIT DRUG USE. THUS, WE ARE PROPOSING TO UTILIZE A FOURTH GENERATION EC (JUUL) TO EXAMINE BEHAVIORAL AND HEALTH BIOMARKER CHANGES OF MMS SMOKERS INTERESTED IN SWITCHING FROM COMBUSTIBLE CIGARETTES TO ECS. GIVEN THE CONTINUING POPULARITY OF ECS, THERE IS AN URGENT NEED TO IMPROVE OUR UNDERSTANDING OF BOTH THE POTENTIAL BENEFITS AND RISKS OF EC USE IN THIS VULNERABLE POPULATION. WE PROPOSE TO CONDUCT A 4-YEAR RANDOMIZED CLINICAL TRIAL OF 240 MMS WHO ARE INTERESTED IN SWITCHING TO ANOTHER NICOTINE ALTERNATIVE. PARTICIPANTS WILL BE RANDOMLY ASSIGNED (2:1) TO EITHER 6-WEEKS OF EC (JUUL; N=160) OR TO 6-WEEKS OF NICOTINE REPLACEMENT THERAPY (NRT; IN THE FORM OF NICOTINE LOZENGES; N=80). PARTICIPANTS IN BOTH CONDITIONS WILL ATTEND WEEKLY ASSESSMENT SESSIONS WHERE SMOKING STATUS IS CONFIRMED. AT THE END OF 6 WEEKS, WE WILL ASSESS BIOMARKERS OF TOTAL NICOTINE INTAKE AND TOBACCO TOXICANT EXPOSURE, RESPIRATORY SYMPTOMS, AND SPIROMETRY-DETERMINED LUNG FUNCTIONING AS WELL AS RATES OF COMPLETE SWITCHING, EC, NRT, AND CC USE (INCLUDING DUAL USE), TOBACCO DEMAND AND SELF-EFFICACY FOR QUITTING CC. CONTINUED USE OF EC, NRT, AND CC WILL BE EXAMINED AT THE 12- AND 24-WEEK FOLLOW-UPS. THIS STUDY WILL BE THE FIRST TO TEST THE POTENTIAL BEHAVIORAL AND HEALTH EFFECTS OF ECS IN SMOKERS WITH OPIOID USE DISORDER, A POPULATION THAT IS HIGHLY DEPENDENT ON NICOTINE, HIGHLY VULNERABLE TO SMOKING-RELATED MORBIDITY AND MORTALITY, AND SEARCHING FOR NOVEL METHODS TO LOWER SMOKING-RELATED RISKS.

PRIMARY CARE TRAINING AND ENHANCEMENT -- RESIDENCY TRAINING IN STREET MEDICINE - DESCRIPTION: THE KENT/BROWN FAMILY MEDICINE RESIDENCY IS LOCATED IN A HEALTH PROFESSIONALS SHORTAGE AREA IN PAWTUCKET, RI. THE PURPOSE OF OUR PROPOSED INITIATIVE IS TO ENHANCE THE CURRICULAR AND CLINICAL TRAINING EXPERIENCES OF: FAMILY MEDICINE (FM) RESIDENTS, FM FACULTY, INTERPROFESSIONAL (MENTAL HEALTH/BEHAVIORAL HEALTH, MEDICAL AND PHARMACY STUDENTS TRAINING TOGETHER IN THE FAMILY CARE CENTER; AND OTHER PRIMARY CARE PROVIDERS (PCPS) IN RI. WE AIM TO CULTIVATE A WORKFORCE OF PCPS WHO ARE: WELL PREPARED TO ADDRESS THE COMPREHENSIVE HEALTH CARE NEEDS OF PEOPLE EXPERIENCING HOMELESSNESS AND ESPECIALLY THOSE WITH SUBSTANCE USE AND MENTAL HEALTH DISORDERS; WELL VERSED IN COMMUNITY OUTREACH STRATEGIES TO DELIVER PATIENT-CENTERED, EVIDENCE-BASED CARE TO THOSE WITH LIMITED ACCESS; AND WHO WILL CONTINUE TO CARE FOR PEOPLE EXPERIENCING HOMELESSNESS UPON GRADUATION. NEEDS TO BE ADDRESSED: OUR INITIATIVE ADDRESSES KEY HRSA PRIORITIES BY DEVELOPING A STREET MEDICINE TRACK. IT ALSO RESPONDS TO HEALTH NEEDS IN RHODE ISLAND. THEY INCLUDE TRAINING FUTURE/CURRENT FAMILY PHYSICIANS AND OTHER PCPS TO 1) DELIVER PRIMARY CARE FOR PEOPLE EXPERIENCING HOMELESSNESS; 2) DEVELOP ADVANCED SKILLS TO ADDRESS THE BEHAVIORAL NEEDS OF PEH INCLUDING TO TREAT OPIOID USE DISORDER AND SUBSTANCE USE DISORDER; 3) WORK IN INTRADISCIPLINARY TEAMS TO PROVIDE COMPREHENSIVE CARE THAT ALSO ADDRESSES SOCIAL DETERMINANTS OF HEALTH. TRAINEE SPECIFIC OBJECTIVES TO BE ACCOMPLISHED: ANTICIPATED OUTCOMES FOR YEARS 2 – 5: 80% FM GRADUATES WILL PRACTICE IN PRIMARY CARE 50% FM GRADUATES WILL PRACTICE IN UNDERSERVED AREAS 20% FM GRADUATES WILL PRACTICE IN RURAL AREAS 20% FM GRADUATES WILL PARTICIPATE IN STREET MEDICINE 100% OF FM GRADUATES AND FM FACULTY WILL GAIN EXPERIENCE IN STREET MEDICINE TWO FM GRADUATES/YEAR WILL COMPLETE THE NEWLY ESTABLISHED STREET MEDICINE TRACK 75% OF FM GRADUATES AND 150 RI PCPS WILL PARTICIPATE IN ECHO/TELEMENTORING ACTIVITIES HOW PROJECT WILL BE ACCOMPLISHED: WE WILL DESIGN, IMPLEMENT AND EVALUATE A NEW STREET MEDICINE TRACK IN PARTNERSHIP WITH THE BROAD STREET CLINIC, THE RI STREET MEDICINE ORGANIZATION AS WELL AS PROJECT WEBER RENEW AND HOUSE OF HOPE. IN ADDITION, WE WILL DESIGN, IMPLEMENT AND EVALUATE NEW CURRICULA AND CLINICAL SERVICES AIMED AT BUILDING OUR PRIMARY CARE TRAINEES’ CAPACITY TO TREAT OPIOID USE DISORDER AND SUBSTANCE USE DISORDER IN PEH. THE KENT/BROWN FM RESIDENCY, STRENGTHENED BY ITS PARTNERSHIP WITH BROWN UNIVERSITY’S WARREN ALPERT MEDICAL SCHOOL AND MULTIPLE COMMUNITY PARTNERS, HAS A LONG TRACK RECORD OF EDUCATIONAL LEADERSHIP AND SUCCESSFUL IMPLEMENTATION OF INNOVATIVE PROGRAMS FOR PREPARING PCPS TO ADDRESS THE CHANGING HEALTH CARE NEEDS OF ALL POPULATIONS, WITH A FOCUS ON THE CARE OF UNDERSERVED COMMUNITIES. POPULATION GROUPS TO BE SERVED: RI HAS THE SECOND HIGHEST RATE OF HOMELESSNESS IN THE COUNTRY, A HIGH RATE OF OUD, AND IS WITHOUT A TARGETED PLAN TO IMPROVE PRIMARY CARE TO THESE POPULATIONS IN THE FUTURE. OUR INITIATIVE RESPONDS DIRECTLY TO THE POSSIBLE DRIVERS OF GAPS IN SERVICES AND WORKFORCE IN OUR STATE, WHILE AT THE SAME TIME HOLDING RELEVANCE FOR ONGOING CHANGE WITHIN REGIONAL AND NATIONAL HEALTH CARE DELIVERY SYSTEMS.

AMBULATORY ASSESSMENT OF GLUCOSE REGULATION IN SUICIDAL THOUGHTS AND BEHAVIORS - PROJECT SUMMARY SUICIDE RATES IN THE UNITED STATES ALARMINGLY INCREASED BY 37% IN THE LAST TWO DECADES. DESPITE EXTENSIVE RESEARCH EFFORTS TO IDENTIFY RISK FACTORS, ACCURATE PREDICTION OF SUICIDAL THOUGHTS AND BEHAVIORS (STBS) REMAINS POOR. THERE IS A CRITICAL NEED TO IMPROVE DETECTION OF WHO IS AT GREATEST RISK FOR SUICIDE AND WHEN SUICIDAL CRISES WILL OCCUR TO ENABLE PERSONALIZED AND TIMELY INTERVENTIONS. PASSIVE AMBULATORY MEASUREMENT METHODS THAT CAN DETECT RISK FOR STBS IN DAILY LIFE, WITHOUT RELYING ON PARTICIPANT SELF-REPORTING DURING PERIODS OF DISTRESS, MAY BE THE KEY TO MAKING PROGRESS ON THIS CRITICAL ISSUE. ONE PROMISING STB RISK FACTOR THAT IS AMENABLE TO PASSIVE MONITORING IS PERIPHERAL GLUCOSE (BLOOD SUGAR) REGULATION. PSYCHIATRIC AND METABOLIC DISORDERS ARE HIGHLY COMORBID, AND ROBUST LITERATURE IDENTIFIES ABNORMAL GLUCOSE REGULATION IN INDIVIDUALS WITH STBS. HOWEVER, PRIOR STUDIES OF GLUCOSE REGULATION IN STBS WERE CROSS-SECTIONAL AND RETROSPECTIVE, PREVENTING THE ASSESSMENT OF WHETHER GLUCOSE PATTERNS SIGNAL RISK FOR STBS IN REAL-TIME AND DURING HIGH-RISK PERIODS. THIS K23 PROPOSES TO CONDUCT THE FIRST STUDY EXAMINING HOW AMBULATORY GLUCOSE REGULATION RELATES TO STBS IN DAILY LIFE. WE PROPOSE TO ENROLL 110 NON-DIABETIC ADULT PSYCHIATRIC INPATIENTS WITH RECENT STBS, A POPULATION AND TIME-PERIOD WITH EXTRAORDINARILY HIGH SUICIDE RISK. PARTICIPANTS WILL COMPLETE A MULTIMODAL AMBULATORY ASSESSMENT PROTOCOL FOR 28 DAYS FOLLOWING HOSPITALIZATION, INCLUDING CONTINUOUS GLUCOSE MONITORING AND ECOLOGICAL MOMENTARY ASSESSMENT (EMA). USING STATE-OF-THE-SCIENCE ANALYTIC METHODS FOR MULTIMODAL INTENSIVE LONGITUDINAL DATA, WE WILL EXAMINE PASSIVELY COLLECTED GLUCOSE METRICS AS PROSPECTIVE PREDICTORS OF (1) PROXIMAL SUICIDAL IDEATION (CAPTURED VIA EMA) AND SUICIDAL BEHAVIOR AT FOLLOW-UP (AIM 1), AND (2) PROXIMAL AFFECTIVE-COGNITIVE RISK FACTORS FOR STBS (CAPTURED VIA EMA) AND OVERALL AFFECTIVE-COGNITIVE RISK FACTORS MEASURED AT FOLLOW-UP (AIM 2). WE WILL ALSO EXPLORE POTENTIAL MECHANISMS LINKING GLUCOSE REGULATION TO STBS BY INVESTIGATING IF THESE PATHWAYS VARY ACROSS MODIFIABLE HEALTH BEHAVIORS THAT IMPACT GLUCOSE REGULATION (EXPLORATORY AIM 3). THIS KNOWLEDGE COULD IMPROVE PERSONALIZED STB RISK DETECTION AND INFORM THE DEVELOPMENT OF PRECISION INTERVENTIONS THAT TARGET MODIFIABLE METABOLIC RISK FACTORS FOR SUICIDE. THE CANDIDATE’S TRAINING PLAN DIRECTLY ALIGNS WITH THE PROPOSED STUDY AND WILL PROVIDE IMMERSIVE TRAINING IN (1) DESIGNING AND DIRECTING MULTIMODAL AMBULATORY ASSESSMENT PROTOCOLS; (2) ETHICAL AND REGULATORY ASPECTS OF SUICIDE RESEARCH IN HIGH-RISK SAMPLES; (3) UNDERSTANDING AND ASSESSING METABOLIC RISK FACTORS FOR SUICIDE; (4) ADVANCED ANALYSES FOR MULTIMODAL DATA; AND (5) GRANT-WRITING, LABORATORY MANAGEMENT, AND INTERDISCIPLINARY COLLABORATION. THE CANDIDATE’S TEAM OF INTERDISCIPLINARY MENTORS, DRS. ABRANTES, SCHATTEN, RICHARDSON, TYRKA, AND BRICK, ARE RENOWNED EXPERTS IN THESE TOPICS, AND BUTLER HOSPITAL AND BROWN UNIVERSITY PROVIDE AN EXCEPTIONAL TRAINING ENVIRONMENT WITH AN EXTENSIVE HISTORY OF SUPPORTING CAREER DEVELOPMENT AWARDS. THIS K23 WILL FACILITATE THE CANDIDATE’S SUCCESSFUL TRANSITION TO AN INDEPENDENT RESEARCH CAREER FOCUSED ON ADVANCING SUICIDE PREDICTION AND PREVENTION USING ECOLOGICALLY VALID AND BIOBEHAVIORAL APPROACHES.

A COMPUTATIONAL ANALYSIS OF PSYCHIATRIC GENETICS DATA: PATHWAYS AND ARCHITECTURE

DEVELOPMENT OF A BEHAVIORAL TEAM INTERVENTION FOR OBSESSIVE COMPULSIVE DISORDER

INTEGRATIVE YOGA AND MINDFUL SELF-COMPASSION TO REDUCE DISTRESS IN WOMEN SURVIVORS OF INTERPERSONAL VIOLENCE - PROJECT ABSTRACT THE OVERALL OBJECTIVE OF THIS MENTORED RESEARCH SCIENTIST CAREER DEVELOPMENT AWARD IS TO SUPPORT DR. TOSCA BRAUN’S TRANSITION TO AN INDEPENDENT INVESTIGATOR WITH A FOCUS ON USING COMMUNITY-ENGAGED APPROACHES TO DEVELOP AND DISSEMINATE COMMUNITY-ENGAGED MINDFULNESS-BASED INTERVENTIONS TO ADVANCE HEALTH IN VULNERABLE AND MINORITY POPULATIONS. INTERPERSONAL VIOLENCE IS COMMONLY EXPERIENCED AMONG BLACK/AFRICAN AMERICAN (AA; 44%), HISPANIC/LATINO/A/X (34%), AND NON-HISPANIC/LATINO/A/X WHITE WOMEN (37%) IN THE US, AS WELL AS STIGMATIZATION RELATED TO IV AND OTHER ATTRIBUTES (E.G., RACE/ETHNICITY, WEIGHT). VIOLENCE AND STIGMA BOTH DRIVE “DOWNSTREAM” POOR BEHAVIORAL AND PHYSICAL HEALTH. STIGMA SEQUELAE – DISTRESS IN RESPONSE TO STIGMA, ANTICIPATED (FEAR OF) STIGMA, INTERNALIZED STIGMA – INDEPENDENTLY FOSTER SHAME AND AFFECT DYSREGULATION, THUS MAGNIFYING DISTRESS AND CONSEQUENT HEALTH IMPACTS. THESE INTERPERSONAL VIOLENCE (IV) SEQUELAE CAN BE ALLEVIATED BY REDUCING DISTRESS, YET CULTURALLY SENSITIVE TRANSDIAGNOSTIC APPROACHES TO REDUCE SURVIVOR DISTRESS ACROSS ETHNO- RACIAL POPULATIONS ARE RARE. WE PROPOSE TO USE COMMUNITY-ENGAGED RESEARCH TO DEVELOP A COMPLEMENTARY MEDICINE PROGRAM THAT INTEGRATES ADAPTED MINDFUL SELF-COMPASSION (MSC) TRAINING WITH TRAUMA-INFORMED YOGA (TIY) TO IMPROVE STIGMA SEQUELAE AND REDUCE DISTRESS IN ETHNO-RACIALLY DIVERSE SURVIVORS: INTEGRATED TIY AND MSC (I-YMSC). MSC TARGETS STIGMA-RELATED PROBLEMS (AFFECT DYSREGULATION, SHAME) AND IMPROVES DISTRESS IN THE LONG-TERM, YET CAN TEMPORARILY INCREASE SHORT-TERM DISTRESS. TIY REDUCES SHORT-TERM DISTRESS AND PROMOTES PHYSIOLOGICAL-AUTONOMIC REGULATION. DR. BRAUN’S PROGRAM EVALUATION DATA SUGGESTS ADAPTING MSC TO EXPLICITLY ADDRESS CULTURAL FACTORS AND INTERSECTIONAL STIGMA AND INTEGRATING THIS APPROACH WITH TIY IS STRONGLY WARRANTED AND HAS POTENTIAL TO AMELIORATE HEALTH INEQUITIES EXPERIENCED BY ETHNO-RACIALLY DIVERSE IV SURVIVORS. FURTHER, TRAINING COMMUNITY YOGA INSTRUCTOR SURVIVORS TO TEACH I-YMSC REPRESENTS AN ADDITIONAL LEVEL OF ENGAGEMENT WITH OUR STIGMATIZED TARGET POPULATION THAT IS UNUSUAL IN MINDFULNESS RESEARCH. IN THIS K23 PROPOSAL, BLACK/AA, HISPANIC/LATINO/A/X, AND WHITE SURVIVORS WILL BE EQUALLY REPRESENTED ACROSS ALL PROJECT PHASES (33% EACH), WITH RESULTS CONSIDERED BOTH ACROSS PARTICIPANTS AND WITHIN EACH SUBGROUP. SPECIFIC AIMS INCLUDE: (1) (1.1) DEVELOP I- YMSC USING COMMUNITY-ENGAGED RESEARCH WITH WOMEN IV SURVIVOR STAKEHOLDER PARTNERS, (1.2) PRE-PILOT THE INTERVENTION IN AN OPEN PILOT TRIAL TO FURTHER REFINE THE INTERVENTION, (1.3) DEVELOP A COMMUNITY-ENGAGED TEACHER TRAINING, AND (2) (2.1) CONDUCT A 2-ARMED TEST OF THE BEHAVIORAL INTERVENTION COMPARED TO A HEALTH EDUCATION CONTROL TO ASSESS THE FEASIBILITY AND ACCEPTABILITY OF THE I-YMSC INTERVENTION, AND (2.2) PILOT THE TEACHER TRAINING. THE ESSENTIAL HANDS-ON LEARNING AND MENTORED TRAINING IN THIS GRANT WILL SUPPORT DR. BRAUN IN ESTABLISHING HER PROGRAM OF RESEARCH AS AN INDEPENDENT INVESTIGATOR IN COMMUNITY-ENGAGED MIND-BODY RESEARCH WORKING WITH VULNERABLE AND MINORITY POPULATIONS, INCLUDING WOMEN SURVIVORS OF VIOLENCE. FINDINGS MAY ALSO HAVE APPLICABILITY TO PROMOTING HEALTH RESILIENCY AND RESTORATION IN OTHER MARGINALIZED POPULATIONS WHO EXPERIENCE HEALTH INEQUITIES.

AFFECTIVE EXECUTIVE FUNCTIONING AS A MECHANISM OF MINDFULNESS-BASED COGNITIVE THERAPY: A PILOT RANDOMIZED CONTROLLED TRIAL - PROJECT SUMMARY/ABSTRACT MINDFULNESS-BASED COGNITIVE THERAPY (MBCT) IS AN EFFICACIOUS TREATMENT FOR PATIENTS WITH SYMPTOMS OF DEPRESSION. HOWEVER, THE PROCESSES BY WHICH MBCT ACHIEVES ITS OUTCOMES ARE NOT WELL UNDERSTOOD. DRAWING ON LITERATURE ON BASIC COGNITIVE FUNCTIONING AND COGNITIVE BIASES IN DEPRESSION, THIS K23 WILL USE A RANDOMIZED CONTROLLED TRIAL TO TEST THE EFFECT OF MBCT VS. HEALTH EDUCATION (HE) ON AFFECTIVE INHIBITION (AN IMPORTANT COMPONENT OF EXECUTIVE FUNCTIONING (EF)), AND A POSSIBLE MECHANISM OF ACTION BY WHICH MBCT HAS AN IMPACT ON DEPRESSION SYMPTOMS. AS A SECONDARY AIM, THIS PROJECT WILL ALSO TEST THE EFFECT OF MBCT VS. HE ON AFFECTIVE UPDATING AND AFFECTIVE SHIFTING (TWO REMAINING COMPONENTS OF EF). IN EXPLORATORY ANALYSES, WE WILL EXAMINE WHETHER DEPRESSION SYMPTOM SEVERITY COVARIES WITH CHANGE IN AFFECTIVE EF (I.E., AFFECTIVE INHIBITION, SHIFTING, AND UPDATING) OVERTIME, AND WHETHER ADHERENCE TO THE TREATMENT PROTOCOL PREDICTS ENDPOINT EF. TO ACCOMPLISH THESE GOALS, 76 ADULT PARTICIPANTS WITH ELEVATED DEPRESSION SYMPTOMS WILL BE RECRUITED FROM THE COMMUNITY AND WILL BE RANDOMIZED TO EITHER AN 8-WEEK MBCT COURSE AT THE MINDFULNESS CENTER AT BROWN UNIVERSITY OR AN 8-WEEK PSYCHOEDUCATIONAL HEALTH EDUCATION CLASS (I.E., A CONTROL ARM). PARTICIPANTS WILL COMPLETE VALIDATED COMPUTER-BASED TASKS OF AFFECTIVE EF AT 5-ASSESSMENTS, 2 BEFORE, 2 DURING, AND 1 AFTER, THE 8-WEEK MBCT OR HE PROGRAMS. THIS PROJECT DIRECTLY ADDRESSES NCCIH’S OBJECTIVE TO ADVANCE THE UNDERSTANDING OF MECHANISMS THROUGH WHICH MIND AND BODY APPROACHES AFFECT HEALTH, RESILIENCE AND WELL-BEING. THIS PROJECT WILL DIRECTLY ADDRESS THE CANDIDATE’S TRAINING GOALS OF GAINING CLINICAL TRIALS METHODS EXPERIENCE WITH MOOD DISORDERS, EXPANDING KNOWLEDGE OF MINDFULNESS-BASED INTERVENTIONS (SPECIFICALLY MBCT), GAIN KNOWLEDGE IN NEUROCOGNITIVE ASSESSMENT OF INDIVIDUALS WITH DEPRESSION SYMPTOMS, RECEIVE TRAINING IN REPEATED LONGITUDINAL ASSESSMENT, AND FURTHER DEVELOP PROFESSIONAL DEVELOPMENT, RESEARCH ETHICS, AND GRANTS MANAGEMENT SKILLS. THE CANDIDATE WILL COMPLETE A NUMBER OF FORMAL AND INFORMAL ACTIVITIES (E.G., COURSES, WORKSHOPS, CONFERENCES, DIRECTED READINGS, AND REGULARLY SCHEDULED MEETINGS WITH MENTORS) TO MEET THE TRAINING GOALS. THESE TRAINING GOALS WILL ASSIST THE CANDIDATE TO BECOME A SUCCESSFUL INDEPENDENT INVESTIGATOR EXAMINING COGNITIVE MECHANISMS OF MIND-BODY INTERVENTIONS FOR DEPRESSION AND RELATED DISORDERS. THE MINDFULNESS CENTER AT BROWN UNIVERSITY AND BUTLER HOSPITAL ARE THE IDEAL ENVIRONMENTS FOR THIS PROJECT, AS THEY ARE LEADING INSTITUTIONS IN CLINICAL TRIALS RESEARCH AND MINDFULNESS-BASED INTERVENTIONS, WITH NUMEROUS OPPORTUNITIES FOR TRAINING AND SUPPORT SERVICES EMBEDDED WITHIN THE SYSTEMS.

TDCS TO DECREASE OPIOID RELAPSE

DEVELOPMENT OF A LIFESTYLE PHYSICAL ACTIVITY INTERVENTION TO REDUCE RISK FOR PERINATAL CANNABIS USE - ABSTRACT RATES OF PRENATAL CANNABIS USE (CU) HAVE RISEN SHARPLY IN RECENT YEARS, A SERIOIUS CONCERN GIVEN ASSOCIATED ADVERSE MATERNAL AND INFANT OUTCOMES. MOTIVATION TO CHANGE POTENTIALLY UNHEALTHY BEHAVIORS LIKE CU IS HIGH AMONG MANY PREGNANT WOMEN. HOWEVER, UNFORTUNATELY, INTERVENTION APPROACHES FOR THIS POPULATION ARE CURRENTLY LACKING. IN ADDITION, MANY WOMEN EXPERIENCE MENTAL HEALTH SYMPTOMS (ANXIETY, DEPRESSION) AND UNCOMFORTABLE PREGNANCY SYMPTOMS (NAUSEA, PHYSICAL DISCOMFORT) THAT POSE CHALLENGES TO ABSTAINING FROM CU. THUS, INTERVENTIONS THAT HELP PREGNANT WOMEN DEVELOP ALTERNATE COPING STRATEGIES TO COPE WITH THESE SYMPTOMS MAY HAVE AN IMPORTANT ROLE IN DECREASING OR PREVENTING CU DURING PREGNANCY AND LONGER TERM. GIVEN PRIOR RESEARCH DEMONSTRATING BENEFITS OF PHYSICAL ACTIVITY TO POTENTIATE LONG-TERM EFFECTS ON DEPRESSION/ANXIETY AND PREGNANCY SYMPTOMS, AS WELL AS ACUTE EFFECTS ON NEGATIVE AFFECT AND CANNABIS CRAVINGS, A LIFESTYLE PHYSICAL ACTIVITY (LPA) INTERVENTION COULD BE HIGHLY IMPACTFUL. OUR TEAM’S R34 AWARD (R34DA055317-01A1; BATTLE) IS THE FIRST STUDY TO EXAMINE WHETHER AN LPA INTERVENTION COULD REPRESENT A FEASIBLE AND ACCEPTABLE STRATEGY TO HELP REDUCE CANNABIS USE AND CRAVINGS DURING PREGNANCY. THE PROPOSED ADMINISTRATIVE SUPPLEMENT WOULD ALLOW OUR TEAM TO EXTEND THE IMPACT OF THIS R34 STUDY BY EXAMINING THE POTENTIAL MECHANISMS OF ACTION OF THE LPA INTERVENTION. OUR TEAM PROPOSES TO USE SUPPLEMENTAL FUNDING IN RESPONSE TO NOT-OD-22-140 TO ADD AN ECOLOGICAL MOMENTARY ASSESSMENT (EMA) PROTOCOL TO THE PLANNED CLINICAL TRIAL, WHICH WOULD BE COMPRISED OF THREE 7-DAY BURSTS OF DAILY EMA ASSESSMENT TO MEASURE DAILY-LEVEL PHYSICAL ACTIVITY, MATERNAL AFFECT, PHYSICAL DISCOMFORT, AS WELL AS CANNABIS CRAVINGS AND USE. WITH THIS ADDITIONAL DATA COLLECTION, WHICH WILL INCLUDE 30 PARTICIPANTS IN THE PILOT RANDOMIZED TRIAL, WE WILL BE ABLE TO MORE FULLY EVALUATE THE CONCEPTUAL MODEL ON WHICH THE STUDY INTERVENTION IS BASED. FINDINGS FROM THE ANALYSIS OF THE ADDITIONAL EMA DATA COLLECTED AS PART OF THIS SUPPLEMENT WILL PROVIDE VALUABLE INFORMATION REGARDING THE RELATIONSHIP BETWEEN WOMEN’S MENTAL HEALTH AND CANNABIS CRAVINGS -- AND WHETHER PHYSICAL ACTIVITY CAN HELP REDUCE NEGATIVE AFFECT, PHYSICAL DISCOMFORTS AND CANNABIS CRAVINGS. IN ADDITION, THIS SUPPLEMENTAL DATA WILL PROVIDE CRITICAL FEASIBILITY DATA REGARDING IMPLEMENTING AN EMA WITH THIS POPULATION TO INFORM FUTURE STUDIES.

OPTIMIZATION AND MULTI-SITE FEASIBILITY OF YOGA FOR CHRONIC PAIN IN PEOPLE IN TREATMENT FOR OPIOID USE DISORDER

A TAILORED PHYSICAL ACTIVITY SMARTPHONE APP FOR PATIENTS WITH ALCOHOL DEPENDENCE

DEVELOPMENT AND PRELIMINARY TESTING OF A PEER NARRATIVE VIDEO INTERVENTION FOR OLDER ADULTS WITH CHRONIC PAIN - CHRONIC MUSCULOSKELETAL (MSK) PAIN, WHICH INCLUDES SPINAL PAIN, OSTEOARTHRITIS, AND FIBROMYALGIA, IS A COMMON AND COSTLY PROBLEM FOR OLDER ADULTS AND IS ASSOCIATED WITH DECREASED QUALITY OF LIFE. THERE IS A CLEAR NEED FOR INTERVENTIONS THAT INCREASE ONE’S ABILITY TO COPE WITH CHRONIC PAIN AND ENGAGE IN MEANINGFUL LIFE ACTIVITIES EVEN WITH THE PRESENCE OF CHRONIC PAIN. ACCEPTANCE AND COMMITMENT THERAPY (ACT) IS A PSYCHOTHERAPY THAT USES MINDFULNESS AND PSYCHOLOGICAL ACCEPTANCE TO SUPPORT INDIVIDUALS IN WORKING TOWARD BEHAVIORAL GOALS GUIDED BY THEIR PERSONAL VALUES, EVEN IN THE PRESENCE OF UNDESIRABLE EXPERIENCES SUCH AS CHRONIC PAIN. CLINICAL PRACTICE GUIDELINES RECOMMEND THE USE OF ACT FOR TREATING CHRONIC PAIN BASED ON EVIDENCE OF EFFECTIVENESS FROM MULTIPLE RCTS. HOWEVER, UPTAKE AND REACH ARE LIMITED BECAUSE THERE ARE INSUFFICIENT NUMBERS OF MENTAL HEALTH PROFESSIONALS WHO CURRENTLY OFFER ACT OR OTHER RECOMMENDED THERAPIES (E.G., COGNITIVE-BEHAVIORAL THERAPY) FOR CHRONIC PAIN. IN ADDITION, MANY OLDER ADULTS ARE NOT WILLING OR ABLE TO ENGAGE IN TRADITIONAL PSYCHOTHERAPY FOR CHRONIC PAIN EVEN WHEN IT IS AVAILABLE. ALTHOUGH SOME BIBLIOTHERAPY AND DIGITAL HEALTH INTERVENTIONS (E.G., APPS) HAVE BEEN DEVELOPED FOR TREATING PAIN, MANY OLDER ADULTS FAIL TO USE THEM DUE TO LOW LEVELS OF COMFORT WITH TECHNOLOGY OR LACK OF MOTIVATION FOR INTENSIVE SELF-GUIDED APPROACHES. NARRATIVE COMMUNICATION IS AN ALTERNATIVE WAY TO DELIVER BEHAVIOR CHANGE PRINCIPLES THAT INVOLVES “STORYTELLING” INVOLVING REAL PATIENTS TALKING ABOUT THEIR STRUGGLES AND RECOVERY PROGRESS. THERAPEUTIC NARRATIVES DELIVERED VIA VIDEOS MAY BE MORE ENGAGING AND IMMERSIVE THAN TRADITIONAL SELF-HELP FORMATS FOR OLDER ADULTS. IN PREVIOUS GRANT-FUNDED RESEARCH, OUR TEAM HAS DEVELOPED METHODS FOR CREATING NARRATIVE, VIDEO-BASED INTERVENTIONS DESIGNED TO REDUCE DEPRESSION IN PRIMARY CARE PATIENTS AND PREVENT SUICIDE IN PATIENTS FOLLOWING A PSYCHIATRIC HOSPITAL. THUS, IN THIS PROJECT, WE PROPOSE TO CREATE RECLAIM YOUR DAY (RYD), WHICH WILL CONSIST OF 6, 30-MIN WEEKLY VIDEO EPISODES HIGHLIGHTING PATIENTS’ INSPIRING AND ILLUSTRATIVE EXPERIENCES LIVING WITH CHRONIC PAIN IN ORDER TO TEACH CURRENT PATIENTS WITH CHRONIC MSK PAIN HOW TO APPLY ACT’S EVIDENCE-BASED STRATEGIES. IN PHASE 1 OF THIS PROJECT, WE WILL INTERVIEW OLDER ADULTS WITH CHRONIC MSK PAIN ABOUT THEIR COPING HISTORY, AND CODE INTERVIEWS FOR CONSISTENCY WITH ACT PRINCIPLES. WE WILL INVITE A SUBSET OF THESE INDIVIDUALS TO WORK WITH A PROFESSIONAL STORYTELLING COACH TO DEVELOP AND VIDEORECORD THEIR ACT-CONSISTENT STORIES. THESE DOCUMENTARY-STYLE VIDEOS THAT WILL FORM THE BASIS OF RYD. IN PHASE 2, WE WILL CONDUCT A PILOT RCT (N=100) OF OLDER ADULTS WITH CHRONIC MSK PAIN. ALL PARTICIPANTS WILL RECEIVE A 30-MIN INTRODUCTORY PAIN EDUCATION VIDEO. PARTICIPANTS WILL BE RANDOMIZED TO RECEIVE EITHER RYD OR A COMPARISON INTERVENTION (HEALTH EDUCATION VIDEOS). WE WILL EXAMINE RYD FEASIBILITY AND ACCEPTABILITY AS WELL AS CHANGES OVER TIME IN OUTCOMES (PAIN INTERFERENCE, DEPRESSION, QUALITY OF LIFE) AND PUTATIVE MEDIATORS.

PEER-FACILITATED PHYSICAL ACTIVITY INTERVENTION DELIVERED DURING METHADONE MAINTENANCE

NEUROANATOMICAL CHANGES AFTER VENTRAL CAPSULOTOMY FOR INTRACTABLE OCD: A TRANSLAT

TRANSLATING COPD GUIDELINES INOT PRIMARY CARE PRACTICE

DEVELOPMENT OF A PSYCHOSOCIAL TREATMENT FOR PSYCHOTIC DEPRESSION

MOBILE AFTER-CARE SUPPORT INTERVENTION FOR PATIENTS WITH SCHIZOPHRENIA FOLLOWING HOSPITALIZATION

EXAMINING FEASIBILITY, ACCEPTABILITY, AND SUSTAINABILITY OF A NOVEL PERSONALIZED SMARTPHONE INTERVENTION FOR SUICIDE. - PROJECT SUMMARY/ABSTRACT SUICIDE IS A SERIOUS PUBLIC HEALTH CONCERN IN THE UNITED STATES. HOWEVER, DESPITE AN INCREASE IN THEORETICAL MODELS OF AND TREATMENTS FOR SUICIDE, THE SUICIDE RATE HAS RISEN 33% SINCE 1999. GIVEN THE WIDESPREAD AVAILABILITY OF SMARTPHONE TECHNOLOGY, THERE IS GREAT POTENTIAL TO DELIVER INTERVENTIONS VIA MOBILE PLATFORMS. HOWEVER, DESPITE THE PROLIFERATION OF SMARTPHONE TOOLS FOR SUICIDE, FEW OFFER EVIDENCE-BASED SUPPORT AND SOME INCLUDE POTENTIALLY HARMFUL CONTENT. IN RESPONSE, WE HAVE CONDUCTED INITIAL DEVELOPMENT OF A MOBILE SUICIDE PREVENTION SYSTEM: MOBILE APPLICATION TO PREVENT SUICIDE (MAPS). MAPS WAS SPECIFICALLY DESIGNED TO IDENTIFY INCREASED SUICIDE RISK AND DELIVER PERSONALIZED INTERVENTION FOR PATIENTS TRANSITIONING OUT OF A PSYCHIATRIC HOSPITAL, A TIME OF EXTRAORDINARILY HIGH RISK. MAPS PROVIDES BOTH A MOBILE APP AND CLINICIAN SUPPORT, AND INCLUDES MULTIPLE EVIDENCE-BASED COMPONENTS: (1) MONITORING OF THOUGHTS, EMOTIONS, AND BEHAVIORS VIA ECOLOGICAL MOMENTARY ASSESSMENT (EMA), (2) PERSONALIZED, INTERACTIVE COPING STRATEGY ADMINISTRATION BASED ON PARTICIPANTS’ CURRENT RISK STATE, (3) DIRECT ACCESS TO CLINICIANS AND CRISIS SUPPORT SERVICES, AND (4) PSYCHOEDUCATION. WE WILL LEVERAGE EXISTING COMPONENTS OF MAPS AND DEVELOP AND TEST NEW FEATURES. TO PLAN FOR SUSTAINABILITY OF MAPS, WE WILL DELIVER THE INTERVENTION THROUGH THE BUTLER HOSPITAL TRANSITIONAL OUTPATIENT PROGRAM, ASSIGNING PARTICIPANTS TO MASTER’S LEVEL HOSPITAL CLINICIANS, AND CONVENE A STAKEHOLDER ADVISORY BOARD WITH A FOCUS ON PROGRAM SUSTAINABILITY. SPECIFICALLY, THE PRIMARY AIM OF THIS INVESTIGATION IS TO ESTABLISH FEASIBILITY, ACCEPTABILITY, SAFETY, AND ESTIMATE KEY PARAMETERS FOR PRIMARY OUTCOMES (I.E., SUICIDAL IDEATION AND BEHAVIOR; RE-HOSPITALIZATION), AND TARGET MECHANISMS (I.E., SELF-MONITORING, USE OF COPING STRATEGIES, REDUCTION OF NEGATIVE AFFECT, SELF-EFFICACY). THE ULTIMATE GOAL OF THIS PROJECT IS TO FURTHER DEVELOP AND REFINE THE MAPS SYSTEM AND ENGAGE IN PRELIMINARY TESTING IN PREPARATION FOR A FULLY-POWERED RANDOMIZED CLINICAL TRIAL (R01) TO ESTABLISH EFFECTIVENESS OF THE INTERVENTION IN A LARGER HEALTH CARE SYSTEM AND TO FURTHER OPTIMIZE INTERVENTION COMPONENTS AND DELIVERY (E.G., MACHINE LEARNING TECHNIQUES). THIS PROPOSAL OUTLINES PROCEDURES FOR INTERVENTION AND CLINICIAN TRAINING PROGRAM REFINEMENT THROUGH FOCUS GROUPS AND OPEN AND RANDOMIZED PILOT TRIALS. THUS, THE PRESENT STUDY IS DESIGNED TO DEVELOP THE TOOLS, PROCEDURES, AND KNOWLEDGE BASE FOR A NOVEL INTERVENTION.

BRIEF MINDFULNESS CESSATION TRAINING WITH EMA FOR POST-HOSPITAL DEPRESSED SMOKERS

DEVELOPMENT OF AN ADJUNCTIVE VIDEO-BASED SUICIDE PREVENTION INTERVENTION IMMEDIATELY FOLLOWING PSYCHIATRIC HOSPITALIZATION

EFFECTIVENESS OF PSYCHOSOCIAL TREATMENT FOR INPATIENTS WITH PSYCHOSIS

COMPUTER-BASED MI TO ENGAGE SMOKERS LIVING WITH HIV IN TOBACCO QUITLINE TREATMENT

DEVELOPMENT OF A TREATMENT ADHERENCE PROGRAM FOR BIPOLAR SUBSTANCE ABUSERS

NARRATIVE INTERVENTION TO DISSEMINATE ACT FOR DEPRESSION IN PRIMARY CARE

A TARGETED, REAL-TIME, TECHNOLOGY-SUPPORTED INTERVENTION FOR PATIENTS WITH ALCOHOL USE DISORDER ON DISULFIRAM

PROJECT CHOICE: CHOOSING HEALTHY OPTIONS IN COPING WITH EMOTIONS, A PERSONALIZED-FEEDBACK EMA/EMI STUDY FOR EMERGING ADULTS LEAVING PSYCHIATRIC PARTIAL HOSPITALIZATION - ABSTRACT EMERGING ADULTHOOD REPRESENTS A COMMON TIME FOR PROBLEMATIC MENTAL HEALTH ISSUES, PARTICULARLY AFFECTIVE DISORDERS SUCH AS ANXIETY AND DEPRESSION, AND PROBLEMATIC PATTERNS OF ALCOHOL USE. HEAVY ALCOHOL USE CAN LEAD TO NEGATIVE MENTAL HEALTH, ACADEMIC, PHYSICAL HEALTH, AND COGNITIVE FUNCTIONING OUTCOMES. IN PARTICULAR, INDIVIDUALS WHO USE ALCOHOL ARE MORE LIKELY TO HAVE PSYCHIATRIC COMORBIDITY AND HAVE POORER CLINICAL OUTCOMES. COMORBIDITY IS ASSOCIATED WITH MORE RISK THAN PSYCHIATRIC SYMPTOMATOLOGY OR ALCOHOL USE ALONE, YET IS RARELY TARGETED IN MENTAL HEALTH SETTINGS. USING SUBSTANCES FOR THE MOTIVE OF COPING WITH NEGATIVE AFFECT COMPOUNDS RISKS, AS THOSE WHO USE TO COPE EXPERIENCE THE MOST PROBLEMS. AS SUCH, IT IS IMPORTANT TO TARGET ALCOHOL USE, PARTICULARLY IN EA WITH AFFECTIVE DISORDERS WHO USE TO COPE. TYPICAL TREATMENT FOR ALCOHOL IS BRIEF, MOTIVATIONALLY-BASED, AND PROVIDES NORMATIVE FEEDBACK. WE PROPOSE TO ENHANCE OUR EXISTING INTERVENTIONS WITH EA IN PSYCHIATRIC CARE WITH AFFECTIVE DISORDERS WHO USE ALCOHOL TO COPE, WHICH CAPITALIZED ON TECHNOLOGY. TECHNOLOGY ALLOWS FOR ASSESSMENT OF HIGH-RISK SITUATIONS IN REAL TIME THROUGH ECOLOGICAL MOMENTARY ASSESSMENT (EMA) AND DELIVERY OF INTERVENTIONAL CONTENT BY ECOLOGICAL MOMENTARY INTERVENTION (EMI). THE DELIVERY OF TAILORED, JUST-IN-TIME RISK REDUCTION MESSAGE PAIRED WITH PERSONALIZED NORMATIVE FEEDBACK MAY IMPACT PROBLEMATIC USE AND DEPRESSION/ANXIETY OUTCOMES BY REDUCING THE LIKELIHOOD OF USE AND NEGATIVE OUTCOMES OF USE. WE PROPOSE TO ENHANCE OUR EXISTING PILOT INTERVENTION BY INTEGRATING PARTICIPANT FEEDBACK AND PROTOCOL REFINEMENT. IN PHASE 1, WE WILL (1) MAKE CHANGES TO THE PILOT PFICOPE+EMI, BASED ON PARTICIPANT AND RESEARCHER EXPERIENCE; (2) EVALUATE THE REFINED INTERVENTION THROUGH A SERIES OF FOCUS GROUPS. IN PHASE 2, WE WILL TEST OUR REFINED INTERVENTION (PFICOPE+EMI) AND IN A RANDOMIZED, CONTROLLED TREATMENT TRIAL AS COMPARED TO PERSONALIZED NORMATIVE FEEDBACK ONLY, DELIVERED AT BASELINE (PNF). THE PFICOPE+EMI CONSISTS OF: 1) AN IN-PERSON PERSONALIZED FEEDBACK SESSION TO PRESENT NORMATIVE INFORMATION, DISCUSS THE INDIVIDUAL'S USE, AND GENERATE RISK REDUCTION MESSAGES TO BE USED IN EMI; 2) EMA TO MONITOR AFFECT, USE INTENTION, ACTUAL ALCOHOL USE, COPING MOTIVES, AND ALTERNATE COPING SKILLS UTILIZATION; AND 3) TAILORED MESSAGES (EMI) BASED ON EMA (I.E., NORMATIVE FEEDBACK PLUS INDIVIDUALIZED RISK REDUCTION MESSAGES WHEN INDIVIDUALS REPORT NEGATIVE AFFECT AND USE INTENTION). THE PNF CONDITION WILL RECEIVE 1) AN IN-PERSON PERSONALIZED FEEDBACK SESSION TO PRESENT NORMATIVE INFORMATION, DISCUSS THE INDIVIDUAL'S USE, DELIVERED AT BASELINE. WE ANTICIPATE THAT THIS PROJECT WILL LEAD TO THE DEVELOPMENT OF A WELL-SPECIFIED, NOVEL, TECHNOLOGY- SUPPORTED, REAL-TIME INTERVENTION FOR EA WITH COMORBID ALCOHOL AND DEPRESSION/ANXIETY THAT CAN BE LATER TESTED IN A MULTI-SITE FULLY-POWERED RCT.

2/2 COLLABORATIVE STUDY: TESTOSTERONE AUGMENTATION IN WOMEN

PSYCHOSOCIAL TREATMENT DEVELOPMENT FOR DEPRESSION WITH COMORBID CHRONIC PAIN

YOGA TO TREAT CHRONIC PAIN IN PERSONS RECEIVING OPIOID AGONIST THERAPY

ENGAGING HIV PATIENTS IN PRIMARY CARE BY PROMOTING ACCEPTANCE

PHARMACOTHERAPY RELAPSE PREVENTION IN BDD

DEVELOPMENT OF A HOME-BASED FAMILY TREATMENT FOR POSTPARTUM DEPRESSION

NEUROIMAGING PREDICTORS OF RELAPSE DURING TREATMENT FOR OPIATE DEPENDENCE

INSOMNIA AND DRUG RELAPSE RISK

BRIEF COMPUTER INTERVENTION TO MOTIVATE QUITLINE USE FOR SMOKERS IN SUD TREATMENT

TREATING CHRONIC PAIN IN BUPRENORPHINE PATIENTS IN PRIMARY CARE SETTINGS

DEVELOPMENT OF A YOGA INTERVENTION FOR ANTENATAL DEPRESSION

BEHAVIORAL EXERCISE INTERVENTION FOR SMOKING CESSATION

DISTRESS TOLERANCE AND REDUCING EARLY RELAPSE IN BUPRENORPHINE PATIENTS

ROUTINE HIV TESTING IN PRIMARY CARE PRACTICES

COLORECTAL CANCER DECISION AIDS IN PRIMARY CARE

DEVELOPMENT OF A FAMILY-BASED, POST-DEPLOYMENT INTERVENTION

METHODS FOR UNDERSTANDING SENTINEL EVENTS

EXAMINING HIGHLY PALATABLE FOOD CONSUMPTION UPON INITIATION OF METHADONE MAINTENANCE TREATMENT - ABSTRACT INCREASES IN OPIOID USE DISORDER (OUD) IN THE LAST DECADE HAS CREATED A PUBLIC HEALTH CRISIS. METHADONE MAINTENANCE TREATMENT (MMT) IS THE MOST COMMON TREATMENT FOR OUD. WHILE MMT IS EFFECTIVE IN HELPING PATIENTS IMPROVE THEIR QUALITY OF LIFE, PHYSICAL AND MENTAL HEALTH COMORBIDITIES ARE COMMON AND INCREASE RISK FOR PREMATURE DEATH. WHILE UNHEALTHY LIFESTYLE BEHAVIORS SUCH AS PHYSICAL INACTIVITY AND CIGARETTE SMOKING HAVE BEEN TARGETED, THE ROLE OF NUTRITIONAL INTAKE IN THIS POPULATION HAS BEEN RELATIVELY UNEXPLORED. CLINICALLY SIGNIFICANT INCREASES IN WEIGHT (AT LEAST 10%) HAVE BEEN CONSISTENTLY OBSERVED, AS WELL AS OFT-REPORTED CRAVINGS FOR SWEET FOODS UPON MMT INITIATION. MISSING FROM THE EXISTING LITERATURE IS A CLEAR UNDERSTANDING OF WHY THIS PHENOMENON OCCURS, LIMITING THE ABILITY TO EFFECTIVELY TARGET THIS PROBLEM WITH APPROPRIATE INTERVENTION. PURPORTED EXPLANATIONS FOR WEIGHT GAIN HAVE INCLUDED INCREASED FOOD INTAKE TO COMPENSATE FOR UNDERNOURISHMENT DURING THE TIME OF ACTIVE ILLICIT OPIOID USE AND THE PHARMACOLOGICAL EFFECTS OF METHADONE ON PANCREATIC CELL DYSFUNCTION AND SWEET TASTE PREFERENCE. HOWEVER, THESE POSSIBILITIES MAY ONLY PARTIALLY EXPLAIN WEIGHT GAIN AS MOST PATIENTS STARTING TREATMENT ARE ALREADY OVERWEIGHT OR OBESE AND INCREASES IN WEIGHT CONTINUE EVEN WHEN METHADONE DOSES ARE STABLE. WE ARE PROPOSING AN ADDITIONAL HYPOTHESIS: PATIENTS STARTING MMT WILL CONSUME FOODS THAT ARE HIGHLY PALATABLE (HPF; I.E., HIGH IN FAT, SUGAR, OR BOTH) IN AN EFFORT TO MANAGE NEGATIVE AFFECT AND OPIOID CRAVINGS THAT ARE COMMON DURING EARLY RECOVERY. ANECDOTAL REPORTS OF PATIENTS IN SUBSTANCE USE TREATMENT PROVIDE SUPPORT FOR THIS HYPOTHESIS – HPF PROVIDE EMOTIONAL RELIEF AND DECREASE DRUG CRAVINGS. AN EMERGING BODY OF BASIC SCIENCE LITERATURE DEMONSTRATES SHARED NEURAL MECHANISMS OF BOTH HPF AND DRUGS OF ABUSE. AS WITH DRUGS, HPF POTENTIATES ENDOGENOUS OPIOID AND DOPAMINE RELEASE IN THE NUCLEUS ACCUMBENS, WHICH, THROUGH REPEATED OVERCONSUMPTION, CAN ALSO LEAD TO DISRUPTED REWARD PATHWAYS. INDEED, IN NON-SUBSTANCE USING POPULATIONS, OVERCONSUMPTION OF HPF CAN LEAD TO POORER PSYCHOLOGICAL FUNCTIONING SUCH AS DEPRESSION AND ANXIETY (KNOWN RELAPSE RISKS IN THOSE WITH OUD). THEREFORE, WHILE HPF MAY HAVE A SHORT-TERM BENEFICIAL EFFECT ON IMPROVING NEGATIVE AFFECT AND DECREASING OPIOID CRAVINGS AMONG PATIENTS IN MMT, IT MAY ALSO CONFER A LONGER-TERM RISK FOR RELAPSE IN THIS POPULATION. UNDERSTANDING THE WITHIN-PERSON ASSOCIATIONS BETWEEN NEGATIVE AFFECT, OPIOID CRAVINGS, AND CONSUMPTION OF HPF AT THE DAILY LEVEL AND OVER THE COURSE OF EARLY MMT INITIATION IS CRITICAL FOR INFORMING THE DEVELOPMENT OF ADJUNCTIVE, NUTRITION-FOCUSED INTERVENTIONS IN THIS AT-RISK POPULATION. WE PROPOSE TO CONDUCT A 26-WEEK PROSPECTIVE STUDY OF 80 PATIENTS WHO RECENTLY INITIATED MMT UTILIZING ECOLOGICAL MOMENTARY ASSESSMENT (EMA; THROUGH THREE, 21-DAY BOUTS). IN DOING SO, WE CAN ANSWER THE QUESTION OF WHETHER HPF CONSUMPTION DURING EARLY MMT IS BENEFICIAL OR DETRIMENTAL TO RISK FOR RETURNING TO ILLICIT OPIOID USE. WITH THIS INFORMATION, MORE EFFECTIVE INTERVENTIONS COULD BE DEVELOPED TO EXTEND RECOVERY AND DECREASE THE PUBLIC HEALTH IMPACT OF OUD.

DEVELOPMENT OF AN INTERVENTION FOR SUICIDE ATTEMPTERS

DEVELOPMENT AND PRELIMINARY TESTING OF A PEER NARRATIVE VIDEO INTERVENTION FOR OLDER ADULTS WITH CHRONIC PAIN - CHRONIC MUSCULOSKELETAL (MSK) PAIN, WHICH INCLUDES SPINAL PAIN, OSTEOARTHRITIS, AND FIBROMYALGIA, IS A COMMON AND COSTLY PROBLEM FOR OLDER ADULTS AND IS ASSOCIATED WITH DECREASED QUALITY OF LIFE. THERE IS A CLEAR NEED FOR INTERVENTIONS THAT INCREASE ONE’S ABILITY TO COPE WITH CHRONIC PAIN AND ENGAGE IN MEANINGFUL LIFE ACTIVITIES EVEN WITH THE PRESENCE OF CHRONIC PAIN. ACCEPTANCE AND COMMITMENT THERAPY (ACT) IS A PSYCHOTHERAPY THAT USES MINDFULNESS AND PSYCHOLOGICAL ACCEPTANCE TO SUPPORT INDIVIDUALS IN WORKING TOWARD BEHAVIORAL GOALS GUIDED BY THEIR PERSONAL VALUES, EVEN IN THE PRESENCE OF UNDESIRABLE EXPERIENCES SUCH AS CHRONIC PAIN. CLINICAL PRACTICE GUIDELINES RECOMMEND THE USE OF ACT FOR TREATING CHRONIC PAIN BASED ON EVIDENCE OF EFFECTIVENESS FROM MULTIPLE RCTS. HOWEVER, UPTAKE AND REACH ARE LIMITED BECAUSE THERE ARE INSUFFICIENT NUMBERS OF MENTAL HEALTH PROFESSIONALS WHO CURRENTLY OFFER ACT OR OTHER RECOMMENDED THERAPIES (E.G., COGNITIVE-BEHAVIORAL THERAPY) FOR CHRONIC PAIN. IN ADDITION, MANY OLDER ADULTS ARE NOT WILLING OR ABLE TO ENGAGE IN TRADITIONAL PSYCHOTHERAPY FOR CHRONIC PAIN EVEN WHEN IT IS AVAILABLE. ALTHOUGH SOME BIBLIOTHERAPY AND DIGITAL HEALTH INTERVENTIONS (E.G., APPS) HAVE BEEN DEVELOPED FOR TREATING PAIN, MANY OLDER ADULTS FAIL TO USE THEM DUE TO LOW LEVELS OF COMFORT WITH TECHNOLOGY OR LACK OF MOTIVATION FOR INTENSIVE SELF-GUIDED APPROACHES. NARRATIVE COMMUNICATION IS AN ALTERNATIVE WAY TO DELIVER BEHAVIOR CHANGE PRINCIPLES THAT INVOLVES “STORYTELLING” INVOLVING REAL PATIENTS TALKING ABOUT THEIR STRUGGLES AND RECOVERY PROGRESS. THERAPEUTIC NARRATIVES DELIVERED VIA VIDEOS MAY BE MORE ENGAGING AND IMMERSIVE THAN TRADITIONAL SELF-HELP FORMATS FOR OLDER ADULTS. IN PREVIOUS GRANT-FUNDED RESEARCH, OUR TEAM HAS DEVELOPED METHODS FOR CREATING NARRATIVE, VIDEO-BASED INTERVENTIONS DESIGNED TO REDUCE DEPRESSION IN PRIMARY CARE PATIENTS AND PREVENT SUICIDE IN PATIENTS FOLLOWING A PSYCHIATRIC HOSPITAL. THUS, IN THIS PROJECT, WE PROPOSE TO CREATE RECLAIM YOUR DAY (RYD), WHICH WILL CONSIST OF 6, 30-MIN WEEKLY VIDEO EPISODES HIGHLIGHTING PATIENTS’ INSPIRING AND ILLUSTRATIVE EXPERIENCES LIVING WITH CHRONIC PAIN IN ORDER TO TEACH CURRENT PATIENTS WITH CHRONIC MSK PAIN HOW TO APPLY ACT’S EVIDENCE-BASED STRATEGIES. IN PHASE 1 OF THIS PROJECT, WE WILL INTERVIEW OLDER ADULTS WITH CHRONIC MSK PAIN ABOUT THEIR COPING HISTORY, AND CODE INTERVIEWS FOR CONSISTENCY WITH ACT PRINCIPLES. WE WILL INVITE A SUBSET OF THESE INDIVIDUALS TO WORK WITH A PROFESSIONAL STORYTELLING COACH TO DEVELOP AND VIDEORECORD THEIR ACT-CONSISTENT STORIES. THESE DOCUMENTARY-STYLE VIDEOS THAT WILL FORM THE BASIS OF RYD. IN PHASE 2, WE WILL CONDUCT A PILOT RCT (N=100) OF OLDER ADULTS WITH CHRONIC MSK PAIN. ALL PARTICIPANTS WILL RECEIVE A 30-MIN INTRODUCTORY PAIN EDUCATION VIDEO. PARTICIPANTS WILL BE RANDOMIZED TO RECEIVE EITHER RYD OR A COMPARISON INTERVENTION (HEALTH EDUCATION VIDEOS). WE WILL EXAMINE RYD FEASIBILITY AND ACCEPTABILITY AS WELL AS CHANGES OVER TIME IN OUTCOMES (PAIN INTERFERENCE, DEPRESSION, QUALITY OF LIFE) AND PUTATIVE MEDIATORS.

TECHNOLOGY-ASSISTED ASSESSMENT OF POST-HOSPITAL ADHERENCE IN SCHIZOPHRENIA

MECHANISMS OF ACCELERATED AGING: STRESS, HEALTH BEHAVIORS, AND THE ROLE OF MITOCHONDRIA - EARLY LIFE ADVERSITY, INCLUDING CHILDHOOD MALTREATMENT AND OTHER TRAUMAS, IS A MAJOR RISK FACTOR FOR A HOST OF AGING-RELATED CONDITIONS, INCLUDING CARDIOVASCULAR DISEASE, STROKE, PAIN SYNDROMES, AND DIABETES. HEALTH BEHAVIORS, SUCH AS POOR DIET AND SEDENTARY LIFESTYLE, AND ADULT STRESSORS, ARE LINKED TO CHILDHOOD ADVERSITY AND FURTHER CONTRIBUTE TO RISK FOR THESE DISEASES. THESE EFFECTS COMPOUND OVER TIME AND POOR HEALTH OUTCOMES ARE MOST EVIDENT IN ADULTS WHEN BIOLOGICAL EFFECTS OF STRESS AND HEALTH BEHAVIORS COMBINE WITH AGE-RELATED DECLINE TO PRODUCE FRANK DISEASE. THERE IS NOW SUBSTANTIAL EVIDENCE OF GLUCOCORTICOID AND INFLAMMATORY MECHANISMS THAT ACCELERATE AGING AND CONFER RISK FOR DISEASE FOLLOWING EARLY ADVERSITY. CONVERGING EVIDENCE FROM ANIMAL MODELS AND RECENT HUMAN STUDIES INDICATE THAT MITOCHONDRIA PLAY A KEY ROLE IN COORDINATING THE STRESS RESPONSE AND IN THE AGING PROCESS, AND MAY BE A MECHANISM OF RISK FOR THESE STRESS- AND AGE-RELATED DISORDERS. RECENT WORK IN HUMANS HAS IMPLICATED MITOCHONDRIA IN THE EFFECT OF EARLY TRAUMA ON RISK FOR PSYCHIATRIC DISORDERS. OUR LABORATORY SHOWED THAT MITOCHONDRIAL DNA COPY NUMBER (MTDNACN) IS INCREASED IN LEUKOCYTES OF HEALTHY ADULTS WITH A HISTORY OF CHILDHOOD TRAUMA, AS WELL AS THOSE WITH DEPRESSIVE AND ANXIETY DISORDERS. RESULTS OF OTHER RECENT STUDIES SUGGEST THAT STRESS IS LINKED WITH ALTERATIONS OF MITOCHONDRIAL ENZYMES AND IMPAIRED MITOCHONDRIAL RESPIRATION. HEALTH BEHAVIORS, SUCH AS DIET, EXERCISE, AND SLEEP, MAY BE ALTERED WITH EARLY ADVERSITY AND PLAY AN IMPORTANT ROLE IN THE EFFECTS OF EARLY ADVERSITY ON MOLECULAR AND HEALTH OUTCOMES INDICATIVE OF ACCELERATED AGING. THE PROPOSED STUDY LEVERAGES DATA AND SPECIMENS AVAILABLE IN A STUDY OF CHILDHOOD MALTREATMENT THAT INCLUDES RICH DATA ON EXPOSURES, HEALTH BEHAVIORS, BIOLOGICAL SPECIMENS, AND HEALTH OUTCOMES. RESULTS OF THIS STUDY ARE EXPECTED TO PROVIDE INSIGHT INTO THE BIOLOGICAL MECHANISMS OF ADVERSITY-RELATED RISK FOR ACCELERATED AGING AND RISK FOR DISEASE, AND PROVIDE TARGETS FOR NEW TREATMENT AND PREVENTION APPROACHES.

DISCONTINUATION OF LONG-TERM SRIS IN OBSESSIVE COMPULSIVE DISORDER

A SMARTPHONE APP TO FACILITATE BUPRENORPHINE DISCONTINUATION

A TAILORED PHYSICAL ACTIVITY SMARTPHONE APP FOR PATIENTS WITH ALCOHOL DEPENDENCE

TREATMENT-SEEKING FOR DEPRESSION AMONG PREGNANT WOMEN

A MACHINE LEARNING APPROACH FOR INFERRING ALCOHOL INTOXICATION LEVELS FROM GAIT DATA

CHILDHOOD MALTREATMENT: EPIGENETIC MODULATION OF THE GLUCOCORTICOID RECEPTOR

BEHAVIORAL CONSULTATION FOR HIV+ OLDER ADULTS PRESCRIBED OPIOIDS FOR CHRONIC PAIN

TREATING CHRONIC PAIN AND DEPRESSION IN HIV PATIENTS IN PRIMARY CARE SETTINGS

DEVELOPMENT OF TAILORED INTERVENTION TO PROMOTE CRC SCREENING AMONG LATINO MEN

COVID19 VACCINE HESITANCY AMONG PERINATAL WOMEN AT RISK FOR HEALTH DISPARITIES - ABSTRACT DESPITE SAFETY DATA SUPPORTING USE OF COVID-19 VACCINES AMONG PREGNANT AND LACTATING WOMEN, COVID-19 VACCINE COVERAGE AMONG PERINATAL WOMEN IN THE UNITED STATES IS VERY LOW, WITH UPTAKE EVEN LOWER AMONG SOME RACIAL AND ETHNIC GROUPS SUCH AS BLACK/AFRICAN AMERICAN AND LATINA WOMEN. CONCERNINGLY, PREGNANCY IS ASSOCIATED WITH MORE SEVERE OUTCOMES ASSOCIATED WITH COVID-19 INFECTION: PREGNANT WOMEN WITH COVID-19 HAVE HIGHER RATES OF ICU ADMISSION, MECHANICAL VENTILATION, AND MORTALITY COMPARED TO WOMEN WITH COVID-19 WHO ARE NOT PREGNANT. FURTHER, INFANTS BORN TO WOMEN WITH COVID-19 ARE MORE LIKELY TO BE BORN PRETERM, POTENTIALLY LEADING TO NUMEROUS DOWNSTREAM NEGATIVE CONSEQUENCES FOR THE CHILD’S HEALTH AND DEVELOPMENT. IN SPITE OF THE HIGH STAKES OF INFECTION FOR WOMEN AND THEIR OFFSPRING, LITTLE IS KNOWN ABOUT FACTORS CONTRIBUTING TO COVID-19 VACCINE HESITANCY (VH) AND REFUSAL AMONG PERINATAL WOMEN, PARTICULARLY THOSE AT HIGHEST RISK FOR HEALTH DISPARITIES. IDENTIFYING FACTORS CONTRIBUTING TO VH AMONG THIS VULNERABLE GROUP OF WOMEN IS CRUCIAL TO THE DEVELOPMENT OF EFFECTIVE INTERVENTIONS TO PROMOTE VACCINE UPTAKE. FURTHER, LITTLE IS KNOWN ABOUT FACTORS RELATING TO PRENATAL CARE PROVIDER BEHAVIOR AND RECOMMENDATIONS REGARDING COVID-19 VACCINATION DURING PREGNANCY AND POSTPARTUM. OUR EXPERIENCED, INTERDISCIPLINARY TEAM PROPOSES A 2-YEAR, MIXED METHODS R21 INVESTIGATION THAT INCLUDES BOTH A PATIENT COMPONENT AND A PROVIDER COMPONENT IN ORDER TO IDENTIFY KEY FACTORS CONTRIBUTING TO COVID-19 VACCINE UPTAKE AND REFUSAL IN THE PERINATAL PERIOD. IN THE PATIENT COMPONENT, WE WILL RECRUIT 120 ENGLISH AND SPANISH-SPEAKING FINANCIALLY-DISADVANTAGED PREGNANT AND POSTPARTUM WOMEN, INCLUDING HALF WHO WERE VACCINATED IN PREGNANCY AND HALF WHO ARE UNVACCINATED. GUIDED BY THE THEORY OF PLANNED BEHAVIOR AND THE FIVE C’S MODEL OF VACCINE HESITANCY, AND WITH INPUT FROM A DIVERSE GROUP OF COMMUNITY STAKEHOLDERS, WE WILL ASSESS COGNITIVE AND AFFECTIVE FACTORS, PSYCHOLOGICAL SYMPTOMS, MEDICAL MISTRUST, AND OTHER CONTRIBUTORS TO VACCINE DECISION-MAKING. WE WILL CONDUCT QUALITATIVE INTERVIEWS WITH A SUBSET OF WOMEN (N=30) TO AUGMENT OUR UNDERSTANDING OF FACTORS DRIVING VACCINE RELUCTANCE AND REFUSAL. IN THE PROVIDER COMPONENT, WE WILL RECRUIT 60 PRENATAL CARE PROVIDERS WHO WORK WITH FINANCIALLY DISADVANTAGED WOMEN (OBS, FAMILY MEDICINE, MIDWIVES, NURSES) TO TAKE PART IN AN IN-DEPTH SURVEY REGARDING FACTORS CONTRIBUTING TO VH, REFUSAL AND UPTAKE DURING THE PERINATAL PERIOD; A SUBSET OF 30 PROVIDERS WILL TAKE PART IN QUALITATIVE INTERVIEWS TO EXPLORE THESE ISSUES FURTHER. OUR ANALYTIC PLAN INVOLVES GENERALIZED LINEAR MODELS TO EXAMINE PREDICTORS OF PATIENT VACCINATION OUTCOMES, AND QUALITATIVE THEMATIC ANALYSIS TO IDENTIFY KEY THEMES WOMEN AND PROVIDERS ENDORSE REGARDING COVID-19 VACCINE HESITANCY. FINDINGS WILL INFORM PROVIDER EDUCATION AND SERVICES INNOVATIONS, AS WELL AS INTERVENTION DEVELOPMENT TO TARGET INCREASED VACCINATION UPTAKE THIS VULNERABLE PATIENT GROUP.

TDCS FOR INHIBITORY CONTROL DEFICITS: A TEST IN OCD

RESIDENCY TRAINING IN PRIMARY CARE

MID-CAREER INVESTIGATOR AWARD IN SUBSTANCE ABUSE - RESEARCH

TDCS FOR INCREASING EXERCISE ADHERENCE IN INDIVIDUALS WITH ELEVATED DEPRESSIVE SYMPTOMS

A BRIEF MARIJUANA INTERVENTION FOR ADOLESCENT WOMEN

MARIJUANA AND SLEEP IN YOUNG ADULTS

PEER-FACILITATED PHYSICAL ACTIVITY INTERVENTION DELIVERED DURING METHADONE MAINTENANCE

TREATMENT OF SUICIDE IN ALCOHOLIC AND DEPRESSED PATIENTS

ANTIDEPRESSANTS DURING OFFICE-BASED BUPRENORPHINE

LEAD EXPOSURE AND EARLY BRAIN DEVELOPMENT

EHEALTH BP CONTROL PROGRAM

ARRA - EQUIPMENT TO ENHANCE TRAINING FOR HEALTH PROFESSIONALS

PRIMARY CARE TRAINING AND ENHANCEMENT

HEALTH CARE AND OTHER FACILITIES

DOUBLE-BLIND STUDY OF SAME VS ESCITALOPRAM IN MDD

INITIATING AND MAINTAINING PHYSICAL ACTIVITY IN DEPRESSED INDIVIDUALS

PSYCHOTHERAPY FOR DEPRESSED PRIMARY CARE PATIENTS

STRUCTURING APPROPRIATE AND FEASIBLE EVALUATIONS OF RISK (SAFER) - ABSTRACT SUICIDE REMAINS A LEADING PUBLIC HEALTH CRISIS, CLAIMING OVER 49,000 LIVES IN 2022. AMONG COLLEGE-AGED INDIVIDUALS, SUICIDE IS THE SECOND LEADING CAUSE OF DEATH, WITH STUDIES INDICATING THAT 6.4% OF STUDENTS DEVELOP NEW-ONSET SUICIDAL IDEATION, EXCEEDING RATES SEEN IN THE GENERAL POPULATION. TO ADDRESS THIS, RESEARCHERS INCREASINGLY UTILIZE TECHNOLOGICAL TOOLS FOR REAL-TIME SUICIDE RISK ASSESSMENT. WHILE THESE TOOLS ENHANCE RISK DETECTION, THEY ALSO INTRODUCE ETHICAL CHALLENGES, PARTICULARLY IN BALANCING PARTICIPANT SAFETY WITH SCIENTIFIC VALIDITY. EXISTING PROTOCOLS FOR MANAGING SUICIDE RISK IN RESEARCH LACK EMPIRICAL VALIDATION, CREATING INCONSISTENCIES THAT DELAY STUDIES AND HINDER PROGRESS. THE PROPOSED STUDY, STRUCTURING APPROPRIATE AND FEASIBLE EVALUATIONS OF RISK (SAFER), AIMS TO ADDRESS THIS GAP BY DEVELOPING EVIDENCE-BASED SUICIDE RISK MANAGEMENT PROTOCOLS. SAFER WILL INCORPORATE PERSPECTIVES FROM STUDENTS WITH LIVED EXPERIENCE AND SUICIDOLOGISTS TO CREATE AND EVALUATE RISK ASSESSMENT AND INTERVENTION PROTOCOLS. THE PROJECT HAS THREE PRIMARY AIMS: (1) EXAMINING STAKEHOLDER VIEWS ON THE ACCEPTABILITY OF SUICIDE RISK MANAGEMENT PROTOCOLS, (2) EVALUATING THE EFFECTS OF DIFFERENT PROTOCOLS ON PARTICIPANT SAFETY, AND (3) ASSESSING THEIR IMPACT ON DATA VALIDITY. AIM 1 WILL DEVELOP A STAKEHOLDER PANEL CONSISTING OF ~16 STUDENTS WITH LIVED EXPERIENCE AND ~16 SUICIDOLOGISTS. SEMI-STRUCTURED INTERVIEWS WILL BE CONDUCTED UNTIL SATURATION IS REACHED. AIM 2 WILL ASSESS THE PERCEIVED ACCEPTABILITY AND EFFECTIVENESS OF VARIOUS SUICIDE RISK MANAGEMENT PROTOCOLS AMONG HIGH-RISK COLLEGE STUDENTS (N=30) AND SUICIDOLOGISTS (N=10). PARTICIPANTS WILL EVALUATE DIFFERENT RISK RESPONSE STRATEGIES, INCLUDING VARIATIONS IN OUTREACH, SAFETY MEASURES, AND RESOURCE PROVISION. AIM 3 WILL TEST THE IMPACT OF DIFFERENT LEVELS OF RESEARCH PERSONNEL OUTREACH ON REPORTS OF SUICIDAL IDEATION AND BEHAVIORS. A COHORT OF 50 STUDENTS AT RISK FOR SUICIDE WILL COMPLETE DAILY ASSESSMENTS. RESPONSES WILL TRIGGER STRATIFIED INTERVENTIONS, RANGING FROM AUTOMATED RESOURCE REMINDERS TO DIRECT OUTREACH BY RESEARCH STAFF. PARTICIPANTS WILL EVALUATE THE ACCEPTABILITY OF THESE INTERVENTIONS AT THE STUDY’S CONCLUSION. THIS PROJECT WILL GENERATE EMPIRICAL DATA TO REFINE ETHICAL GUIDELINES FOR SUICIDE RISK MANAGEMENT, ENSURING THEY ARE BOTH PROTECTIVE AND CONDUCIVE TO RESEARCH INTEGRITY. BY BALANCING PARTICIPANT SAFETY WITH SCIENTIFIC FEASIBILITY, SAFER WILL PROVIDE SCALABLE, EVIDENCE-BASED RISK MANAGEMENT STRATEGIES APPLICABLE TO DIVERSE RESEARCH SETTINGS. THESE FINDINGS WILL CONTRIBUTE TO NATIONAL EFFORTS IN BIOETHICS, ALIGNING WITH THE BELMONT REPORT PRINCIPLES WHILE ADDRESSING CRITICAL GAPS IN SUICIDE RESEARCH METHODOLOGIES.

PEER GROUP NETWORKS AND ADOLESCENT SMOKING

A CLIMATE FOR EVIDENCE-BASED PRACTICE IMPLEMENTATION IN THE PATIENT-CENTERED MEDICAL HOME

THE DEVELOPMENT OF AN IMPLICIT MEASURE OF NON-JUDGMENT OF INTERNAL EXPERIENCES

BARRIERS TO ENTRY INTO COUPLES' TREATMENT OF PROBLEMATIC ALCOHOL USE

INTEGRATED PRIMARY CARE FOR MEDICALLY UNEXPLAINED SYMPTOMS

TRAINING CED/COR PEDIATRIC AND CHILD PSYCHIATRY

HEALTH CARE FACILITIES AND OTHER CONSTRUCTION

BIOMARKERS OF RISK FOR POST-TRAUMATIC STRESS DISORDER