Let’s Go All IN: Inclusion, Innovation, Influence

Monica Baskin, PhD, SBM President

Monica Baskin, PhD
SBM President

I am honored to serve as the 42^nd President of the Society of Behavioral Medicine (SBM). SBM has been my professional home for over 17 years. Like my personal home, it is my goal for SBM to be a “place” where all members and guests feel welcome, valued and are able to grow. I recognize the tremendous responsibility it is to be president of the Society, particular at this point in history. Our nation is in the midst of dealing with two pandemics: COVID-19 and racial injustice. However, during times of turmoil and uncertainty many rely on a trusted home base to center oneself, gather essential tools, energize and organize for collective action. SBM is that place.

Over the past few months, our physicians, nurses, psychologists and other healthcare providers have been on the front lines of providing medical and mental health care to COVID-19 patients. They have pointed out additional challenges including risks of domestic violence, barriers to accessing service and the shortfalls of telehealth in the midst of COVID-19. Our public health practitioners and behavioral science researchers have sounded the alarm around the need for the promotion of facts not fear and consistency and transparency in reporting the impact of COVID-19.  In that vein, SBM has called for equitable healthcare during the COVID-19 pandemic and research on disparities in COVID-19-related morbidity and mortality. Members have also shared resources and evidence-based strategies including coping with social isolation and loneliness and remaining physically active in the midst of a pandemic.

As if COVID-19 wasn’t enough, we were hit with the highly publicized senseless deaths of Mr. George Floyd (Minneapolis, MN), Ms. Breonna Taylor (Louisville, KY) and Mr. Ahmaud Arbery (Brunswick, GA). SBM released my initial statement calling out racism and its negative impact on the mental, behavioral and physical health of blacks and other racial/ethnic groups that have been targets of violent and traumatic events. A collaboration between the Health Policy Council and Health Equity SIG led to SBM’s policy position urging Congress to reform policing and increase funding for anti-racist research. Further still, our members have articulated a vision for Black men’s health in the face of COVID-19 and police brutality, recognizing that there are structural issues in law enforcement, academia, and healthcare that have to be addressed to dismantle racism in our county.

In the face of these pandemics and the associated uncertainty, SBM will cultivate resilience in the face of adversity. We will continue to thrive and deploy our proven science to ensure better health for all. This fall we will develop a new strategic framework for how the Society can continue to grow and meet the current needs of our larger society and allow for flexibility to address emerging issues. Over the next year, we will facilitate increased opportunities to listen to our membership and promote inclusion so that SBM feels more like home. We will continue to foster innovation with provocative questions and novel dissemination methods of our proven science. We will maintain and build strategic partnerships, increase our direct communications to the public and strengthen relationships with policymakers to expand our influence. I encourage you to Go All IN as our efforts towards INclusion will drive our INnovation and fuel our INfluence on the health of the larger society.

Editor's Note: Special Section on Behavioral Medicine during the Time of COVID-19

Crystal Lumpkins, PhD; Editor, Outlook

Crystal Lumpkins, PhD

For several months now, the images of police and protestor clashes, looting and human suffering have played over and over again like a continuous loop of unforgettable footage on social media, television and other media. We are in fact seeing history unfold before our eyes as we are witnessing the cycles of major news stories begin and others begin with no end in sight.

These images and stories combined with the ongoing public health crisis of COVID-19 have in many ways held us captive. The unknowns of the pandemic and unbelievable footage like that of a police officer’s knee on George Floyd’s neck for nearly 9 minutes are just some of the news stories that have penetrated directly or indirectly our professional and personal lives. This summer’s issue is the beginning of a series of special sections that will highlight current events like these. For this special edition of Outlook, we have articles that speak to the cascading effect that COVID-19 has had on several aspects of life. Those articles from our membership include social isolation and loneliness among veterans, resilience in the face of adversity, domestic violence during the time of COVID-19, and the impact on health equity of Black Men during this time. We are also fortunate to have other articles that highlight the important research that you do.

As our 42^nd President Monica Baskin details in her note, we must go all in as we are not working in isolation. The work that we do is in fact translatable into several facets of life and the seeds of change may very well be ready to bloom. It gives me great joy to see the articles submitted and hope that you consider submitting articles to future themed issues. These stories are informational, inspiring and give us a sense that our science does in fact matter and gives us pause to celebrate our efforts to make a difference.

From Personal Health to Pandemics, Police Brutality, and Protests – A Vision for Black Men’s Health Equity in 2020

Tiffany L. Carson, PhD, MPH^✉; Aldenise Ewing, PhD, MPH, CPH^✉; Betina Yanez, PhD^✉; Health Equity SIG

Derek Griffith, PhD, and Charles Rogers, PhD, MPH, MS, CHES

June is Men’s Health Month. However, in a time when Black men must decide between wearing a mask to lower the risk of spreading or contracting COVID-19 or not wearing a mask to lower their risk of being seen as a threat or a criminal, achieving racial health equity must be a part of the 2020 conversation on men’s health.

Racial disparities in men’s health are well documented. For example, prostate cancer occurs more often among Black men and Black men are more likely to die of prostate cancer when compared to white men.1,2  Black men also have a higher prevalence of hypertension and incidence of stroke than their white counterparts.3-5 These differences are largely driven by social determinants of health including access to quality health care, chronic stress, cultural mistrust of the health care system, and unfavorable environmental conditions. However, when we layer systemic racism and oppression on top of a legacy of unfavorable societal conditions, achieving optimal health and quality of life for Black men may seem like a daunting challenge.                           

While inequities among Black men have recently come to the attention and consciousness of many due to current events like the COVID-19 pandemic and killings of Mr. George Floyd and Mr. Ahmaud Arbery, experts like Derek Griffith, PhD, and Charles Rogers, PhD, MPH, MS, CHES, have dedicated their careers to addressing men’s health issues. Dr. Griffith is Professor of Medicine, Health and Society, and he is the Founder and Director of the Center for Research on Men’s Health at Vanderbilt University.  Dr. Rogers is an Assistant Professor in the Division of Public Health at the University of Utah School of Medicine, an Associate Member at the Huntsman Cancer Institute, Founding Director of the Men’s Health Inequities Research Lab, and an Associate Member of the Michigan Mixed Methods Program. Below, they lend their perspectives on a vision for achieving Black men’s health equity.
 

What do you think are existing challenges in achieving equity in men’s health outcomes?

Dr. Griffith: The biggest challenge in achieving equity in men’s health outcomes is the fact that few policies or programmatic strategies take into account both the gendered and non-gendered factors that are obstacles to health equity and optimal health. For example, most strategies consider race and sex/gender separately and do not consider how these factors intersect. The second biggest challenge is that most data used to evaluate programs and policies similarly separate race and sex but do not consider the intersection of the two to determine if race by sex/gender groups fare differently than considering either factor alone. The third challenge I will mention is that we tend not to consider the full range of determinants of health are gendered and racialized in our conceptions of the problems or in our policy or programmatic interventions.
 

What recommendations do you have for translating research into policy?

Dr. Griffith:

1. Offer recommendations for policy that are actually within the purview of policy makers. While we can always suggest that more research is needed and we need more funding for research, it is important that we provide guidance about where funding should be allocated, protections should be offered, and regulations should be revised.
2. Strengthen data sources and refine strategies to use and present data that align with our need to identify the populations with the worst health outcomes. Some determinants – like sex/gender – operate in ways that may be counterintuitive yet are consistent with data.
3. Pay attention to the way that we frame problems and solutions for populations of interest. One of the biggest challenges with men’s health promotion is that many believe that men’s poor health is rooted primarily in men’s notions of masculinity or manhood and not in the larger societal structures that impede other efforts to achieve equity.”
    

What have your experiences been in achieving the translation of research into policy?

Dr. Rogers: I have fostered interdisciplinary relationships with academics, physicians, advocacy organizations, and community members to become a respected leader focused on achieving health equity and improving the health of underrepresented groups. Owing to advocacy efforts and research, my contributions informed the Cancer Plan Minnesota 2025, and also encouraged two Minnesota senators to introduce legislation addressing colorectal cancer and health disparities among American Indians and African Americans.
 

Given the current climate of our society, what are some important actions that we can take now in working to achieve health equity for men?

Dr. Rogers: Coronavirus disease 2019 (COVID-19) has made it even more challenging to achieve health equity as COVID-19 has emphasized how health disparities are extensive for communities of color who battle numerous social determinants of health (e.g., racism, health insurance, economic stability, food security). Better understanding the prominence of these economic and social factors is key to assuring all men are able to live the healthiest life possible no matter how much money they make, what race they self-identify as, nor where they live, work, play, and worship. Actionable steps include: 1) assuring men from racial/ethnic minority groups are amply represented in clinical trials, 2) implementing theory-based interventions and policy change to assure bias is reduced in health care settings, 3) increasing workforce diversity, 4) partnering with community organizations aiming to achieve health equity, 5) challenging institutional racism by disassembling norms preserving race-based gain, 6) endorsing and supporting paid family leave for men, and 7) expanding Medicaid and/or investing in universal healthcare.

References

1. Rebbeck TR. Prostate Cancer Disparities by Race and Ethnicity: From Nucleotide to Neighborhood. Cold Spring Harbor perspectives in medicine. 2018;8(9).
2. U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on November 2018 submission data (1999-2016): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; www.cdc.gov/cancer/dataviz, June 2019.
3. Heron M. Deaths: Leading Causes for 2016. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2018;67(6):1-77.
4. Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. Hypertension prevalence and control among adults: United States, 2015–2016. NCHS data brief, no 289. Hyattsville, MD: National Center for Health Statistics. 2017.
5. Howard VJ, Madsen TE, Kleindorfer DO, et al. Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors. JAMA Neurol. 2019;76(2):179–186. doi:10.1001/jamaneurol.2018.3862

Telehealth & Behavioral Science during COVID-19: An Interview with Dr. Hayden Bosworth

Caitlin Sullivan, BS and Allison A. Lewinski, PhD, MPH^✉; Integrated Primary Care SIG

The current pandemic remarkably impacted face-to-face health care delivery with the exponential increase and upward shift to telehealth and other virtual care modalities. These changes have strengthened access to health care resources, and the ability to engage in health and wellness practices. Telehealth holds tremendous promise for maintaining and/or increasing access to health care during and after the pandemic. Yet, considerations exist to ensure that the exponential growth of telehealth does not result in unintended consequences or to widen health inequities. We interviewed Dr. Hayden Bosworth to hear expert advice for behavioral scientists interested in telehealth research and to learn more about use of telehealth to improve health outcomes. We are interested in telehealth and are members of the Improving Access through Virtual Care Focused Area of Research at the Durham Center of Innovation to Accelerate Discovery and Practice Transformation.

Who is Hayden Bosworth, PhD?

I am a health services researcher and Professor of Population Health Sciences at Duke University Medical Center as well as the Deputy Director of the Durham Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham Veterans Affairs Medical Center. My research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) implementation research to eliminate health care disparities. I lead and collaborate on telehealth research in health systems both nationally and internationally.
 

What current challenges are we facing in regards to telehealth and the COVID-19 pandemic?

We have seen dramatic increases in the uptake and adoption of telehealth. We went from one extreme of not fully and adequately using telehealth prior to the pandemic to using telehealth as much as possible when the pandemic started. For instance, I’m aware of how one healthcare system increased their use of telehealth by 5x (times) in April, and that growth is probably not unusual for other systems. We need to remember that while telehealth is one tool that can improve outcomes, we cannot use the same hammer for every problem, in every situation, or with every patient. It is too early to know all the unintended consequences of rapidly shifting to telehealth during the pandemic. Future data will demonstrate whether we misdiagnosed, misused, or mistreated conditions during this rapid shift to telehealth from face-to-face encounters.
 

What concerns exist in increasing telehealth use during COVID-19?

Telehealth is not appropriate for everyone and for all circumstances. The pandemic highlighted unequal access to, and use of, telehealth in several populations. We need to ensure that we do not increase disparities by rushing to, and relying solely on, telehealth during times of crisis. When thinking about telehealth use, we need to consider the individual’s preferences as well as socioeconomic status, age, and rurality. Individuals who have a difficult time accessing or figuring out telehealth will be at a significant disadvantage. These individuals may not trust telehealth and/or not know how to use it and may delay necessary treatment due to these challenges and not be appropriately treated. We need to remember that technology does not work for everyone, and different diseases may require adaptation of our telehealth models.
 

What has been an unexpected challenge working in telehealth prior to COVID-19?

Over my career, I’ve experienced two challenges designing telehealth research and programs. These challenges highlight how multidisciplinary collaborations are important as we work to integrate telehealth more fully into our health care delivery systems.

Reimbursement, rules, and regulations. Historically thinking about health care—telehealth delivery was primarily limited by reimbursement. Telehealth was difficult to sustain or implement because reimbursement was not aligned with the use of telehealth and legal issues impeded uptake. Fewer barriers to telehealth currently exist due to changes in care delivery and reimbursement policies around COVID-19. Now, telehealth aligns more with financial models—the rules and regulations are changing in a good way. Hopefully after COVID-19, we will continue to see alignment of reimbursement to increase the use and uptake of telehealth.

Disconnection between developing a telehealth program and deploying the program. Practical issues exist when using telehealth, and individuals may experience distress and anxiety when using telehealth in place of face-to-face appointments. I have heard these concerns over the years in my own research and seen these concerns play out in in my own family. How does someone who is not experienced with, or exposed to, technology figure out how to work these tools? Do individuals have a stable Internet connection? Do they have the right technological tools? Do they know how to use these tools? So, it is important to consider the patient’s familiarity with technology as well as other factors.
 

How can behavioral scientists prepare to examine telehealth use and uptake during and after COVID-19?

Behavioral science informs telehealth use, uptake, and adaptation. Behavioral scientists should have a knowledge base with an understanding of different behavioral theories, frameworks, and models that explain behavior change as well as knowledge of different study methods to evaluate interventions. We are in an applied field—so we need to ask the right questions first and then consider the study design or technology. If you start with the newest technology or shiny new object, you may fail to implement your research in the real world because it is impractical and inefficient. First, start with the behaviors you want to change, which will lead to an appropriate research question and design. Telehealth or the technology may or may not be a component. That is ok because if you expect telehealth to solve every problem that’s where you can get into trouble. Second, make sure the intervention is contextually appropriate for the right type of patient. Third, remember not all studies need to have a quantitative outcome or be randomized controlled trials. Be flexible and continue to learn about theories, methods, and study designs.
 

What should behavioral scientists consider when using telehealth to improve health outcomes?

We need to realize that everything in health care does not have to be via telehealth. The goal is to match and align the individual patient with the appropriate clinician or clinical service and telehealth modality. Focus on developing theory-based content and less on the technological device itself. Your content should stay constant, and good content can work across technologies. By creating the content first, and then determining the modality for delivering the content you can find the sweet spot of how to use telehealth appropriately for your population.
 

Any final thoughts?

The idea that one tool is going to fit for everyone will ultimately leave some behind. Instead of using one hammer, such as telehealth, we need to make use of our entire toolbox to figure out how to engage individuals across diverse populations, and if we can do it properly, we can help reduce health inequities. Technology will continue to change rapidly, so it all comes back to behavior and matching the technology to the needs of the individual. It’s a great time to work in telehealth and improve health outcomes in the real-world.

Reducing Sedentary Time during the COVID-19 Pandemic

Dori Rosenberg, PhD, MPH^✉ and Linda Trinh, PhD^✉; Physical Activity SIG Chairs

Keeping physically active during the coronavirus pandemic can help improve your mental and physical health. However, even if you are physically active, spending too much time sitting or lying down (except for sleeping) is associated with worse health outcomes including greater risk for all cause mortality, cardiovascular disease, and type 2 diabetes. It is likely that sedentary time has increased population wide given that people are largely confined to their homes. Sedentary time has received significant attention in recent years due to the health risks associated with this behavior, as well as the high volumes of sitting time we engage in. Among the U.S. population, the estimated amount of sitting time has increased over time where adults now spend approximately 6.4 hours per day in total sitting time based on data obtained from the National Health and Nutrition Examination Survey (NHANES). In the updated Physical Activity Guidelines for Americans, it now suggests that most people would benefit from both increasing moderate-to-vigorous physical activity and reducing sitting time. There is insufficient evidence to recommend a specific healthy target goal of how much sitting time should be reduced or the number of interruptions throughout the day. While sitting time is unavoidable in our current society and especially during the pandemic, there are a number of ways we can interrupt the large volumes of sitting time that we accumulate throughout the day.

Interventions to reduce sedentary time are effective and may improve cardiometabolic health. From theories of habit formation, we surmise that sitting is an automatic, unconscious behavior that is habitual. To break the habit, bringing conscious awareness to sitting behavior is warranted. Over time new habits can then be established and can become more automatic. It is still not clear what specific behavior change strategies assist individuals in reducing their sedentary time. There is some evidence suggesting that self-monitoring is a viable strategy. However, it is cumbersome for people to record their sedentary time and, while there are a plethora of commercially available devices that provide tracking and feedback on physical activity, there are very few devices that provide information on how much sedentary time one is engaging in. The most valid field-based device for assessing sitting time is the activPAL accelerometer. This is a thigh worn device, which provides very accurate information but does not provide real time output. Therefore, it is primarily used within research studies as an outcome measure. Technologic advancements in the area of real time assessment of sedentary behavior are needed to advance the field.

There are many things you can do within your home environment, or at work once we are able to return, to alter your sedentary patterns. There are two main ways to do this: break up sitting bouts regularly and/or stand or move for periods of time throughout the day. Here are some suggestions from the Physical Activity SIG advisory board members that may help you to change your sedentary time.

Look for opportunities to stand up and move more whenever you can, and as much as your abilities allow you to!

Coping with Social Isolation & Loneliness During COVID-19: Strategies from Two Military & Veteran Health Researchers

Natalie Golaszewski, PhD^✉; Military and Veterans Health SIG

For many of us, COVID-19 has brought upon the experience of social isolation and feelings of loneliness. These experiences and feelings are often common among Veterans, Active Military Service members and their families during deployments, relocations, and reintegration. By definition, social isolation is the quantifiable measure of social interactions and relationships, whereas loneliness is the perceived level of social isolation (Masi et al., 2011). Drs. Sara Kinztle and Alan Teo provide insight into their research on social connection and social isolation, as well as coping strategies used in practice among Veterans, active military and their families.

Dr. Kintzle’s research focuses on social connectedness among Veterans. Her work has shown that transitions for Veterans often come with feelings of disconnectedness, where individuals are searching for connection and sense of belonging to a community (Castro & Kintzle, 2016; Kintzle et al., 2018). Her community efforts with the Los Angeles Veteran Orientation (LAVO) provides opportunities for recently transitioned Veterans or Veterans new to LA to connect to a community, that includes a shared military identity, and feelings of mutual trust. Dr. Kinztle believes that it is the shared experience that allows people to connect and build communities. She points out that this is also demonstrated in spouses, partners, and families of military service members as they have a long-established tradition of strong communities and shared group identity (Huebner et al., 2009). Part of this group identity includes reaching out and helping others during deployments, relocating, and/or transitions.

• Strategy: We can emulate these efforts to build stronger communities by sharing and listening to each other’s stories, whether COVID-19 related or not, will provide opportunities for us to develop quality connections.
• Strategy: While physical distancing is still in place, there are also opportunities for us to connect in virtual communities (e.g., related to hobbies, life transitions, book clubs).

Dr. Alan Teo examines social isolation and loneliness among Veterans, as well as developing and implementing coping strategies. Based on his research and practice in the field, he suggests using a range of high-tech, low-tech, and no-tech approaches to enhance our social connections. For many active military service members and Veterans who have relocated far from loved ones, meeting in-person may not be feasible. He recommends video calls as the next best thing, as they provide an immersive experience more so than exchanging text messages, and perhaps that is why people show more evidence of deep bonds after video chats (Sherman et al., 2013; Teo et al., 2019). However, there is also a benefit for using low-tech or no-tech as recent research in military personnel has shown that sending caring messages through text messages reduces suicidal ideation and attempts (Comtois et al., 2019). Dr. Teo also recommended mixing technologies and methods of connecting to others, but also suggests/recommends social-distance-face-to-face interactions when and if possible. He shared that he enjoys seeing “sidewalk socials,” where neighbors stay physically separated (at least 6 ft), each sitting in their respective patio furniture, but still able to socialize – how creative! His research shows a dose-dependent relationship between the frequency of time spent together in-person and reductions in depression years later (Teo et al., 2015). Lastly, Dr. Teo noted that a long line of research has shown that the quality of our social connections is critical, not so much the quantity of our interactions.

• Strategy: Try using a range of high-tech (e.g., video chatting), low-tech (e.g., sending caring text messages), and no-tech (e.g., handwritten postcards) ways to connect with family and friends.
• Strategy: Monitor how you feel after a virtual meetup, and use your emotional response to guide whether to keep doing them. If scheduling a video chat with loved ones ends up feeling more like work than fun, try other avenues to connect.

Many thanks to Drs. Kinztle (University of Southern California) and Teo (VA Portland Health Care System; Oregon Health & Science University) for taking the time to contribute to this article.

References

1. Castro, C. A., & Kintzle, S. (2016). Military matters: The military transition theory: Rejoining civilian life. International Society for Traumatic Stress Studies.
2. Comtois, K. A., Kerbrat, A. H., DeCou, C. R., Atkins, D. C., Majeres, J. J., Baker, J. C., & Ries, R. K. (2019). Effect of Augmenting Standard Care for Military Personnel With Brief Caring Text Messages for Suicide Prevention: A Randomized Clinical Trial. JAMA Psychiatry, 76(5), 474. https://doi.org/10.1001/jamapsychiatry.2018.4530
3. Huebner, A. J., Mancini, J. A., Bowen, G. L., & Orthner, D. K. (2009). Shadowed by War: Building Community Capacity to Support Military Families. Family Relations, 58(2), 216–228. https://doi.org/10.1111/j.1741-3729.2008.00548.x
4. Kintzle, S., Barr, N., Corletto, G., & Castro, C. A. (2018). PTSD in U.S. Veterans: The Role of Social Connectedness, Combat Experience and Discharge. Healthcare, 6(3), 102. https://doi.org/10.3390/healthcare6030102
5. Masi, C. M., Chen, H.-Y., Hawkley, L. C., & Cacioppo, J. T. (2011). A Meta-Analysis of Interventions to Reduce Loneliness. Personality and Social Psychology Review : An Official Journal of the Society for Personality and Social Psychology, Inc, 15(3). https://doi.org/10.1177/1088868310377394
6. Sherman, L. E., Michikyan, M., & Greenfield, P. M. (2013). The effects of text, audio, video, and in-person communication on bonding between friends. Cyberpsychology: Journal of Psychosocial Research on Cyberspace, 7(2), Article 2. https://doi.org/10.5817/CP2013-2-3
7. Teo, A. R., Choi, H., Andrea, S. B., Valenstein, M., Newsom, J. T., Dobscha, S. K., & Zivin, K. (2015). Does Mode of Contact with Different Types of Social Relationships Predict Depression in Older Adults? Evidence from a Nationally Representative Survey. Journal of the American Geriatrics Society, 63(10), 2014–2022. https://doi.org/10.1111/jgs.13667
8. Teo, A. R., Markwardt, S., & Hinton, L. (2019). Using Skype to Beat the Blues: Longitudinal Data from a National Representative Sample. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 27(3), 254–262. https://doi.org/10.1016/j.jagp.2018.10.014

Domestic Violence in the Time of COVID-19: Directions for Future Research

By Em V. Adams PhD, CTRS^✉; Violence and Trauma SIG Co-Chair

Domestic Violence (DV) is a broad term used to describe intimate partner violence, child abuse, elder abuse, and sexual violence.¹ DV is associated with a broad range of negative health outcomes, including chronic illness, PTSD, and acute traumatic injury.¹ When stay-at-home orders first began rates of DV have increased from 25%-33% globally.² Rates in the U.S. are still unknown, but some individual cities report seeing an increase, while others report their hotlines and resources are getting less traffic.
 

Risks of DV amid COVID-19

Risk factors for DV include unemployment, substance use disorder, mental illness, and access to guns and ammunition, and social isolation.³ The stay-at-home orders related to COVID-19 have exacerbated these risk factors in several ways:⁴ Unemployment rates increased in the in the U.S. from 3.4 to a current 14.7 percent;⁵ Since stay-at-home orders were first implemented alcohol sales have increased by 55%;⁶ Access to mental illness resources is imited;⁷ Gun sales are up by 20% and ammunition sales have increased by 400%-500%.⁸ In addition to these risk factors, people are essentially trapped at home potentially with exploitive relationships, increases the potential for DV to occur.⁹ The potential for increased prevalence is compounded by increased difficulty accessing services.¹⁰
 

Barriers to Accessing Service

Access to services may have been limited in several ways. First, because people were at home, many without an excuse to leave, may not have been able to call for help without risking further violence. Depending on the state, volunteer services such as peer mentoring, and help support hotlines may not have been listed as essential services. Shelters were more difficult to get into because they were trying to reduce crowding and prevent transmission of COVID-19.

 

Directions for Future Research

The first wave of COVID-19 highlighted gaps in services and research. Needed research may include:

• Developing and testing targeted campaigns to distribute information about discrete ways victims can reach help.
• How to ensure a continuum of care and minimize treatment disruption for people already receiving treatment for mental illness and substance use disorder.
• Testing the feasibility of telehealth services and support.
• Develop specific interventions to promote coping strategies that can be used at home.
• Ensuring there is a continuum of care for people already receiving treatment.
• Strategies to provide technology to clients so they can access telehealth services.
• Trying to determine prevalence rates during COVID-19, and associations between rate increased and differences between city policies and services.
• How to prevent intrapersonal barriers such as fear of law-enforcement violence if emergency services are called.
• Evaluating impact of access to ‘non-essential’ volunteer services.

While stay-at-home orders have eased for the time being, it is uncertain if rates of COVID-19 will spike again. Research to help establish protocol for handling DV in times of emergency should be a priority among researchers.

References

1. Center for Disease Control. “Prevent Domestic Violence in Your Community.” (2019) https://www.cdc.gov/injury/features/intimate-partner-violence/index.html Accessed May 28, 2020
2. Campbell, Andrew M. "An increasing risk of family violence during the Covid-19 pandemic: Strengthening community collaborations to save lives." Forensic Science International: Reports (2020): 100089.
3. Center for Disease Control and Prevention. “Risk and Protective Factors for Perpetration” (2019). https://www.cdc.gov/violenceprevention/intimatepartnerviolence/riskprotectivefactors.html Accessed May 28, 2020
4. van Gelder N., Peterman A., Potts A., O'Donnell M., Thompson K., Shah N. & Oertelt‐Prigione S. (2020). COVID‐19: “Reducing the risk of infection might increase the risk of intimate partner violence.” EClinicalMedicine, Retrieved on 19th April, 2020 from doi: 10.1016/j.eclinm.2020.100348.
5. The United States Bureau of Labor Statistics. “News Release” (2020) https://www.bls.gov/news.release/pdf/empsit.pdf Accessed June 4, 2020
6. Nielsen. Rebalancing the Effect of COVID-19 on alcohol sales.” (2020) https://www.nielsen.com/us/en/insights/article/2020/rebalancing-the-covid-19-effect-on-alcohol-sales/ Accessed June 1, 2020
7. Galea, Sandro, Raina M. Merchant, and Nicole Lurie. "The mental health consequences of COVID-19 and physical distancing: The need for prevention and early intervention." JAMA internal medicine (2020).
8. National Public Radio. “Some Stock Up on Guns and Ammunition” (2020) https://www.npr.org/2020/03/20/817369503/some-stock-up-on-guns-and-ammunition-during-coronavirus-crisis Accessed May 31, 2020.
9. Bradbury‐Jones, Caroline, and Louise Isham. "The pandemic paradox: the consequences of COVID‐19 on domestic violence." Journal of clinical nursing (2020).
10. Usher, Kim, et al. "Family violence and COVID‐19: Increased vulnerability and reduced options for support." International journal of mental health nursing (2020).

Cultivating Resilience in the Face of Adversity

Lila J. Finney Rutten, PhD, MPH^✉, SBM Member Delegate; and Amit Sood, MD, MSc

Stress and Resilience

Data from more than 135,000 interviews conducted by Gallup Poll in 2017 reveal significant decline in well-being among U.S. adults.¹ Indeed, feelings of stress, loneliness, and depression are pervasive in the U.S.² All of us face stress and adversity throughout our lives, but some of us seem to manage it with greater grit, and recover from it faster and more fully. This ability to withstand and recover from adversity and derive personal growth from challenging life events is called resilience.^2-9

Four domains of resilience have been described.^7,10 Physical resilience is characterized by good health, strength, and the ability to quickly recover from illness or injury. Cognitive resilience is the ability to maintain focus and judgment and make good decisions under stress. Emotional resilience is characterized by emotional stability and the ability to quickly recover from negative emotions. Spiritual resilience can be described as having a sense of higher purpose, living a principled life, and having the ability to maintain an altruistic perspective when faced with adversity. Integration of these domains provides a useful construct for individuals to thrive personally and professionally.
 

Enhancing Resilience

A large body of research has emerged examining the association between resilience and health, wellbeing, and longevity.^9-21 This research points to important ways in which all of us can cultivate our own resilience.^7,10-18

Physical resilience can be nurtured through healthy lifestyle choices including participating in regular physical activity, eating a healthy diet, getting adequate sleep, and effectively managing stress.^7,10

Cognitive resilience can be fostered through attention training practices.^7,10 Bringing mindfulness and intentionality to your attention can help reduce internal distractions and worries and soften judgment of or reactivity to others. For example, by taking back control of your attention, amidst adversity, you may more easily be able to guide your thoughts toward the actionable, while keeping hope and positivity. Similarly, by training yourself to practice kind attention, you may more easily diffuse anger.

Emotional resilience can be fostered through mindfulness practices aimed at cultivating gratitude, compassion, acceptance, meaning, and forgiveness. ^7,10

Gratitude

Making efforts to recognize valued aspects of one’s experience has been shown to improve mood, enhance wellbeing, improve self-esteem, and lower risk of post-traumatic stress disorder.^22-24

Compassion

Compassion refers to the ability to relate to others in a way that is empathetic, while being mindful of our shared human struggles, and the desire of belonging and safety. Cultivating compassion lowers stress, decreases pain, improves immune function, decreases length of acute illness, and improves satisfaction with healthcare.^25-27 Compassion can be enhanced through recognizing and validating others’ struggles, delaying negative judgment, and identifying a sense of connectedness to those who are struggling. Compassion toward self is as important as compassion toward others.

Acceptance

Acceptance is the ability to recognize and cope with that which you cannot control. Acceptance requires openness to experiences as they are, allowing for imperfections, set-backs, and failure. Acceptance isn’t giving up; instead acceptance is empowered engagement. Research has demonstrated that acceptance is associated with improvements in quality of life, greater coping ability, better control of anxiety and depression, decreases in chronic pain, and improvement in chronic disease management ^28-30 Acceptance can be cultivated through: developing rational expectations; seeking meaning in challenging aspects of your relationships; and considering the context of others’ behaviors while valuing their strengths. 

Meaning

Meaning is attached to consideration of one’s identity, existence, and place. Finding meaning is associated with reductions in negative affect, improved quality of life and coping skills, improved physical health, and increased survival.^31,32 Experientially, meaning is often derived from our sense of belonging (relationships), purpose (work), and understanding (spirituality).⁷ 

Forgiveness

Forgiveness is a conscious choice to let go of anger and resentment. It does not mean denial or justification for wrong doing. It is a purposeful choice to free up your energy for more positive experiences. Forgiveness is associated with improvements in psychological, social, and positive health outcomes^33-37 Practice patience with the process of forgiveness as it may take time and repeated effort. Draw upon compassion for others recognizing that everyone struggles in their own unique way. Accept imperfections in yourself and others, and adjust your expectations accordingly.

Try these easy practices to foster emotional resilience.

Spiritual resilience can be pursued through varied paths including service, meaningful work, attending to nature, intentional focusing on the moment, tending to relationships, and through specific faith-based practices.^7,10 Practices and experiences that allow you to get in touch with that which is meaningful and serves your greater sense of purpose will nurture your spirituality.
 

Meet Yourself With Loyalty

Reflect on the ways you may benefit from efforts to nurture your own resilience. Show yourself compassion, acceptance, and forgiveness as a starting point for developing new practices and perspectives that will help you build reserve for life’s inevitable challenges and losses.

References

1. Witters D. Americans' Well-Being Declines in 2017. 2017; https://news.gallup.com/poll/221588/americans-declines-2017.aspx. Accessed June 19, 2018.
2. Sood A. Executive Resilience. Global Center for Resilience and Wellbeing
3. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82.
4. Masten AS, Obradovic J. Competence and resilience in development. Ann N Y Acad Sci. 2006;1094:13-27.
5. Rutter M. Psychosocial resilience and protective mechanisms. Am J Orthopsychiatry. 1987;57(3):316-331.
6. Windle G, Bennett KM, Noyes J. A methodological review of resilience measurement scales. Health Qual Life Outcomes. 2011;9:8.
7. Sood A. The Mayo Clinic Guide to Stress-Free Living. Boston, MA: Da Capo Press; 2013.
8. Windle G. What is resilience? A review and concept analysis. Reviews in Clinical Gerontology 2011;21(2):152-169
9. Leppin AL, Bora PR, Tilburt JC, et al. The efficacy of resiliency training programs: a systematic review and meta-analysis of randomized trials. PLoS One. 2014;9(10):e111420.
10. Sood A. The Mayo Clinic Handbook for Happiness: A 4-Step Plan for Resilient Living. Boston, MA: Da Capo Press; 2015.
11. Dyrbye LN, Shanafelt TD, Werner L, Sood A, Satele D, Wolanskyj AP. The Impact of a Required Longitudinal Stress Management and Resilience Training Course for First-Year Medical Students. J Gen Intern Med. 2017;32(12):1309-1314.
12. Magtibay DL, Chesak SS, Coughlin K, Sood A. Decreasing Stress and Burnout in Nurses: Efficacy of Blended Learning With Stress Management and Resilience Training Program. J Nurs Adm. 2017;47(7-8):391-395.
13. Stonnington CM, Darby B, Santucci A, et al. A resilience intervention involving mindfulness training for transplant patients and their caregivers. Clin Transplant. 2016;30(11):1466-1472.
14. Chesak SS, Bhagra A, Schroeder DR, Foy DA, Cutshall SM, Sood A. Enhancing resilience among new nurses: feasibility and efficacy of a pilot intervention. Ochsner J. 2015;15(1):38-44.
15. Sharma V, Sood A, Prasad K, Loehrer L, Schroeder D, Brent B. Bibliotherapy to decrease stress and anxiety and increase resilience and mindfulness: a pilot trial. Explore (NY). 2014;10(4):248-252.
16. Leppin AL, Gionfriddo MR, Sood A, et al. The efficacy of resilience training programs: a systematic review protocol. Syst Rev. 2014;3:20.
17. Loprinzi CE, Prasad K, Schroeder DR, Sood A. Stress Management and Resilience Training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: a pilot randomized clinical trial. Clin Breast Cancer. 2011;11(6):364-368.
18. Sood A, Prasad K, Schroeder D, Varkey P. Stress management and resilience training among Department of Medicine faculty: a pilot randomized clinical trial. J Gen Intern Med. 2011;26(8):858-861.
19. Bennett KM, Windle G. The importance of not only individual, but also community and society factors in resilience in later life. Behav Brain Sci. 2015;38:e94.
20. Windle G. The contribution of resilience to healthy ageing. Perspect Public Health. 2012;132(4):159-160.
21. Almedom AM. Resilience research and policy/practice discourse in health, social, behavioral, and environmental sciences over the last ten years. Afr Health Sci. 2008;8 Suppl 1:S5-13.
22. Emmons RA, McCullough ME. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003;84(2):377-389.
23. McCullough ME, Emmons RA, Tsang JA. The grateful disposition: a conceptual and empirical topography. J Pers Soc Psychol. 2002;82(1):112-127.
24. McCullough ME, Tsang JA, Emmons RA. Gratitude in intermediate affective terrain: links of grateful moods to individual differences and daily emotional experience. J Pers Soc Psychol. 2004;86(2):295-309.
25. Selph RB, Shiang J, Engelberg R, Curtis JR, White DB. Empathy and life support decisions in intensive care units. J Gen Intern Med. 2008;23(9):1311-1317.
26. Redelmeir DA, Molin JP, Tibshirani R. A randomized trial of the homeless in an emergency department Lancet. 1995;345(8958):1131-1134.
27. Joans WB, Crawford CC. Healing, intention, and energy medicine. . New York, NY: Livingstone; 2003.
28. Low CA, Stanton AL, Bower JE. Effects of acceptance-oriented versus evaluative emotional processing on heart rate recovery and habituation. Emotion (Washington, DC). 2008;8(3):419-424.
29. Kranz D, Bollinger A, Nilges P. Chronic pain acceptance and affective well-being: A coping perspective. Eur J Pain. 2010;14(10):1021-1025.
30. Ford BQ, Lam P, John OP, Mauss IB. The Psychological Health Benefits of Accepting Negative Emotions and Thoughts: Laboratory, Diary, and Longitudinal Evidence. J Pers Soc Psychol. 2017.
31. Simonelli LE, Fowler J, Maxwell GL, Andersen BL. Physical sequelae and depressive symptoms in gynecologic cancer survivors: meaning in life as a mediator. Ann Behav Med. 2008;35(3):275-284.
32. Taylor EJ. Transformation of tragedy among women surviving breast cancer. Oncol Nurs Forum. 2000;27(5):781-788.
33. Wilson T, Milosevic A, Carroll M, Hart K, Hibbard S. Physical health status in relation to self-forgiveness and other-forgiveness in healthy college students. J Health Psychol. 2008;13(6):798-803.
34. Friedberg JP, Suchday S, Shelov DV. The impact of forgiveness on cardiovascular reactivity and recovery. Int J Psychophysiol. 2007;65(2):87-94.
35. Friedberg JP, Suchday S, Srinivas VS. Relationship between forgiveness and psychological and physiological indices in cardiac patients. Int J Behav Med. 2009;16(3):205-211.
36. Carson JW, Keefe FJ, Goli V, et al. Forgiveness and chronic low back pain: a preliminary study examining the relationship of forgiveness to pain, anger, and psychological distress. J Pain. 2005;6(2):84-91.
37. Hansen MJ, Enright RD, Baskin TW, Klatt J. A palliative care intervention in forgiveness therapy for elderly terminally ill cancer patients. J Palliat Care. 2009;25(1):51-60.

Want to conduct a systematic review? Start here!

Carrie Patnode, PhD, MPH^✉ and Nora Henrikson, PhD, MPH^✉; Evidence-Based Behavioral Medicine SIG Co-Chairs

Systematic reviews attempt to collect all existing evidence on a specific topic to answer a specific research question. To do one well takes a lot of time and effort, and careful attention to decisions before fully diving in can save you time in the long run.
 

What evidence do you want to review?

Defining your research question takes time and thoughtful conversation with mentors, collaborators, or clients. What will the review be used for? Is there a specific decisional dilemma you are attempting to address? What interventions, in what populations, in what settings are of most interest? Be as specific and narrow as possible - this will help you identify the most relevant studies. At this stage, start thinking about the review PICO(TS) you will have to specify later: the population, intervention, outcome(s), comparators, timing, and settings of interest for your review.
 

Do you really need to do a review?

Familiarize yourself with other systematic reviews in your topic area and prepare a precise statement of what gap yours will fill (PubMed, The Cochrane Library, and Campbell Collaboration are good places to start). Are you updating the evidence base because you know of new evidence? Are you exploring an aspect of the topic that was excluded from previous reviews? Is it truly a new review? Establishing reputation by authoring one’s own systematic review is not a sufficient reason for proceeding—in the past decade, there has been at least a 3-fold increase in the number of published systematic reviews, with the quality and reporting varying widely.¹ Consider how you might use or update existing systematic reviews rather than conducting a de novo review. In many cases, a rapid, scoping, narrative, or other non-systematic review may be a more appropriate and less time-consuming method.
 

Develop and publish your protocol.

Akin to a protocol for a randomized trial, a systematic review protocol articulates your predetermined methodologic decisions. At this stage, you will formulate your inclusion and exclusion criteria for selecting studies eligible for your review. What study designs will you allow? What outcomes will and will not be included? Will you require that those outcomes be reported at a certain follow-up time point? Your review methods must be transparent enough that an independent research group could replicate and find the same body of evidence and results. In addition to describing your research questions and eligibility criteria, your protocol should detail the information sources and search strategy, study screening and selection process, methods for data extraction and risk of bias assessment, and plans for data synthesis, including processes for qualitative or quantitative (meta-analysis, network meta-analysis) analyses. Consider publishing your protocol in a peer-reviewed journal (the journal Systematic Reviews routinely publishes systematic review protocols) and registering your review at https://www.crd.york.ac.uk/prospero/.
 

Time to conduct your review!

There are many good resources that walk through the standards and methods for conducting a reputable systematic review including the IOM Standards for Systematic Reviews, the Cochrane Handbook for Systematic Reviews of Interventions, and the Agency for Healthcare Research and Quality’s Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Following these standards can help you produce a trustworthy and useful research product.

References

1. Page MJ, Shamseer L, Altman DG, Tetzlaff J, Sampson M, Tricco AC, et al. Epidemiology and reporting characteristics of systematic reviews of biomedical research: a cross-sectional study. PLoS Med. 2016;13(5):e1002028.

The Importance of Language for Addressing Stigma in Diabetes Care

Allyson S. Hughes, PhD^✉, Diabetes SIG Chair; and Elizabeth A. Beverly, PhD, Diabetes SIG Past-Chair

More than 34 million people in the U.S. have Type I or Type II Diabetes. Diabetes is a group of diseases characterized by high blood glucose levels resulting from the body's inability to produce and/or use insulin.¹ Unfortunately, this disease may cause stigma as self-care in diabetes management may influence how individuals view the disease. Diabetes requires specific self-care recommendations, including following a healthy diet,² weight management,³ engaging in regular physical activity,^4,5 monitoring blood glucose levels,^6,7 taking medication as prescribed,⁸ checking feet daily,⁹ and attending medical appointments.^10,11 Diabetes stigma refers to negative feelings, such as exclusion, rejection, or blame, associated with having diabetes.¹² The most common stigma, unrelated to type of diabetes, is the belief that people with diabetes are responsible for their own diabetes.¹² Prior research has documented negative attributions by people who engage with people with diabetes including healthcare professionals, friends, and family members.¹³

Stigma has significant health implications. People with diabetes who perceive more stigma report higher levels of psychological distress, more depressive symptoms, less social support, and lower quality of life.¹⁴ Psychological distress, depressive symptoms, and lower quality of life are associated with fewer self-care behaviors,^15,16 higher A1C values,^16-20 and increased complications.^21,22 Importantly, when people develop a negative relationship with their diabetes, they may change how they behave in public, try to hide the disease, have a lower sense of self-worth, and internalize stigma^.23 Internalized stigma may lead to fewer self-care behaviors, difficulties with social interactions, and social isolation.²³ Moreover, people who internalize stigma may struggle to form meaningful relationships and feel disconnected from friends and loved ones.²³
 

Diabetes Language Recommendations

Upon identification that language in diabetes can be stigmatizing and harmful, the following organizations have published position statements: Diabetes Australia,²⁴ International Diabetes Federation,²⁵ American Diabetes Association,²⁶ and American Association of Diabetes Educators.²⁶ Recommendations include avoiding language that: 1) Implies that the person is disabled (e.g., diabetic child), 2) Equates a person to their condition (e.g., diabetic), 3) Uses unnecessary, negative overtones (e.g., suffering from diabetes), and 4) Uses judgmental language (e.g., noncompliant, poorly controlled diabetes). People with diabetes are diverse and what applies to one person will not apply to another. For this reason, it is impossible to predict what any single individual might prefer or not prefer. Therefore, ask the person you are interacting with what terminology they prefer.
 

The Power of Language

Language expresses “what disability is, how it affects or interacts with your personhood, and how other people see you.”²⁷ Language impacts perceptions and behaviors.²⁶ Words can intentionally or unintentionally inflict harm and/or stigma.²⁶ For these reasons, the American Psychological Association advocates the use of person-first language.²⁸ Person-first language acknowledges what a person has and not what a person is (e.g., ‘a person with diabetes’ versus ‘diabetic’). On the other hand, disability culture and disability studies scholars have challenged the rationale of person-first language use, instead promoting use of identity-first language.²⁹

Identity-first language places the disability or chronic disease first recognizing that it is an integral part of them and their identity. Identity-first language is seen as empowering. It acknowledges that the disability is vital to who the person is whereas person-first language suggests that the disability is problematic. Using this logic, disability scholars argue that person-first language perpetuates stigma rather than puts a stop to it.³⁰ A recent analysis of the use of person-first language in scholarly writing found that person-first language was used more frequently to refer to children with the most stigmatized disabilities (i.e., intellectual disability) compared to children with less stigmatized disabilities (e.g., deafness), children without disabilities, and adults with disabilities.³⁰ To address this bias, experts recommend clinicians, researchers, and professional organizations refer to all persons, both with and without disabilities, using the same person-first language.³⁰ Alternatively, experts recommend adopting identity-first language alongside person-first constructions to maintain human dignity.²⁹ Inclusion of both identify-first and person-first language promotes inclusion and diversity as well as addressing the concerns raised by disability studies and disability culture.²⁹ Importantly, clinicians should ask their patients about their preferred terminology. Similarly, in research settings, researchers should ask participants about their preferred terminology.
 

Want to Learn More?

Looking for more information? The Diabetes Online Community (DOC) has many places where people with diabetes converse including Twitter chats (#dsma – every Wednesday at 9PM EST), t1dchick’s Instagram, myglu.org, Beyond Type 1, The Juicebox Podcast, and highly popular blog Sixuntilme.
 

Takeaways

• Language impacts perceptions and behavior.
• Always ask the person you are interacting with what language they prefer.
• Play it safe and choose person-first language.

References

1. Diabetes. 2020; https://www.diabetes.org/diabetes. Accessed February 29, 2020.
2. Pi-Sunyer FX, Maggio CA, McCarron DA, et al. Multicenter randomized trial of a comprehensive prepared meal program in type 2 diabetes. Diabetes Care. 1999;22(2):191-197.
3. Shantha GP, Kumar AA, Kahan S, Cheskin LJ. Association between glycosylated hemoglobin and intentional weight loss in overweight and obese patients with type 2 diabetes mellitus: a retrospective cohort study. Diabetes Educ. 2012;38(3):417-426.
4. Maiorana A, O'Driscoll G, Goodman C, Taylor R, Green D. Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract. 2002;56(2):115-123.
5. Conn VS, Hafdahl AR, Mehr DR, Lemaster JW, Brown SA, Nielsen PJ. Metabolic effects of interventions to increase exercise in adults with type 2 diabetes. Diabetologia. 2007;50(5):913-921.
6. Karter AJ, Ackerson LM, Darbinian JA, et al. Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry. Am J Med. 2001;111(1):1-9.
7. Virdi N, Daskiran M, Nigam S, Kozma C, Raja P. The association of self-monitoring of blood glucose use with medication adherence and glycemic control in patients with type 2 diabetes initiating non-insulin treatment. Diabetes Technol Ther. 2012;14(9):790-798.
8. Marinho FS, Moram CBM, Rodrigues PC, Leite NC, Salles GF, Cardoso CRL. Treatment Adherence and Its Associated Factors in Patients with Type 2 Diabetes: Results from the Rio de Janeiro Type 2 Diabetes Cohort Study. J Diabetes Res. 2018;2018:8970196.
9. Lincoln NB, Radford KA, Game FL, Jeffcoate WJ. Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial. Diabetologia. 2008;51(11):1954-1961.
10. Jacobson AM, Adler AG, Derby L, Anderson BJ, Wolfsdorf JI. Clinic attendance and glycemic control. Study of contrasting groups of patients with IDDM. Diabetes Care. 1991;14(7):599-601.
11. Dyer PH, Lloyd CE, Lancashire RJ, Bain SC, Barnett AH. Factors associated with clinic non-attendance in adults with type 1 diabetes mellitus. Diabet Med. 1998;15(4):339-343.
12. Liu NF, Brown AS, Younge MF, Guzman SJ, Close KL, Wood R. Stigma in People With Type 1 or Type 2 Diabetes. Clinical diabetes : a publication of the American Diabetes Association. 2017;35(1):27-34.
13. Browne JL, Ventura A, Mosely K, Speight J. 'I call it the blame and shame disease': a qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open. 2013;3(11):e003384.
14. Gredig D, Bartelsen-Raemy A. Diabetes-related stigma affects the quality of life of people living with diabetes mellitus in Switzerland: implications for healthcare providers. Health Soc Care Community. 2017;25(5):1620-1633.
15. Gonzalez JS, Delahanty LM, Safren SA, Meigs JB, Grant RW. Differentiating symptoms of depression from diabetes-specific distress: relationships with self-care in type 2 diabetes. Diabetologia. 2008;51(10):1822-1825.
16. Fisher L, Hessler DM, Polonsky WH, Mullan J. When is diabetes distress clinically meaningful?: establishing cut points for the Diabetes Distress Scale. Diabetes Care. 2012;35(2):259-264.
17. Fisher L, Glasgow RE, Strycker LA. The relationship between diabetes distress and clinical depression with glycemic control among patients with type 2 diabetes. Diabetes Care. 2010;33(5):1034-1036.
18. Fisher L, Mullan JT, Arean P, Glasgow RE, Hessler D, Masharani U. Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care. 2010;33(1):23-28.
19. Reddy J, Wilhelm K, Campbell L. Putting PAID to diabetes-related distress: the potential utility of the problem areas in diabetes (PAID) scale in patients with diabetes. Psychosomatics. 2013;54(1):44-51.
20. de Groot M, Jacobson AM, Samson JA, Welch G. Glycemic control and major depression in patients with type 1 and type 2 diabetes mellitus. Journal of Psychosomatic Research. 1999;46(5):425-435.
21. Fisher EB, Thorpe CT, Devellis BM, Devellis RF. Healthy coping, negative emotions, and diabetes management: a systematic review and appraisal. Diabetes Educ. 2007;33(6):1080-1103; discussion 1104-1086.
22. de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001;63(4):619-630.
23. Kato A, Fujimaki Y, Fujimori S, et al. A qualitative study on the impact of internalized stigma on type 2 diabetes self-management. Patient Educ Couns. 2016;99(7):1233-1239.
24. Speight J, Conn J, Dunning T, Skinner TC, Diabetes A. Diabetes Australia position statement. A new language for diabetes: improving communications with and about people with diabetes. Diabetes Res Clin Pract. 2012;97(3):425-431.
25. International Diabetes Federation Language Philosophy: Technical Document. In. Brussels, Belgium: International Diabetes Federation; 2014.
26. Dickinson JK, Guzman SJ, Maryniuk MD, et al. The Use of Language in Diabetes Care and Education. Diabetes Educ. 2017;43(6):551-564.
27. Thorpe JR. What Is Identity-First Language, & Should You Use It? Bustle. 2017. https://www.bustle.com/p/what-is-identity-first-language-should-you-use-it-74901.
28. Disability. 2020; https://apastyle.apa.org/style-grammar-guidelines/bias-free-language/disability. Accessed April 24, 2020.
29. Dunn DS, Andrews EE. Person-first and identity-first language: Developing psychologists' cultural competence using disability language. Am Psychol. 2015;70(3):255-264.
30. Gernsbacher MA. Editorial Perspective: The use of person-first language in scholarly writing may accentuate stigma. J Child Psychol Psychiatry. 2017;58(7):859-861.

SBM Adopts Open Science Recommendations

Megan McVay, PhD^✉; Chair, Publication & Communication Council

In 2019, SBM’s then-President Michael Diefenbach initiated the development of an SBM working group focused on open science. This group was asked to explore the implications of open science for behavioral scientists, to educate SBM members about open science, and to develop open science recommendations for the SBM Board to consider. This group was chaired by Bradford Hesse, and included members David Conroy, Kenneth Tercyak, Dominika Kwasnicka, Molly Waring, Abby King, Eric Hekler, and Sarah Andrus (Ms. Andrus is a representative from the Society’s journal publisher, Oxford University Press).

Open science has many components, and the SBM working group focused on three broad categories: (1) Publications, including editorial policy for SBM journals, (2) Resource sharing, and (3) Citizen science. This Spring, the Working Group presented to the SBM Board of Directors a set of recommendations, which were approved by the Board. The recommendations from each of the areas of focus are summarized as follows:
 

Publications

The working group identified several opportunities to increase the transparency of our scientific publications. The working group recommended that SBM adopt Transparency and Openness Promotion (TOP) Guidelines at Level 1. TOP Guidelines were developed by journals, funders, and societies to help journals implement more transparent research practices (more information on TOP Guidelines can be found at https://www.cos.io/our-services/top-guidelines. Level 1 of these guidelines focuses primarily on embracing disclosure of certain transparency practices for journal articles. For example, authors might be asked to explicitly report if their research was pre-registered and if their data and materials are publicly available. The working group also recommended that journals start to use Open Science Badges for articles that engage in certain open science practices, such as sharing data (see here for more information on Open Science Badges: https://www.cos.io/our-services/badges. The working group further recommended that journals permit and encourage prior publication on preprint servers. Finally, the group recommended  adding journal sections for replication studies, and encouraged the Society’s journals to investigate a two-stage peer review process, often called “Registered Reports” (learn more here: https://www.cos.io/our-services/registered-reports).
 

Resource Sharing

Shared resources may include data, data collection tools, statistical code, intervention content, and digital health tools. The working group recommended that SBM strive to build member awareness of current data and resource sharing opportunities. They also recommended that the Society nurture efforts by SBM members to seek funding for external data and resource sharing platforms. Additionally, the working group encourages SBM and SBM journals to integrate policies and tools to ease the burden of data and resource sharing, as they become available.
 

Citizen Science

The working group discussed ways to open science by focusing on greater participation by general citizenry in the conduct of science. The working group specifically recommended the Society take steps to support and develop citizen science methods, such as extensions of community-based work and personal science practices. The working group also focused on the role of open science in addressing the “is-ought problem,” which refers to the idea that closed scientific discourse focuses on “what is” and less on “what ought to be.” Opening science to the broader community can help increase a focus on “what ought to be.” The group recommended advocating for resources and pathways to support methods and strategies that can address the is-ought problem.
 

More details on the SBM Open Science Working Group’s activities and recommendations will soon be available in a Translational Behavioral Medicine publication. These recommendations are just the beginning. Already, the Editors-in-Chief of Annals of Behavioral Medicine (Tracey Revenson, PhD) and Translational Behavioral Medicine (Suzanne Miller, PhD), have been hard at work considering how the recommendations can be adopted by the journals. Furthermore, SBM members should expect to hear more about open science and the role of SBM in open science practices over the coming years. For example, future SBM annual meetings and webinars are sure to include many more opportunities to expand the knowledge and skills of Society members on these important topics. We encourage all members to engage in a dialogue about how we can use open science to improve our research and public health impact.

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

Bidirectional Associations of Momentary Affect with Physical Activity and Sedentary Behaviors in Working Adults

Jinhyuk Kim, David E Conroy, Joshua M Smyth

Background
Affective experiences and movement-based behaviors form a system that has been shown to influence exercise adherence and mental health outcomes. Little is known about the naturalistic dynamics of the reciprocal associations in this system.
Purpose
We examined the time intervals at which momentary affect precedes and follows movement-based behaviors in everyday life.
Methods
A community sample of working adults (n = 111) completed ecological momentary assessments (EMA) asking about current affect states (sad, happy, tired, and interested) six times a day for three consecutive days. Ratings were used to generate scores for momentary affective arousal and valence. Participants also wore an activity monitor. Total activity counts and sedentary duration in the shorter to longer time intervals (5–120 min) before or after EMA were used as indicators of movement-based behaviors.
Results
Multilevel modeling showed that current affective arousal predicted higher subsequent activity counts in the longer time intervals (120 min) and less subsequent sedentary behavior in the shorter to longer time intervals (5, 60, and 120 min). For the reversed sequence, neither movement-based behavior predicted subsequent momentary arousal or valence. Affective valence was unrelated to movement-based behaviors in either temporal direction.
Conclusions
Some naturally occurring affective experiences (i.e., arousal) might precede, rather than follow, movement-based behaviors. Understanding affective arousal may contribute to improved management of subsequent movement-based behaviors in everyday life.

Resilience and Function in Adults With Chronic Physical Disabilities: A Cross-Lagged Panel Design

Samuel L Battalio, Connie L Tang, Mark P Jensen

Background
Resilience is a psychological construct referring to one’s positive adaptation in response to adversity. Evidence suggests that resilience may contribute to various function domains in adults with chronic physical disabilities.
Purpose
To test hypothesized temporal associations between resilience and four function domains (anxiety, depression, social role satisfaction, and physical function) in individuals with chronic physical disabilities.
Methods
Participants were 1,574 adults with one of four chronic physical disabilities (spinal cord injury, muscular dystrophy, multiple sclerosis, or postpolio myelitis syndrome) who were participating in a large, ongoing USA-based longitudinal survey study. Three surveys were mailed on an approximately yearly basis. Resilience was assessed using the Connor–Davidson Resilience Scale 10-item (CDRSC-10) and each function domain was assessed using the respective Patient Reported Outcome Measurement System (PROMIS) short-form.
Results
Cross-lagged path models evidenced statistically significant reciprocal relationships between resilience and each function domain except physical function. The standardized lagged coefficients corresponding to resilience predicting social role satisfaction (T1–T2 = 0.09, T2–T3 = 0.09) had similar effect sizes as those corresponding to social role satisfaction predicting resilience (T1–T2 = 0.11, T2–T3 = 0.04), although resilience was a slightly stronger predictor in the second lag. In models assessing psychological function, resilience was a stronger predictor of later psychological function (resilience-to-anxiety, T1–T2 = −0.15, T2–T3 = −0.11; resilience-to-depression, T1–T2 = −0.21, T2–T3 = −0.13) than the inverse (anxiety-to-resilience, T1–T2 = −0.11, T2–T3 = −0.06; depression-to-resilience, T1–T2 = −0.12, T2–T3 = −0.05).
Conclusions
The study findings suggest that resilience is a significant prospective predictor of psychological and social function over time in individuals with chronic physical disabilities.

The Effect of a Priest-Led Intervention on the Choice and Preference of Soda Beverages: A Cluster-Randomized Controlled Trial in Catholic Parishes

J Jaime Miranda, Alvaro Taype-Rondan, Janina Bazalar-Palacios, Antonio Bernabe-Ortiz, Dan Ariely, PhD

Background
Latin America ranks among the regions with the highest level of intake of sugary beverages in the world. Innovative strategies to reduce the consumption of sugary drinks are necessary.
Purpose
Evaluate the effect of a one-off priest-led intervention on the choice and preference of soda beverages.
Methods
We conducted a pragmatic cluster-randomized trial in Catholic parishes, paired by number of attendees, in Chimbote, Peru between March and June of 2017. The priest-led intervention, a short message about the importance of protecting one’s health, was delivered during the mass. The primary outcome was the proportion of individuals that choose a bottle of soda instead of a bottle of water immediately after the service. Cluster-level estimates were used to compare primary and secondary outcomes between intervention and control groups utilizing nonparametric tests.
Results
Six parishes were allocated to control and six to the intervention group. The proportion of soda selection at baseline was ~60% in the intervention and control groups, and ranged from 56.3% to 63.8% in Week 1, and from 62.7% to 68.2% in Week 3. The proportion of mass attendees choosing water over soda was better in the priest-led intervention group: 8.2% higher at Week 1 (95% confidence interval 1.7%–14.6%, p = .03), and 6.2% higher at 3 weeks after baseline (p = .15).
Conclusions
This study supports the proof-of-concept that a brief priest-led intervention can decrease sugary drink choice.

Translational Behavioral Medicine

A primer in genomics for social and behavioral investigators

Erin Turbitt, Barbara B Biesecker

Abstract
Genomics is being increasingly utilized in medical research and health care. Countless opportunities exist for social and behavioral scientists to answer novel and important research questions. Evidence that will be produced from such enquiries can help ensure appropriate use of genomic information and realize the potential of genomics to improve patient care and medical outcomes. Here, we provide an accessible overview of different types of genetic and genomic tests and the resulting information produced. There are important nuances that distinguish genetic from genomic tests and different information that each yield. We outline key examples where social and behavioral scientists have made an impact in this field, and opportunities for future research. The intention of this primer is to introduce or clarify genomics concepts to social and behavioral scientists, summarize prior research and outline future research directions. The time is ripe for social and behavioral scientists to engage in genomics and make important contributions to improve clinical and community translation of genomic discoveries.

B-Sure: a randomized pilot trial of an interactive web-based decision support aid versus usual care in average-risk breast cancer patients considering contralateral prophylactic mastectomy

Sharon L Manne, Barbara L Smith, Sara Frederick, Anna Mitarotondo, Deborah A Kashy, Laurie J Kirstein

Abstract
The use of contralateral prophylactic mastectomy (CPM) is increasing among breast cancer patients who are at average or “sporadic” risk for contralateral breast cancer. Because CPM provides no survival benefit for these patients, it is not medically recommended for them. Decision support aids may facilitate more informed, higher quality CPM decision. The purpose of this study was to evaluate the feasibility and acceptability of B-Sure, an online decision support aid to facilitate informed decisions regarding CPM, and to compare the impact of B-Sure in increasing CPM knowledge, reducing decisional conflict, and increasing preparedness to make the CPM decision among breast cancer patients at sporadic risk who are considering CPM. Ninety-three patients with unilateral, nonhereditary breast cancer considering CPM completed a baseline survey, were randomized to receive B-Sure or Usual care, and completed a 4-week follow-up survey assessing decisional conflict, preparedness to make the CPM decision, and CPM knowledge as well as self-efficacy, perceived risk, worry, CPM motivations, and the surgical decision. Study participation was high. B-Sure was viewed by almost 80% of the participants and was evaluated positively. At follow-up, patients assigned to B-Sure reported significantly higher clarity regarding the personal values relevant to the CPM decision and higher knowledge about CPM. B-Sure had smaller effects on other aspects of decisional conflict. B-Sure improved CPM knowledge and reduced decisional conflict. Patients considering CPM may benefit from an online decision support aid, but may be sensitive to approaches that they perceive as biased against CPM.

Do different factors predict the adoption and maintenance of healthy sleep behaviors? A reasoned action approach

Paul Branscum, Katie Qualls Fay, Valerie Senkowski

Abstract
Sleep deprivation is a serious public health concern in the United States that often goes unnoticed, particularly among college students and young adults. Concerted efforts are needed to help those who are not engaging in healthy sleep behaviors, while also helping those who are already maintaining healthy sleep behaviors. The purpose of the study was to evaluate theory-based determinants of intentions toward healthy sleep behaviors among students currently not sleeping 7–9 hr per night, oriented toward initiating the behavior (to start sleeping 7–9 hr per night in the next 30 days; behavioral adoption), and students currently sleeping 7–9 hr per night, oriented toward maintaining the behavior (sleeping 7–9 hr per night for the next 6 months; behavioral maintenance). The theoretical framework for this study was the reasoned action approach (RAA). A valid and reliable survey was distributed online to university students (adopters = 310, maintainers = 300). Regression analyses revealed which latent constructs predicted variance of intentions, using a three-construct and a six-construct model. For the adoption group, attitudes, perceived norms, and perceived behavioral control (PBC) accounted for 29.3% of the variance of intentions, and perceived norms and PBC accounted for 32.6% of the variance of intentions for the maintenance group. Furthermore, PBC, stemming from capacity (self-efficacy), was found to have the strongest influence on intentions for both groups. Results from this study support the use of the RAA as a model for designing future sleep interventions. Implications and recommendations for future research and practice are presented.

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.

Marissa Burgermaster, PhD
Dr. Burgermaster was recently elected to serve a 3-year term on the Board of Directors for the Society for Nutrition Education and Behavior.

Leigh Callahan, PhD
Dr. Callahan has been voted President-Elect of the U.S. Bone & Joint Initiative.

Carly M. Goldstein, PhD
Dr. Goldstein was recently named a Fellow of the American Association for Cardiovascular and Pulmonary Rehabilitation.

Michelle T. Jesse, PhD
Dr. Jesse was recently named a Fellow of the American Society of Transplantation.

Ashley E. Mason, PhD
The Academy of Behavioral Medicine Research has selected Dr. Mason for the 2020 Neal Miller Award.

Debbe Thompson, PhD
Dr. Thompson recently received the PA Senior Research Scientist of the Year Award

Caroline F. Zimmermann, MS
Ms. Zimmerman was awarded a 2020 Fulbright Fellowship to conduct research on the psychosocial effects of social stigmas related to skin disease among young adults in Germany.

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.

Jasmine Abrams, PhD
Nature featured Dr. Abrams in a recent article highlighting Black scientists who have called on their institutions to address systemic racism.

Linda E. Carlson, PhD
Dr. Carlson authored a piece in The Conversation on mental health coping tips during the COVID-19 pandemic.

Howard S. Friedman, PhD
Dr. Friedman was featured in an article on personality and health in Proto, the online science magazine of the Massachusetts General Hospital.

Megan Hosey, PhD
Dr. Hosey has recently appeared on CBS Local News, the Public Health OnCall Podcast, and in The Atlantic discussing her research on psychosocial treatment and recovery from critical illness.