David E. Conroy, Ph.D. - US grants

The broad, long-term objective of this research is to understand personal and environmental factors that influence interpersonal behavior by studying dyadic processes. Interpersonal phenomena occur between people in "interpersonal fields" instead of within people as is often assumed in individual differences research designs. The stability of an interpersonal field can be inferred from the predictability of transitions from antecedent to consequent communications with a dyad. Stable interpersonal field can be inferred from the predictability of transitions from antecedent to consequent communications with a dyad. Stable interpersonal fields are desirable because they are theoretically associated with consistent behavioral patterns, reduced anxiety, increased relatedness, and more enduring relationships. Interpersonal fields in sport coaching dyads provide an important context for this research. Coaching behaviors have been associated with mental health (e.g., self-esteem, fear of failure), physical activity has known self- esteem enhancing, anxiolytic, and anti-depressant effects, and coaches' interpersonal behaviors have been shown to perpetuate or reduce participation in physical activity. To study interpersonal fields, the Structural Analysis of Social Behavior, an interpersonal circumplex model that captures a broad spectrum of interpersonal behavior, will be used to code behavioral exchanges in coaching dyads during lessons, Several predictive principles associated with the SASB have been adapted to describe the full-range of possible transitions between antecedent and consequent communications according to their stability. Influences on the stability of dyadic interpersonal transitions, defined according to the SASB predictive principles, have not been investigated although previous research and preliminary data suggest that neuroticism, openness to experience, attachment style, and wishes to be self-loving may moderate the stability of these transitions. Establishing the influence of individual differences and individual difference similarities between members of a dyad on the stability of interpersonal transitions within that dyad will enhance understanding of factors that regulate interpersonal fields. This knowledge also will inform scientific and clinical efforts to promote optimal mental health and functioning.

[unreadable] DESCRIPTION (provided by applicant): The primary objective of this research project is to examine one possible mechanism by which coach behaviors impact the psychosocial development of youth participating in sports. Previous research has established the effectiveness of Coach Effectiveness Training (CET; Smith & Smoll, 1996) for enhancing self-esteem (Smith, Smell, & Curtis, 1979; Smell, Smith, Barnett, & Everett, 1993), decreasing performance anxiety (Smith, Smell, & Barnett, 1995), improving attraction to coaches (Smith et al., 1979), and decreasing rates of attrition from organized sports (Barnett, Smoll, & Smith, 1992). This project is a randomized blind trial of an enhanced-CET intervention. The conceptual model underlying this research proposes that coach training will change observed coach behaviors and youth perceptions of coach behaviors. Youth's internalization of coach behaviors is hypothesized to be manifest in youth achievement goal orientations and self-talk. This internalization process is hypothesized to be the mechanism for the intervention's effects of increasing self-esteem and decreasing fear of failure. Coaches from two community-based sport leagues will be randomly assigned to either an enhanced-CET training session or sport science training session that does not include psychosocial components. After receiving preseason training in these workshops, coaches will self-monitor their behaviors and receive booster telephone calls and mailings on a weekly basis, Youth will complete measures of self-talk, achievement goal orientations, fear of failure, and self-esteem throughout the season. The first aim of the present research is to establish the effects of the intervention on youth psychosocial development. The second aim is to evaluate whether observed coaching behaviors mediate the effects of the intervention on youth development. The third aim of this research is to evaluate whether youth internalization of coaches' behavior mediates the effects of coaching behaviors on their psychosocial development. [unreadable] [unreadable]

Project Summary Physical inactivity is part of a constellation of lifestyle factors ? with smoking and diet ? that contribute to weight gain in early adulthood. Risk factors that compromise cardiovascular health begin to accumulate during the transition into adulthood. Interventions that prevent decreases in physical activity (PA) during this period can reduce long-term chronic disease risk. Text message interventions have shown a consistent positive effect on PA but efforts to increase those intervention effects via tailoring, targeting or personalizing have not realized their potential. New approaches have emerged for tailoring interventions based on treatment responses or contextual factors (e.g., stepped care, just-in-time adaptive interventions) but they apply a single decision rule uniformly for all participants. Behavior is complex and multiply determined so it is possible that treatment responses are idiosyncratic, necessitating personalized decision rules. Building on interest in precision medicine, we propose a method to develop personalized adaptive messaging interventions using intensive longitudinal data (from wearable sensors and momentary weather indices) and tools from control systems engineering (system identification and robust control synthesis). In preliminary work, we developed a computational model of physical activity responses to individual text messages. The greatest barrier to implementing that approach in interventions is that the computational models required for predictive modeling of PA dynamics have a high degree of uncertainty and are too complex to run efficiently on smartphones and other wearable devices. We propose to solve that problem by (1) developing a dynamical model of physical activity based on historical responses to messages, recent behavior, location-specific weather, and temporal features, and (2) evaluating the acceptability and feasibility of more versus less aggressive adaptation strategies for personalizing an intervention controller. To accomplish these aims, we will recruit young adults to participate in a PA messaging intervention and develop a computational model of responses to different messages under different conditions. A model-based controller will be developed to (a) optimize message timing, frequency, and content selection, and (b) achieve specified behavior change goals under varying conditions. We will then deploy that controller with an independent sample of young adults to determine how more versus less aggressive adaptation strategies over the next six months impact user experience. This study will contribute a model-based intervention controller and an acceptable adaptation strategy to use in a personalized adaptive messaging intervention for increasing PA. If successful, it will increase both PA and user engagement by selecting and timing messages to maximize effects and minimize burden. This approach can be applied to develop personalized interventions for other behaviors relevant for preventing weight gain, preserving cardiovascular health, and reducing chronic disease risk.

Project Summary Kidney stones affect an estimated 8.8% of American adults and direct medical costs exceed $10 billion annually. Five-year recurrence rates for stones have been as high as 40% and a standard guideline for prevention is to increase fluid intake enough to produce > 2.5 L of urine daily. Meeting these guidelines reduces stone recurrence rates by 50-60% yet patients? adherence to fluid intake guidelines is commonly below 50%. Usual care for preventing a recurrence involves education about increasing fluid intake and dietary changes; however, the low adherence rate indicates that many patients would benefit from additional support in adhering to fluid intake guidelines. The long-term goal of this research is to reduce the recurrence of painful and costly stones by improving patient adherence to fluid intake guidelines (secondary prevention). Digital technology offers the promise of increasing reach and supporting treatment adherence but, to date, that promise has not been fully realized in clinical trials of digital tools for supporting treatment adherence. In a series of six preliminary studies, we engaged patients in developing and testing a context-sensitive digital tool called sipIT, a just-in-time adaptive intervention to promote fluid intake and increase urine output. We learned that patients are open to using digital tools provided those tools are integrated with their lifestyle and sensitive to the changing contexts of their lives. The resulting intervention, sipIT, incorporates a novel semi-automated tracking system to trigger smartphone notifications with context-sensitive reminders to drink. The reminder system was informed by contemporary theories of habit formation to support behavior change in the eventual absence of the technology. In this application, we propose to answer question, ?Does sipIT increase 24-hour urine output more than usual care over a 3-month period?? Urine output was selected as a proximal surrogate endpoint based on clinical guidelines for preventing recurrence of kidney stones. The specific aims of this project are (1) to evaluate the efficacy of sipIT vs usual care for increasing urine output in patients with a history of kidney stones, and (2) to identify biological and behavioral moderators of intervention effects on urine output (heterogeneity of treatment effects). We propose a two-arm randomized controlled trial to achieve these aims. Patients will receive either usual care + sipIT (intervention group) or usual care alone (control group). We will evaluate 24-hour urine output, urine supersaturations, and fluid intake habit strength at baseline and 1, 3, and 12 months after intervention. If successful, this research will lead to a cost-effective intervention that leverages consumer technology so it can be scaled for dissemination and implementation in clinical practice to reduce the burden and cost of stones. It advances NIDDK goals of preventing noncancerous urologic diseases and may be applied to support other dehydration-related health concerns (e.g., urinary tract infections, cognitive performance, heat stress, post-surgical hospital readmissions).