Edwin B. Fisher - US grants

This project will develop and implement a sereies of smoking cessation and maintenance programs designed specifically for women. Based on research on the psychology of women, specific issues related to degree of peer support and general competence will be studied. Four separate studies are being proposed over a five year period. In the first study, subjects will participate in cessation and maintenance programs modeled after the ALA group cessation clinics. However, special emphasis will be placed on peer support in some groups, while other groups will receive competence training. Blechman (1981) has presented a model of competence in adult women in which both a rich problem solving repertoire and situational freedom were identified as necessary and sufficient conditions for competence. She has postulated that competence training may be especially effective in treating addictive behaviors. In a second study, a survey will be developed for "self-quitters" to assess salient procedures in their continued abstinence. These will be incorporated into a revised and enhanced self-help manual to be compared in the third study, to the ALA self-help manual that is used currently. In the final demonstration study, women will be recruited form natural groups or populations (e.g., a large employer of women and an HMO). A program will be developed to enhance the ALA group cessation clinics for specific use with women. Information regarding peer support and competence training from the first study will be incorporated to enhance these groups. Women will be given the choice of attending these enhanced groups or of receiving the enhanced self-help manuals (developed from the second study and evaluated in the third study). Finally, a model will be developed to assess the impact of the two procedures (i.e., the enhanced self-help manuals and the enhanced group cessation clinics) taking into account the percent of subjects recruited from the population for each treatment, the percent of subjects who initially achieve success, and the percent of subject who maintain abstinence at six month and one year follow-up.

DESCRIPTION (provided by applicant): This training programhas been highly successful in terms of (I)the research of career paths of trainees (18-21) former trainees have remained in academic research positions, 6 have been promoted to Professor, a total of 9 have been granted tenure) (II)their scholarly productivity ( an average of 2.33 publications per year sincecompleting training), and (III)their success in securing independent funding NIH funding-6 are currently PIS of NIH R01 grants, another 2 are currently Project Directors of NIH sponsored multi- project grants, and one is PI of an R03 grant). The goal of the training program is to encourage independent research careers that contribute to prevention of cardiovascular disease through application of knowledge of biobehavioral and related scholarly approaches. This is an application for a 5th, 5-year award to support three postdoctoral trainees and four predoctoral trainees integrating the broad areas of behavioral science and prevention of cardiovascular disease. Predoctoral trainees will be enrolled in Ph.D. studies in clinical or social/personality Psychology related to health and cardiovascular disease. Postdoctoral trainees will be recruited from psychology and medicine as well as exercise physiology, nutrition, nursing, public health or other areas that pertain to the broad domain the research encompasses. Training resources include the Division of Health Behavior Research of the Departments of Medicine and Pediatrics, the Department of Psychology, the Behavioral Medicine Center within theDepartment of Psychiatry, the Division of Atherosclerosis, Nutrition and Lipid Research, the Division of Cardiology, and the Section of Applied Physiology within the Department of Medicine, and the Diabetes Research and Training Center. An emphasis of the training program has been on broad, interdisciplinary research. Past trainee projects have ranged across community health promotion, psychology and behavioral science, lipid metabolism, exercise physiology, diabetes, cardiovascular reactivity, and developmental aspects of neuroregulation of cardiovascular response.

Community organization may enlist neighborhood formal and informal networks to promote nonsmoking among low income black Americans. An 18- month, Nonsmoking Promotion Program stressing broad promotion of smoking cessation through informal networks will (a) be implemented through a social welfare agency which emphasizes program direction and implementation by neighborhood residents, (b) utilize Neighborhood Steering Committees to develop the program and guide its implementation, including promotional materials and activities, (c) utilize neighborhood residents to promote nonsmoking and recruit participants to program activities, and (d) offer smokers a choice of 2 quitting procedures, self-help manuals selected by Neighborhood Steering Committees to be appropriate for their audiences, and American Lung Association group cessation clinics modified for low income, black audiences. The intervention will be staggered by 1 month in each of 4, predominantly black neighborhoods. Primary evaluation will be by teleplhone survey of 2,500 residents from the 4 target neighborhoods and an equal number from comparison neighborhoods in Kansas City, at pre-, mid-, post- intervention, and 6-month follow-up. Behavioral Risk Factor Surveillance items on smoking and cardiovascular risks will comprise the survey, allowing comparison tto statewid samples and national samples for the 36 states utilizing this instrument, coordinated by the Centers for Disease control. Project evaluation will also include program participation rates and effects, social support and network processes, community organizational factors mediating program impacts, community acceptance, and cost analysis.

Asthma prevalence and mortality among Black children exceed levels among whites. Asthma management programs have reduced symptoms, attacks and emergency room usage. However, a pattern of underutilization and neglect of care among Black Americans in cases of asthma deaths among Black children indicate the importance of promoting ongoing versus episodic care, reduced exposure to triggers, sensitivity to signs of attacks, attack management, and communication with caregivers, professionals, and teachers. Research in Black communities indicates the importance of informal networks and neighborhood influences, in promoting improved asthma care within low-income Black communities. We propose to evaluate a community organization approach to promoting asthma management in 4 neighborhoods in St. Louis with predominantly low income, Black populations. Working with an established community agency, Grace Hill Neighborhood Services and its Community Wellness Board, we shall establish Neighborhood Steering Committees to oversee development and implementation of a Neighborhood Asthma Collaboration (NAC) in each neighborhood. The 36-month NAC will include (a) promotional campaigns to increase awareness of asthma and its care; (b) Neighborhood Volunteers disseminating leaflets encouraging identification of and continuing care for asthma, and recruiting participants into NAC programs; (c) Neighborhood Volunteers trained as Asthma Advocates to work with asthmatic children and their cares--rivers to encourage asthma co-management and to conduct management programs in local institutions; (d) an Asthma Management Course offered through community health centers, churches, and other local institutions; and, (e) local school programs including in-service teacher education on asthma management, an asthma program for all students to enhance support for asthmatic children, and school implementation of the Asthma Management Course. Prior to implementing the NAC, we will (a) review, adopt, pilot and revise existing asthma management educational and promotional materials, (b) work with asthma care providers to gain their involvement in program planning and patient referral to the NAC and (c) adapt from other worksite/community health promotion programs we have developed, procedures for working with Neighborhood Steering Committees and training Neighborhood Volunteers. General evaluation will include (a) surveys of community awareness of and attitudes toward asthma, (b) dissemination and implementation, and (c) pre-post changes in symptoms, attacks, ER visits, and hospitalizations among all child participants in the NAC. These measures as well as kept appointments and serum theophylline levels less than or equal to 5 mg/dl will be used in two controlled studies within the NAC to compare (1) children from study neighborhoods with children from socioeconomically comparable neighborhoods, all of whom receive care through Children's Hospital of Washington University, and (2) children receiving care through two Centers serving other, socieoeconomically similar neighborhoods.

health science research; health care personnel education; diabetes education; biomedical facility; diabetes mellitus; African American; self care; patient care management; education evaluation /planning; health services research tag; human subject; clinical research;

This project will identify factors to guide improvements in interventions for maintenance of smoking cessation among patients with lung cancer. Review of the previous proposal (submitted 6/1/99) emphasized its inclusion of too many variables and associated lack of focus and questionable feasibility. In this revision, we have reduced the number of measures from 39 to 20 (48% reduction) and focused the research plan more clearly around specifying the roles in cessation and relapse among lung cancer patients of variables found important in general samples of smokers and ex-smokers. Little research has examined these issues, leaving an important gap in knowledge on which to base efforts to sustain smoking cessation in this high priority group, approximately 50% of whom relapse. During mos 4 - 45, we will enroll 344 patients receiving surgical treatment for stage I and II, non-small cell lung cancer and who smoked within 3 mos preceding referral for surgical evaluation. We will follow these patients at 3, 6, 12, and, as available, 24 and 36 mos post surgery (through 57 rnos of project period). Measures will include variables found important in cessation and maintenance in general samples of smokers and that interventions might address - nicotine dependence, healthy lifestyle, depression, anxiety, social support, and seriousness of disease (including stage, comorbidity, and quality of life). Smoking status will be validated by cotinine and CO. Analyses will evaluate the influence of individual variables on relapse to smoking, mediating and moderating effects among variables, and the fit to observed data of a conceptual model in which variables are organized around two pathways, one based on the personality characteristic of Appetitive Motivation (reward seeking) and associated with Appetitive Urges for cigarettes (anticipation of pleasurable consequences), and one based on Aversive Motivation (negative affect reducing) and associated with Aversive Urges (reduction of negative affect). Thus, results will identify individual variables that are important in relapse and that interventions might address, place understanding of these within broader frameworks of contemporary personality theory, and integrate the individual variables with the broader framework as a basis for identifying individuals likely to benefit from different interventions.

DESCRIPTION (provided by applicant): The project aims to build sustainable research capabilities in relation to the prevention of cardiovascular disease and diabetes in India, Sri Lanka and Malaysia. In view of current trends observed in each of these countries, the long-term objective of the project is to reduce the disease burden of the growing epidemic of cardiovascular disease, diabetes and their associated complications in these three Asian countries through the development of a sustainable network of researchers and research institutions with the capacity to conduct appropriate, high quality research into the prevention of chronic non-communicable diseases. A total of 39 trainees will be recruited over three cohort intakes (n=13) to participate in an 18-month research capacity building program. The program will consist of a mentored research project in participants' home countries and participation in two residential short courses in Malaysia that will focus on cardiovascular disease and diabetes prevention, research methods and knowledge translation. The program will be led by a project team consisting of experts in chronic disease management, prevention and research capacity building in the Asia Pacific region. The program makes use of state-of-the-art facilities at Monash University in Malaysia, which have already been utilized to deliver similar courses over the past 2 years. Partner institutions have been selected on the basis of their leadership, capacity and track record in research into the increasing burden of cardiovascular disease and diabetes in their countries. PUBLIC HEALTH RELEVANCE: Cardiovascular disease, diabetes and their associated conditions are the fastest growing and most important causes of mortality and morbidity in India, Sri Lanka and Malaysia. Local research capacity needs strengthening to improve the evidence base for policy and intervention design, specifically in relation to prevention. The knowledge translation gap can be best reduced by improving research capability.