Donna Spruijt-Metz - US grants

Physical inactivity increase risk for obesity, breast cancer, cardiovascular disease, osteoporosis, and type 2 diabetes. Obesity has been directly related to weight concerns and negative body image in adolescent girls, putting them at risk for eating disorders, lowered self-esteem, and depressive symptoms. Further, physical inactivity has been directly related to smoking uptake in adolescents. Compelling evidence now suggests that marked decline in physical activity in girls occurs during early adolescence. However, the documented decline in physical activity is not well understood, and existing theories have consistently failed to describe or predict adolescent exercise patterns. In previous work the Principle Investigator has developed the Theory of Meanings of Behavior, and shown that this is an important psychological element that explains behavioral changes in dietary changes in dietary patterns and sleeping habits in adolescence. In the current proposal, we hypothesize that this new theory will help to explain the decline in physical activity in adolescent girls and provide an innovative approach for interventions that will increase physical activity. This study proposes 1) an in-depth study of the determinants of physical activity in adolescent girls as well as an investigation of the mechanisms that link physical activity to various outcomes, focusing on how long girls interpret the meanings of physical activity, and 2) the development of culturally sensitive intervention to improve physical activity in Hispanic and Caucasian adolescent girls. Dr. Spruijt-Metz's short-term training goals are to acquire skills in body composition research, physical activity and nutrition in children and adolescents, and in advanced statistics. Her long term career goal is to become an independent researcher with an integrated program in adolescent health. The University of Southern California provides an outstanding environment for physical activity and health promotion research in children and adolescents. The department of Preventive Medicine has long fostered the careers of young scientists. The ability of the P.I. to interact with the sponsor, Dr. Goran, in addition to Dr. Anderson-Johnson, Dr. Stacy, Dr. Chou, and other excellent scientist at USC will promote her continued development as an independent researcher.

Overall goal: To determine physiological and psychological determinants of the decline in physical activity in Latina and African American girls during puberty. Rationale: The decline in physical activity that occurs during adolescence has been found consistently across gender, ethnicity and nationality in human studies, and across species in animal studies, suggesting a biological basis. The pubertal transition in Latina and African American girls represents a "critical period" of development in which increased insulin resistance and decreased physical activity have been noted. These "risky" metabolic and behavioral changes in this susceptible ethnic group may explain, in part, their increased risk for obesity. This pubertal decrease in physical activity also raises future risk of breast, endometrial and colon cancer. Specific aims and Approach: Aim 1 (Longitudinal Study): To determine the direct impact of pubertal insulin resistance in Latina and African American adolescent girls on physical activity, mood and meanings of physical activity across the pubertal transition from Tanner Stage 1-3. Aim 2: Tc determine how the impact of puberty induced insulin resistance on physical activity is mediated by moot and meanings of physical activity. Aim 3: To investigate ethnic differences in the impact of insulin resistance on mood, meanings of physical activity and physical activity. We will recruit 50 Latina girls and 50 African American girls 9-11 years of age at Tanner Stage 1. Yearly metabolic evaluations and quarterly accelerometry and psychosocial evaluations will be completed for a period of three years. A combination of path models and growth curve models will be used to understand the longitudinal impact of pubertal insulin resistance on mood, motivation and physical activity levels in Latina and African American girls as they mature. Central hypotheses: Pubertal insulin resistance leads to a decline in physical activity. The decline in physical activity in girls is partially biologically programmed, emanating from the "trigger" of insulin resistance, which is linked to affective determinants of physical activity including mood and energy levels, and these metabolic and psychological changes contribute to the marked decline in physical activity that occurs during puberty. This study will be the first to examine the temporal relationship between pubertal insulin resistance and the sharp decline in physical activity experienced by Latina and African American girls during puberty.

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The goal of this project is to detemine physiological and pyschological correlates of the decline in physical activity in African American and Latina girls during puberty. The mechanism explaining the well known decline in physical activity that occurs in girls during adolescence is not well understood and hinders the ability to establish effective health promotion interventions during this critical period. However, the fact that this phenomenon has been found consistently across gender, ethnicity and nationality in human studies, and across species in animal studies, suggests it may have a biological basis. The pubertal transtion in African American and Latina girls represents a "critical period" of development in which increased insulin resistance and decreased physical activity have been noted. These "risky" metabolic and behavioral changes in these susceptible groups may explain, in part, their increased risk for obesity, type 2 diabetes and the metabolic syndrome. 100 girls (50 Latina and 50 African American) girls will be followed from Tanner Stage 1 - Tanner Stage 3+. The research will include yearly overnight visits to the GRCR and quarterly accelerometry and questionnaire studies. The overall hypotheses of this study are that pubertal insulin resistance is linked to (downstream) metabolic and affective determinants of physical activity including mood and enery levels, and that these metabolic and psychological changes contribute to the marked decline in physical activity that occurs during puberty.

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. One intriguing line of research that may have broad public health application in this regarding is the role of breakfast habits on rates of obesity. For a number of behavioral and physiological reasons, the breakfast meal may be of unique importance with respect to appetite control, dietary quality, and obesity risk. In children and adolescents, breakfast skipping prevalence is reported to range from 12 to 34% and to increase with age. Numerous observational studies have explored the association between breakfast frequency and risk of obesity, with most noting an inverse association. owever, only a few small short-term randomized trials have been conducted on this topic. Therfore, to fully address whether the frequency of eating breakfast, and the type of breakfast eaten, may play an important role in energy balance, dietary quality, and obesity risk, we propse to conduct a 2-center randomized crossover trial of breakfast intervention in a group of at-risk-for-overweight (85th-94th age/gender appropriate BMI percentiles) and overweight (95th and ablove BMI percentiles) 14-16 year old Latino boys who habitually consume breakfast less than four times per week. THe intervention will include supplying breakfast foods, along with instruction, over 3 week treatment periods so that we can evaluate effects of both breakfast frequency (7days/wk v. usual intake) and quality (whole foods balanced v. highly processed meals) on various outcomes. We hypothesize that increased breakfast frequency and quality will result in improved metabolic, behavioral, and psycological outcomes.

DESCRIPTION (provided by applicant): We will develop and evaluate Virtual Sprouts: Web-Based Gardening Games is an interactive and simulated version of the First Lady's Organic Garden in a game-based environment that will target subjects from low income, minority populations in Los Angeles, including children ages 8 to 11, their parents, other family members, teachers and the community. Virtual Sprouts will serve as a highly engaging and innovative research education program to improve PreK-12 research career opportunities and the community's understanding of the health science advances in obesity and nutrition that are supported by NIH-funded clinical and basic research. Our program has the potential to revolutionize STEM education on obesity, promote healthy food choices and decrease obesity rates, especially in minority youth at high risk of obesity and related disorders. Broad dissemination of Virtual Sprouts will be achieved through our partners, including USC's NCRR-funded Clinical and Translational Science Institute (CTSI), USC Family of Schools, and the California Science Center. Specific Aim 1: Develop a web-based, interactive Virtual Sprouts: Web-Based Gardening Games and web dissemination portal. The game content will build on our successful LA Sprouts gardening curriculum and will incorporate advisory committee feedback to optimize STEM content. The game interface will be grounded in experiential learning theory and developed using a participatory research approach with our target audiences. Specific Aim 2: Disseminate the Virtual Sprouts Web-Based Gardening Games. We will disseminate our game to audiences in three local settings: a) Public Schools: 100 teachers and 3,000 children in grades 3-5 in seven schools from the USC Family of Schools. Over 90% of students are from low-income, minority populations, and over half of teachers are African American or Latino. Our program will include teacher in-service professional development and classroom-based informal science education. b) Community Clinics: We will place kiosks in 3 safety net clinics to reach 83,000 patients, including 3,000 children aged 8-11 and their families from an underserved, low income and largely Latino (70%) population receiving public healthcare services. c) California Science Center: We will incorporate Virtual Sprouts into the Science Center's SuperKids Academy, an existing community outreach program of the Science Center focused on nutrition and obesity, to reach a targeted audience of 1.4 million annual visitors, of which over half are from minority populations and 200,000 of which are children aged 8-11. All of our dissemination partners have national collaborations and partnerships with peer organizations through which they will disseminate our program. Specific Aim 3: Evaluate the Virtual Web-Based Gardening Games. We will use a mixed design with both quantitative and qualitative approaches to evaluate the effectiveness of our education efforts. We will collect multiple diverse, formative and summative data sets related to our program features and goals to measure the impact of our program's educational content on the obesity research knowledge.

Socially Assistive Robots
Lead PI/Institution: Brian Scassellati, Yale University
This Expedition will develop the fundamental computational techniques that will enable the design, implementation, and evaluation of robots that encourage social, emotional, and cognitive growth in children, including those with social or cognitive deficits. The need for this technology is driven by critical societal problems that require sustained, personalized support that supplements the efforts of educators, parents, and clinicians. For example, clinicians and families struggle to provide individualized educational services to children with social and cognitive deficits, whose numbers have quadrupled in the US in the last decade alone. In many schools, educators struggle to provide language instruction for children raised in homes where a language other than English is spoken (over 20%), the fastest-growing segment of the school-age population. This Expedition aims to support the individual needs of these children with socially assistive robots that help to guide the children toward long-term behavioral goals, that are customized to the particular needs of each child, and that develop and change as the child does.
To achieve this vision, this Expedition will advance the state-of-the-art in socially assistive human-robot interaction from short-term interactions in structured environments to long-term interactions that are adaptive, engaging, and effective. This progress will require transformative computing research in three broad and naturally interrelated research areas. First, the Expedition will develop computational models of the dynamics of social interaction, so that robots can automatically detect, analyze, and influence agency, intention, and other social interaction primitives in dynamic environments. Second, the Expedition will develop machine learning algorithms that adapt and personalize interactions to individual physical, social, and cognitive differences, enabling robots to teach and shape behavior in ways that are tailored to the needs, preferences, and capabilities of each individual. Third, the Expedition will develop systems that guide children toward specific learning goals over periods of weeks and months, allowing for truly long-term guidance and support. Research in these three areas will be integrated into socially assistive robots that are deployed in schools and homes for durations of up to one year.
This Expedition has the potential to substantially impact the effectiveness of education and healthcare for children, and the technological tools developed will serve as the basis for enhancing the lives of children and other groups that require specialized support and intervention. The proposed computing research is tied to a comprehensive student training program, bringing a compelling, engaging, and grounded STEM experience to K-12 students through in-school and after-school activities. It also establishes an annual training summit to provide undergraduates with the multi-disciplinary background to engage in this promising research area in graduate school. Finally, by establishing a brand name for socially assistive robotics, this effort will create a central authority for the distribution of high-quality, peer-reviewed information, providing a coherent focal point for enhancing outreach and education.
For more information visit www.yale.edu/SAR

This workshop is organized to bring together leaders and scientists in a variety of different disciplines with complementary expertise including experts in behavior change theory, health and wellness systems, behavior measurement and measurement technology, engineering, computer science, and various types of "persuasive" interventions. The main objective of the workshop is to identify challenges in using computing and networking and information technology in support of behavioral change that would enable healthcare to be more proactive and preventive.

The proposed workshop plans to address a number of open fundamental issues at the intersection of networking, information technology and behavior modification. The workshop is striving to identify the fundamental barriers that currently hamper the use of networking and information technology, how they can be used to mediate processes enabling behavioral change, as well as new methods for the real-time assessment and modeling of behavior, affective states, and the environments in which these behaviors occur.

Reactionary "sick-care" systems that fail to prevent disease have become financially unsustainable. It is a global imperative that healthcare is transformed to a preemptive model that advances health "up front." The global burden of disease is tightly related to conditions that are preventable and treatable through promoting changes in key human behaviors. The ability to change behaviors on a population scale, in an economically feasible way, is therefore likely to have a major impact on the cost of healthcare. In addition, healthy behaviors are typically associated with better quality of life and wellbeing.

DESCRIPTION (provided by applicant): The enormity of the problem of childhood obesity in the US requires that effective, innovative prevention and intervention strategies be developed for the future health and success of our Country. Recently, the formation of the first-ever federal task force began to address this childhood obesity epidemic, with one of the key pillars being making healthy foods more affordable and accessible for families, and uses gardening as a primary vehicle to engage the public. However, few well-designed experimental studies exist that rigorously evaluate the impact of garden-based nutrition interventions on obesity and related metabolic disorders specifically in high-risk youth populations. We recently developed and demonstrated that a pilot 12-week after-school gardening/nutrition intervention (LA Sprouts) in 4th - 5th grade students improved dietary fiber and vegetable intake, increased preference for fruit and vegetable intake, improved cooking and gardening skills, and decreased blood pressure and rate of weight gain in overweight students. However, this pilot study was not a randomized controlled trial, was conducted off-campus at a community garden and included a minimal parental component. Given the paucity of research-based trials supporting the federal initiative, additional studies are warranted. The goal of this project is to extend our LA Sprouts pilot study, and conduct a school-garden-based randomized nutrition and gardening intervention, utilizing lessons on campus during after school hours and family workshops at nearby community gardens on weekends, to improve dietary intake and reduce obesity and related metabolic disorders in Latino children (ages 8-11 years). Two regions, each with two elementary schools (a total of 400 3rd-5th graders, >90% Latino) and a participating community garden will be randomized into either: 1) LA Sprouts (12-week after school gardening/nutrition classes + bi-monthly family workshops; two schools, n=200 students); or 2) Control (Delayed intervention; two schools, n=200 students). This project will assess the effects of the LA Sprouts program on dietary intake and related behaviors, and obesity and related metabolic disorders. We hypothesize that students participating in LA Sprouts will consume more fruits and vegetables, have increased preference, motivation, and self-efficacy to eat fruits and vegetables, and have reduced obesity and metabolic risk factors compared to controls. PUBLIC HEALTH RELEVANCE: Given the enormity of the problem of childhood obesity in the US and the paucity of research-based trials supporting the recent federal anti-obesity initiative which draws on the current momentum for gardening, there is a need to evaluate how a gardening intervention impacts dietary intake/behaviors, and obesity and related metabolic disease risk, especially in a high-risk Latino population. This study will be the first to conduct a randomized controlled gardening and nutrition intervention to reduce obesity and metabolic disorders in high-risk Latino youth.

The Wireless Health Conference Series is now in its fifth year and provides the highest profile academic and industrial research forum for the Wireless, Mobile and Connected Health fields. This year, the conference will be held October 29-31, 2014 at the National Institutes of Health (NIH) in Washington, DC. Wireless and mobile health involves a broad ecosystem of researchers whose expertise spans health and health care, engineering, computer science, behavioral and social sciences, as well as businesses partners. The Wireless Health conference series is currently the only dedicated academic/research conference that brings together leaders in the field across the entirety of the interdisciplinary wireless and mobile health community. This mentoring and travel grant will support travel and lodging for 15 doctoral students to attend the Wireless Health 2014 conference. Students will attend the full Wireless Health conference, present their projects and receive feedback and individual mentoring sessions from conference attendees who are leaders in the field. The fifteen students who will be supported on this grant to attend Wireless Health 2014 will benefit from: (1) unique international experience where they associate with scientists from different countries while visiting NIH; (2) exposure to new application areas of computer science and engineering where their skills are particularly needed, for students in medicine and other areas of public health, exchanging ideas with engineers; (3) learning about new types of computational thinking when applying technologies to wireless health applications; (4) exposure to some of the latest types of devices, robots, sensors or networks, and new mobile technologies; (5) experience in giving presentations, explaining their work, and discussing with persons in other disciplines; and (7) the opportunity to discuss how to succeed in an interdisciplinary field. This award will facilitate the establishment of research and education collaborations with students and/or faculty who are members of underrepresented groups. Another main aim of this award will be mentoring a diverse group of early-career health scientists and engineers in research proposal preparation. Finally, this award will facilitate the establishment of collaborations between disciplines and institutions, among the U.S. academic institutions, industry and government and with international partners.

The 5th Wireless Health Conference Series will be hosted by the Wireless-Life Sciences Alliance (WLSA), in conjunction with a Steering Committee comprised of leaders from the global academic and industrial research communities. More information on the conference, conference leadership, and the conference program can be found at the conference website (http://www.wirelesshealth2014.org). Foundational to the conference is the understanding that facilitating interdisciplinary communication, collaboration and cooperation among participants from academia, public health, clinical practice, government and industry is crucial to address real-world issues of the healthcare industry. Wireless Health 2014 will offer an outstanding set of peer-reviewed papers and abstracts, interactive workshops, demonstrations, and world-renowned invited speakers and facilitate formulation of future research directions and collaborative efforts in wireless health.

Poor health-related behaviors and habits are responsible for approximately 40% of preventable deaths and the majority of the chronic disease burden. However, our current understanding of health-related behavior is largely based on static snapshots of human behavior, rather than ongoing, dynamic feedback loops of behavior in response to ever-changing biological, social and personal environmental states. Rich streams of continuous data are becoming increasingly available through emerging technologies, including wearable and deployable sensors and mobile phones. This data, combined with sophisticated modeling techniques emanating primarily from engineering fields, can provide unprecedented opportunities to understand behavior in context and in real time. However, to take advantage of these opportunities, dedicated collaborations between behavioral/health scientists and data modelers, as well as across different schools of complex data modeling techniques, are required. The proposed workshop focuses on developing new concepts for modeling the temporally dense, contextually rich and personalized data increasingly afforded by emerging technologies. The major goals of this proposed workshop are to 1) amalgamate techniques from sub-disciplines across different computational modeling approaches, 2) facilitate development of a shared vocabulary/ontology to facilitate communication between modelers, behavioral and health scientists and 3) advance the rigor of dynamic behavioral theories to the next level towards causal and predictive dynamic models.

The challenge to 21st century data modeling and health behavior research is to move toward computational, dynamic modeling of behavior that can capture complex and rapid changes in behavioral state and related influencing factors. These new models will pave the way for Just-In-Time, Adaptive Interventions (JITAI) that provide feedback in context, in the moment, when people are most receptive and most likely to benefit. To accomplish this, the workshop proposed here will bring together experts in various types of modeling, for example (but not limited) to systems dynamics, social networks, agent-based modeling, machine learning, and Bayesian inference to work together with behavioral scientists and health care professionals to move this endeavor to the next level. The proposed workshop will follow the International Workshop on Methodologies for Developing and Evaluating Digital Health Interventions, which will be held in London UK, 10-11 September 2015, led by Dr. Susan Michie and Dr. Jeremy Wyatt, sponsored by the Medical Research Council (MRC), UK. The workshop proposed here brings the international leaders in health behavior and mobile interventions together with leaders in big data modeling. This workshop will facilitate an unprecedented collaboration between different streams of "big data" modelers and behaviorists to develop new paradigms for modeling temporally dense, contextualized behavioral data that can guide future JITIAs across health and wellness domains.

This project is funded under a joint solicitation between the National Science Foundation and the National Institutes of Health, named "Smart and Connected Health" (SCH), which aims to accelerate the development and use of innovative approaches that would support the much needed transformation of healthcare across the entire population. The obesity epidemic is the primary cause of recent increases in heart disease, diabetes, cancer, and other diseases that place an untenable strain on healthcare and public health. One of the primary behavioral causes, i.e. dietary intake, is a behavior that science has had little success in understanding, much less affecting. Recent advances in remote sensing have provided a new paradigm for tracking human behavior, but obesity-related efforts focused directly on diet and activity have been hampered by not only the accuracy of behavior tracking (especially dietary intake) but also the lack of behavioral theories and dynamic models for personalized just-in-time, adaptive interventions (JITAIs). Current behavioral science suggests that family eating dynamics (FED) have high potential to impact child and parent dietary intake and obesity rates. The confluence of technology research and behavioral science research creates the opportunity to change the focus of in situ obesity research and intervention from behaviors that have proven difficult to monitor, model, and modify (e.g., what and how much is being eaten) to the family mealtime and home food environment (e.g., who is eating, when, where, with whom, interpersonal stress), providing opportunities for monitoring and modeling (M2) behavior via remote sensing, and the potential for successful behavior modification via personalized, adaptable, real-time feedback.

This project proposes M2FED, an integrated system of in-home beacons, wireless and wearable sensors, and smartphones that collects synchronized real-time FED data that will be used to iteratively develop dynamic, contextualized FED systems models based on that data. The technology, ideographic models, and techniques to iteratively develop those models can guide future JITAIs and thus have a downstream positive impact on diet and ultimately obesity. The project brings together behavioral scientists, system scientists, obesity experts, computer scientists, and electrical engineers to address fundamental challenges of remote, continuous data capture for real-time behavior modeling for obesity prevention and treatment. Behavioral scientists traditionally have not had access to real-time data and dynamic models, while engineers have not had the expertise to identify what to monitor and model or what feedback to provide. This project connects complimentary expertise to develop a dramatically different approach to childhood obesity, focusing on behaviors, i.e. FED rather than diet, that can be more accurately monitored and modeled and have greater potential for positive and long-term modification. Fundamental technology research challenges in realizing the M2FED system include unique individual in-home localization, eating detection, conversation stress and mood assessment in reverberant environments, and a system-of-systems framework that includes heterogeneous sensing and communication systems across the family system itself. Fundamental behavioral research challenges include real-time modeling of FED based on past and ongoing observations of FED states and intra- and interpersonal states and events that create temporal and causal impact on FED. While this project is performed within the context of the obesity/FED relationship (which itself has the potential for sweeping impacts on human health and healthcare costs), the project also generalizes a framework, including both an evidence-based system and an experimental platform that extends to systems and applications beyond childhood obesity and behavior modification. The multidisciplinary nature of this work also provides new outreach and educational opportunities, informing (and being informed by) the public and preparing a workforce that is better equipped to address the fundamental human-behavior-centric challenges of health management and wellness preservation.

Unhealthy behaviors contribute to the majority of chronic diseases, which account for 86% of all healthcare spending in the US. Despite a great deal of research, the development of behavior change interventions that are effective, scalable, and sustainable remains challenging. Recent advances in mobile sensing and smartphone-based technologies have led to a novel and promising form of intervention, called a ?Just-in-time, adaptive intervention? (JITAI), which has the potential to continuously adapt to changing contexts and personalize to individual needs and opportunities for behavior change. Although interventions have been shown to be more effective when based on sound theory, current behavioral theories lack the temporal granularity and multiscale dynamic structure needed for developing effective JITAIs based on measurements of complex dynamic behaviors and contexts. Simultaneously, there is a lack of modeling frameworks that can express dynamic, temporally multiscale theories and represent dynamic, temporally multiscale data. This project will address the theory-development, measurement, and modeling challenges and opportunities presented by intensively collected longitudinal data, with a focus on physical activity and sedentary behavior, and broad implications for other behaviors. For efficiency, we build on the NIH-funded year-long micro- randomized trial (MRT) of HeartSteps (n=60), an adaptive mHealth intervention based on Social-Cognitive Theory (SCT) developed to increase walking and decrease sedentary behavior in patients with cardiovascular disease. The aims of this new proposal are: 1) Refine and develop dynamic measures of theoretical constructs that influence our target behaviors, 2) Enhance HeartSteps with the measures developed in Aim 1 and collect data from two additional year-long HeartSteps cohorts (sedentary overweight/obese adults (n=60) and type 2 diabetes patients (n=60), total n=180), 3) Develop a modeling framework to operationalize dynamic and contextualized theories of behavior in an intervention setting, and 4) Improve prediction of SCT outcomes using increasingly complex models. The work proposed here will provide new digital, data driven measures of key behavioral theory constructs at the momentary, daily, and weekly time scales, provide new tools tailored for the specification of complex models of behavioral dynamics, as well as new model estimation tools tailored specifically to the complex, longitudinal, multi-time scale behavioral and contextual data that are now accessible using mHealth technologies. Finally, we will leverage the collected data and the proposed modeling tools to develop and test enhanced, dynamic extensions of social cognitive theory operationalized as fully quantified, predictive dynamical models. Collectively, this work will provide the theoretical foundations and tools needed to significantly increase the effectiveness of physical activity-based mobile health interventions over multiple time scales, including their ability to effectively support behavior change over longer time scales. !

PROJECT SUMMARY/ABSTRACT Emotional well-being and everyday life function are important outcomes for people with type 1 diabetes (T1D) and are robust contributors to overall quality of life. Various indicators of emotional distress (e.g., negative mood, depressive symptoms, diabetes distress) are elevated in people with T1D. Likewise, function, or the ability to perform necessary or desired daily life activities, is also adversely impacted: symptoms of hypo- and hyperglycemia and T1D self-management tasks can disrupt participation in everyday work, leisure, and social activities among people with T1D. While acute blood glucose levels and variability are thought to contribute to diminished function and well-being in people with T1D, these relationships are poorly understood. Diabetes research to date has primarily relied on global, retrospective measures of blood glucose, function and emotional well-being that cannot capture their complex dynamic relationships as they unfold in everyday life contexts. To overcome this limitation, the Function and Emotion in Everyday Life with Type 1 Diabetes (FEEL- T1D) study is the first large-scale study to integrate continuous glucose monitoring (CGM), accelerometry, and ecological momentary assessment (EMA) to disentangle the short-term dynamic relationships between blood glucose, function, and emotional well-being in adults with type 1 diabetes. In the FEEL-T1D study, 200 adults with T1D will complete a baseline survey battery followed by 14 days of intensive longitudinal data collection using blinded CGM coupled with EMA surveys, ambulatory cognitive tasks, and accelerometer wear. These tools will be used to assess blood glucose, emotional well-being (stress, positive and negative affect, diabetes distress), function (self-reported activity performance, objective cognitive function, physical activity), and covariates that may moderate or confound the relationships of interest. Multiple metrics characterizing blood glucose (acute glucose level, glycemic excursions, glycemic variability, and % time in glycemic ranges) will be derived from CGM data to determine which have the most pronounced relationships with well-being and function on both a short-term and day-to-day basis. By clarifying which metrics of blood glucose are most closely related to clinical and patient-reported outcomes, these analyses will be foundational to the individualization of treatment recommendations and lead to the development of innovative just-in-time adaptive interventions to address the most potent predictors of health and well-being. The study's specific aims are as follows: Aim 1: Understand within-person dynamic relationships between blood glucose metrics, function, and emotional well-being through multi-level time-series analyses using CGM, EMA, and accelerometer data. Aim 2: Examine moderators of short-term and daily relationships, such as demographics, clinical characteristics, and HbA1c, between blood glucose metrics, function, and emotional well-being. Aim 3: Understand how short-term dynamics between blood glucose metrics, function, and emotional well-being are predictive of global function, well-being, and quality of life.

The proposed study will examine the extent to which, among Hispanic youth, the effects of culturally related stressors on alcohol/drug use and conduct problems are mediated by physiological stress responses. Prior work has established the psychosocial and biological pathways through which physiological stress responses potentiate alcohol/drug use and conduct problems. What is not known is the extent to which cultural stressors, over and above other sources of stress, predict physiological stress responses, and whether cultural stressors exert an indirect effect on alcohol/drug use and conduct problems through physiological stress responses. This question is important for prevention science because few interventions have been developed to offset the effects of cultural stressors, and our results will provide essential information regarding whether such interventions are needed ? as well as the protective mechanisms on which such interventions should focus. We propose a 3-year accelerated longitudinal cohort study with two cohorts, one beginning in the seventh grade and one beginning in the ninth grade, to carry out the study aims and to test the study hypotheses. An accelerated longitudinal design includes multiple age cohorts, where each cohort starts at a different age and each is followed for the same amount of time. Such a design allows us to examine five years of development through only three years of data collection. We will recruit and follow 300 Hispanic 7th and 9th graders in Los Angeles and Miami-Dade counties. Adolescents will be followed for 3 years and assessed at both macro (longer measures administered every 6 months) and micro (daily measurement bursts using shorter measures and saliva sample collection for cortisol assays). We will examine the moderating effects of three evidence- based protective mechanisms ? family functioning, life skills, cultural assets, and ethnic socialization ? on the direct and mediated effects of cultural stress on physiological stress responses and on alcohol/drug use and conduct problems. These moderation and moderated mediation analyses will indicate the specific mechanisms that should be targeted within prevention programs. This information is critical to decreasing disparities in conduct problems and alcohol/drug use among Hispanic adolescents.