Behavioral Health

Stomach cancer is the third leading cause of cancer death globally. Rates for stomach cancer are 3-4 times higher among the Navajo Nation compared to the non-Hispanic white population in Arizona. Helicobacter pylori (H. pylori) plays a role in the healthy human gut, but it is also associated with multiple chronic diseases, including stomach cancer. A multi-year research program, conducted in partnership with Northern Arizona University through the Partnership for Native American Cancer Prevention, seeks to estimate the prevalence of H. pylori among Native Americans. The study in 2018 reported a 56.4% prevalence of H. pylori within participants from three Navajo chapters, with 72% of households having at least one infected person. This research program was expanded to continue the study through other regions of Navajo Nation. Together these studies will test hypotheses that the high H. pylori prevalence in Navajo communities correlates with environmental and behavioral factors as well as diagnostic delays and to determine the genotypes of H. pylori in Native Americans in Northern Arizona and antibiotic resistance to therapies.

The overarching goal of this project is to inform parents, pediatricians, and eye care providers if prescribing spectacles for astigmatic toddlers will have a beneficial effect on their global development and will allow clinicians to make evidence-based, rather than consensus-based, recommendations regarding treatment of astigmatism in toddlers. Research area: Vision Science (Ophthalmology)

This project will help to explain the types of stress that may cause health problems among adults in a low-income, predominantly Mexican-origin border community. Guided by a community-based participatory research, this project explores how stress is defined and how community members respond to stress. The findings will inform strategies to lower stress and promote Latinos’ health. This project is receiving federal funding. 

In the United States, a culture where the elderly are often marginalized, the COVID-19 pandemic has left many older adults feeling further devalued.  The pandemic has heightened its risks not only physically but psychologically.  With quarantines in place, the elderly worry about how they will obtain medications, food, and other daily necessities.  Many older adults will not seek medical care for health concerns for fear of contracting COVID-19. Most people have not experienced a pandemic that caused us to have to stay at home and avoid human contact.  Therefore, we want to explore the impact of the pandemic on older adults to be prepared to intervene in case this should happen again in the future. The purpose of this study is to explore older adults’ experiences with the COVID-19 pandemic, including, psychosocial, behavioral responses to the pandemic, and older adult’s overall well-being. The aims of this project are to explore a diverse sample of older adult’s psychosocial responses to COVID-19, explore a diverse sample of older adult’s behavioral responses to the COVID-19 pandemic, and evaluate a diverse sample of older adult’s perceived well-being during the COVID-19 pandemic. 

The overarching aim of this study was to determine if the Nurtured Heart Approach® (NHA) can reduce the symptoms of inattentiveness, hyperactivity, and impulsivity, which are associated with attention deficit/hyperactivity disorder (AD/HD), among children ages six to eight years old. NHA is a six-week, online, behavioral intervention that trains parents on its three primary principles including: (1) completely refusing to engage in negativity, by moving toward the elimination of strong reactions such as reprimands, yelling, and hitting, (2) persistently creating and emphasizing positivity and success, and (3) being absolutely clear when using consequences and setting limits. We randomly assigned 104 parents to either the immediate or delayed NHA intervention. Data were collected and analyzed using surveys from parents at three time points. We expected NHA parent training would be associated with (1) reductions in their child’s AD/HD behaviors, (2) reductions in parental stress, and (3) improvements in parents’ sense of competency. Parents reported significantly improved AD/HD symptoms in their children as well as lower parental stress; however, improvements in parents’ sense of competency were not detected. Collaborators: Richard J. Wahl, MD Betsy C. Wertheim, MS Study Related Links: Study Infographic Study listing on ClincialTrials.gov Published study protocol U of A Alumni article

The goal of this study is to learn about how work-demands and sleep affect mood and lifestyle choices. More specifically, we are interested in understanding how pre-shift sleep and the 911 calls received effect daily emotions, activity patterns, and caffeine intake. Information from this study may be used to develop wellness programs for 911 telecommunicators. Collaborators on this project include Graciela Silva from the College of Nursing and W.D. Scott Killgore from the College of Medicine.

Under this agreement, ASHLine will provide a tobacco cessation program. Services for Phoenix Children's Hospital include: Service Initiation and Enrollment Behavior Change Coaching Program Medication Support Follow-up Reporting The program period is defined as 90 days starting from the date of program enrollment when the employee completes an initial survey with an ASHLine enrollment specialist. Achievement of the program goal is defined as 6 completed coaching sessions during the 90 day program period. Employees may engage in additional coaching sessions beyond the set goal (six sessions) during the program period as needed.

Under this agreement, ASHLine will provide a tobacco cessation program. Services for lnsteel employees include: Service Initiation and Enrollment Behavior Change Coaching Program Medication Support Follow-up Reporting The program period is defined as 90 days starting from the date of program enrollment when the employee completes an initial survey with an ASHLine enrollment specialist. Achievement of the program goal is defined as 6 completed coaching sessions during the 90 day program period. Employees may engage in additional coaching sessions beyond the set goal (six sessions) during the program period as needed.

Midlife (45-64 yr) Mexican-American (MA) men are susceptible to future burden from cardio-metabolic diseases because of numerous factors, most notably less healthful dietary and physical activity (PA) behaviors coupled with low participation in chronic disease prevention and management efforts. Thus, there is an urgent need to understand how to promote health-enhancing diet and PA behaviors in this understudied group of the population. The objective of this application is to use a mixed-methods approach to inform the development of and pilot test a gendered- and culturally-tailored diet- and PA intervention for cardio-metabolic disease prevention among midlife MA men. This objective will be attained by addressing the following specific aims: (1) conduct qualitative research with midlife MA men and their significant others (e.g. spouse, partner, close family member), and key informants (stakeholders from the MA community) to identify: (a) knowledge, perceptions, and behaviors regarding what constitutes healthful diet and PA practices; (b) perceived barriers and enablers of dietary and PA behavior change, (c) proposed strategies to promote dietary and PA behavior change, (d) perceived resources and assets for implementing dietary and PA behavior change interventions, and (e) masculine, cultural, and social identities that interact to influence interest and engagement in healthy lifestyle behaviors; and (2) assess the initial efficacy, feasibility and acceptability of a gender-tailored and culturally-relevant diet and PA behavior change pilot intervention targeting midlife MA men. Phase I of the project will entail focus groups to identify determinants of midlife MA men’s health behaviors, existing good practices and health- promoting values and behaviors, and acceptable intervention strategies. The proposed project will use intersectionality, which examines how the blending of identities and experiences create more accurate reflection of the determinants of men’s health behaviors, within the context of the sociocultural determinants of health, as the conceptual framework. A “grassroots” approach will also explore beliefs, barriers and enablers to dietary and PA change identified by significant others and community stakeholders Information collected during Phase I will inform the development of intervention materials and processes that will be pilot-tested during Phase II. Phase II will consist of a randomized controlled trial to test the initial efficacy, feasibility and acceptability of a gender-tailored, culturally relevant dietary and PA intervention targeting midlife MA men. Innovation lies in our study being the first to apply an intersectional approach in health disparities research with midlife MA men, a severely understudied and high-risk subgroup. To date, no interventions have been developed or adequately tailored to address issues unique to MA men 45-64 yr. Thus, the proposed research is significant be- cause it addresses a critical gap and will inform the development of lifestyle-based interventions targeting mid- life MA men. The proposed project will also establish the foundation for a subsequent test of intervention efficacy, as well as future translation and dissemination in varied community settings. ASU sub-award

ASHline coaches for up to 30 enrollees from Southwest Diagnostic for tobacco cessation services for the 90 day program. The purpose of the Outreach Counselor, Sr for SW Diagnostic is to provide telephone-based tobacco cessation coaching to a caseload of SW Diagnostic clients to help support tobacco users to work through the quitting process while utilizing a client-directed treatment philosophy emphasizes client direction and autonomy through a personalized quit. Additionally, The Outreach Counselor, Sr position will work as part of a team of tobacco cessation coaches to develop quality coaching programs using most up-to-date, evidence-based, best practices and keep accurate records of services through collection of data and continuous quality assurance protocols for SW Diagnostic clients. The Outreach Counselor, Sr., will also provide documentation on all services and provide general information to all other calls. The Outreach Counselor Sr, is also available to provide engagement services that include explaining more detail about the coaching and medication services offered through ASHLine, preparing SW Diagnostic enrollees (clients) about the coaching experience and initiates the quit plan. The Outreach Counselor, Sr., must provide an engaging and friendly response to all calls and be attuned to real time customer feedback for SW Diagnostic clients.

Under this agreement, ASHLine will provide a tobacco cessation program with 24/7 live answer. Services for WebPT’s employees include: Service Initiation and Enrollment Behavior Change Coaching Program Medication Support Follow-Up On-site Engagement Reporting Completion of the quit program is defined as the completion of 6 coaching sessions, which must be completed during the 90 day program period. The program period is defined as 90 days starting from the date of program enrollment completion when the employee completes an initial survey with an ASHLine enrollment specialist. Employees may complete additional coaching sessions beyond the set goal (six sessions) during the program enrollment period as needed.

In the U.S., Hispanic males have the highest rate of overweight and obesity when compared to males of other racial/ethnic groups. Obesity contributes to the risk for certain cancers in Hispanics. For example, obesity is associated with non-alcoholic fatty liver disease (NAFLD), which is 1.4 and 1.9 times more common in Hispanics than in Non-Hispanic Whites (NHW) and African Americans, respectively. While not all individuals with NAFLD develop liver complications, nearly 30% will develop nonalcoholic steatohepatitis (NASH) and be at risk for hepatocellular carcinoma, the most common form of liver cancer in adults. Consequently, Hispanic males have the highest rates of liver cancer incidence in the U.S., twice those of NHW men. Weight loss is considered the first line of prevention for NAFLD progression. Yet, current research is lacking to inform best practices to engage Hispanic males in weight loss and/or to promote a successful weight loss trajectory. Without this information, the health disparities associated with obesity related cancer will continue to increase. Using existing practice guidelines and evidence from our qualitative assessments in overweight/obese Hispanic males, we will test a novel intervention approach to address this knowledge gap. We propose to 1) assess the feasibility, acceptability and preliminary efficacy of a gender- and culturally-sensitive weight loss intervention in 20 overweight/obese Hispanic males ages 18-64 over 24 weeks; and 2) examine pathologic changes in the liver (NAFLD, NASH, fibrosis, or cirrhosis) in 20 overweight/obese Hispanic males ages 18-64 over 24 weeks using a non-invasive Magnetic Resonance Imaging (MRI) of the liver. This project will be the first gender and culturally-sensitive weight loss intervention of which we are aware to explicitly target Hispanic males with an emphasis on reducing body weight. In addition, the intervention will provide highly impactful formative research on the effects of a weight loss lifestyle intervention on liver histology. Given the Hispanic population is the fastest growing in the U.S., efforts to identify strategies to promote weight control among Hispanic males has potential to significantly impact obesity-related cancer health disparities.

The purpose of the study is to shed light on how obesity develops by examining daily behaviors and sleep in people who have involuntarily lost their job. If findings show that disturbances in daily routine and sleep precede weight gain, then there is solid backing for the development of a behavioral sleep prevention program targeting unemployed individuals. Since unemployment, chronic sleep restriction, and obesity are such prevalent social and public health issues, the results of this study are highly relevant to a large segment of the U.S. population. Funding for this study came from the National Heart, Lung, and Blood Institute. 

Located in the Mel and Enid Zuckerman College of Public Health at the University of Arizona and funded by the state tax on tobacco products, The Arizona Smokers’ Helpline (ASHLine) is one of over 50 quitlines across the United States. Established in 1995, it is also one of the oldest and most seasoned quit lines in existence.  As a member of the North American Quitline Consortium, ASHLine is actively engaged in collaborations, research, evaluation and quality improvement to assure all Arizonans have access to high quality, evidence-based tobacco cessation services and support. Nationally, quit rates reported among North American quit lines vary, averaging around 30%.  The Arizona Smokers’ Helpline (ASHLine) has been helping people quit tobacco since its inception in 1995. We are a comprehensive quitline, offering free telephone (both reactive and proactive) and web-based quit services and four to twelve weeks Nicotine Replacement Therapy (NRT). In addition, we have fax and electronic provider referral program and provide free training and technical assistance to healthcare providers and community partners statewide. The Arizona Smokers’ Helpline (ASHLine) is a service entity well-positioned to contribute to ongoing tobacco control efforts by providing effective, evidence-based support to individuals in their effort to end tobacco use.

This pilot project is funded by the newly created, Patient Centered Outcome Research Institute, created through federal appropriation. This was part of the inaugural funding from this institute and this was the only award in the State of Arizona (the project was scored at 1% from over 800 submissions with 50 awarded; http://www.pcori.org/pilot-projects/).  In this participatory research project two innovative methods to improve the delivery of patient-centered behavioral health services are being tested in a federally qualified health center in Yuma County: Sunset Community Health Center (SCHC).

Research: For this contract, I am conducting a process and outcome evaluation of Tucson Indian Center's Native Pride Project funded through the Indian Health Service. Native Pride is an 8 week program designed to increase protective factors, and decrease risk factors, for suicide and substance abuse among Native youth in the greater Tucson area. As lead evaluator, I coordinate all evaluation, data collection, and reporting activities.  Service: I attend biannual advisory committee meetings to disseminate results of the project to TIC staff, community members, and other key stakeholders. I have also developed presentations to disseminate results at regional and national Indian Health Serivice conferences. I also assist TIC with grant proposal development and submission to secure funding to continue Native Pride and other mental health related projects. Nancy Stroupe was a contributor on this project but has since left the University of Arizona.

This project was used to pilot an investigation on whether using physical activity and computer instruction could reduce social isolation in the elderly. This project received funding support through a mini grant within the Mel and Enid Zuckerman College of Public Health. 

This project implemented by Campesinso Sin Fronteras utilizes the promotora model to conduct health outreach and education to farmworker community in South Yuma County. I am overseeing the process of participatory evaluation which focuses on several activities. A core activity is the delivery of the Su Corazon Su Vida curriculum with an enhanced focus on the role of stress and depression on health behaviors. In addition, a leadership curriculum seeks to teach parents to advocate for their children in the school. The project also seeks to improve the cultural competency of the Sunset Community Health Center through provider and staff training. Evaluation of SCHC efforts focuses on patient satisfaction and knowledge of cultural competency among staff. MPH students who have served as graduate assistants on this project receive a community based experience and training in participatory evaluation.

This evaluation contract is now in its 3rd and final year in 2012.  The Center for Well- Beings goal is to provide behavioral health providers with a more comprehensive view of refugee mental health issues, and identify trends within cultural groups and genders. This information will be used to revise assessment tools used to screen refugees and inform referral protocols. Core activities include, but are not limited to the following: 1. Baseline Assessment: Compile baseline information regarding the types and prevalence of mental health issues presented by various refugee groups, including Iraqi, Burmese, Bhutanese, Somali and Burundians. This will be accomplished by creating a questionnaire and surveying service providers. 2. Focus Groups: The compiled baseline information will be augmented by gathering information on the cultural perspectives of refugee groups about the causes of mental health issues and their appropriate treatment. Refugee perspectives will be ascertained by holding small focus groups and interviewing the In-Home Well-Being Promoters. 3. Impact Measurement: Develop a pre- and post-test model to determine Refugee Well Being Project participants knowledge of key concepts and information delivered through in-home instruction; Develop a survey to determine Well-Being Project participants confidence regarding advocacy for themselves and others.

Through the Society for Adolescent Health and Medicine's Spirituality Interest Group, we are collaborating with physicians and mental health providers internationally to conduct an on-line cross-sectional survey of providers' personal spiritual beliefs and practices and how these influence adolescent health care.

A cross-sectional survey of early adolescent girls attending rural and semi-rural schools. Research is part of my dissertation.

This program is a continuation of the ongoing surveillance of autism ​​spectrum​ disorders and intellectual disability among children age​​s​ 4 and​​​​ 8​ in Maricopa​ County.​

Preventing youths' high-risk sexual behaviors represent some of the most difficult and important challenges for social and behavioral scientists. Adolescent sexual risk-taking behaviors are major causes of premature death and disability in the US as well as lead to unplanned pregnancies. Despite evidence suggesting differing patterns of sexual behaviors between and within ethnic groups, the role of socio-cultural factors within comprehensive theory-guided models of the determinants of high-risk sexual behaviors have been relatively untested. This study will identify factors contributing to youths' high-risk sexual behaviors and their disparities. The objectives involve testing a causal model of sexual behaviors guided by the theory of triadic influence, a model well-tested in predicting other adolescent risk behaviors that specifies the operation of key proximal factors as well as more distal factors. Proximal factors will include self-efficacy, attitudes, and social norms. Distal factors include global positive expectancies, depressive symptoms, parental relatedness, and academic orientation. Finally, potentially vital socio-cultural influences will be tested as ultimate (most distal) factors in the model. Global expectancies and cultural orientation in Latinos are two important factors of emphasis in the model that are understudied within comprehensive models of adolescents' sexual behaviors. The objectives will be accomplished through secondary analyses of Add Health data (National Longitudinal Study of Adolescent Health) collected from 1994-2002. Behavioral outcomes of focus at follow-ups include reported early intercourse, unprotected sexual intercourse, and number of sexual partners. Additionally, reported unintended pregnancies, reported STDs, and positive tests on STD assays at Wave III will be included to validate the behavioral reports and to provide further testing of the model's predictive efficacy. By clarifying the causal paths leading to these behaviors and identifying which specific protective or risk factors are most critical for adolescent groups where disparities are apparent, the proposed project may aid in the development of more effective sexual-risk reduction programs designed for diverse adolescent populations. By clarifying such factors like cultural orientation within such a theoretical model, this study will assist preventive programs in their efforts to address the most critical sexual risk-taking deterrence factors for diverse adolescent groups. The project was completed January 31, 2011. The project report was provided to the funder, National Institutes of Health, on April 1, 2011.

This project conducted with the support of an MCH training grant fellow. The project abstract is not available.