Overall Summary
The overarching goal of this application for a Phase 2 COBRE award is to further develop the
VCBH.
The overarching scientific priorities of the VCBH are:
- increasing scientific understanding of the mechanisms underpinning vulnerability to these unhealthy behavior patterns, including the contribution of biases in decision making and socioeconomic disadvantage, and
- developing and evaluating the efficacy and cost-effectiveness of behavior-change interventions to promote health.
Advances in each of those areas are essential to improving U.S. population health, reducing health disparities, and curbing spiraling health care costs. The VCBH made considerable progress during Phase 1 towards establishing a vibrant, multidisciplinary center of research excellence that is already having local, national, and international impact. Phase 2 funding will allow the VCBH to further establish and develop a productive, sustainable presence in this important area of biomedical research.
Specific Aims:
Aim 1: Recruit and organize the multidisciplinary senior and early-career faculty and advisors necessary to lead and sustain the VCBH mission.
Aim 2: Provide promising early-career faculty with the research opportunities, mentoring, and career development support necessary to establish themselves as successful, independent investigators.
Aim 3: Establish an Administrative Core that effectively leads and coordinates a multidisciplinary research center of excellence, trains the next generation of scholars, and obtains the external funding necessary to sustain the VCBH beyond COBRE support.
Aim 4: Establish a research core that supports the efforts of investigators in the VCBH and beyond to study behavior and health relationships pertinent to the VCBH mission. The Behavioral Economics and Intervention Sciences Core (Core B) consists of the following three modules of expertise:
(a) A Decision-Making component that supports research strategies and instruments to examine individual differences in biases and deficiencies in decision-making (e.g., temporal discounting, other executive functions) using conventional paper-and-pencil and laptop assessment platforms, as well as those that leverage functional magnetic resonance imaging (fMRI) testing.
(b) An Intervention Sciences component that (i) assists with development and evaluation of behavior change interventions, and (ii) supports the integration of emerging technologies with those interventions;
(c) An Economic Modeling component that assists with developing and implementing cost-effectiveness analyses for the intervention studies.
Aim 5: Establish a Collaboration, Dissemination, and Education Core (Core C) that facilitates local, state, national, and international impact and educates the next generation of scholars in Behavior and Health by:
(a) Nurturing and coordinating bi-directional collaborative relationships with (i) Vermont leaders in health care policy and delivery, (ii) a network of universities and research institutes located in other IDeA states (Brown University, University of Kentucky, Dartmouth, University of Nebraska, Laureate Institute for Brain Research), non-IDEA states (Johns Hopkins University, State University of New York at Buffalo, Wayne State University), and internationally (University of Glasgow, Glasgow, Scotland; Oviedo University, Oviedo, Spain; Makerere University, Kampala, Uganda) where there is strong interest and expertise in the area of behavior and health;
(b) Disseminating new knowledge on behavior and health through the annual VCBH national conference and annual Special Issues of the peer-reviewed journal Preventive Medicine;
(c) Educating the next generation of scholars in the area of behavior and health through the VCBH monthly lecture series, seminars, and workshops offered at UVM and also streamed live to collaborators and interested others.
COBRE Cores:
CORE A- ADMINISTRATIVE CORE: Unhealthy behavioral choices to smoke, overeat and lead sedentary lifestyles underlie the preponderance of chronic disease in the U.S. Greater understanding of the mechanisms underpinning vulnerability to such unhealthy decision making and developing more effective interventions to promote behavior change is vitally important to improving the U.S. public health. The overarching goal of the Administrative Core of VCBH is to organize and grow existing strengths at UVM while continuing to engage in local, national, and international collaborations in this important area of health research. This core has established the administrative and intellectual infrastructure necessary to (a) strengthen and grow collaboration among an multidisciplinary group of investigators who share research and clinical expertise in this area, (b) effectively mentor early-career faculty in conducting thematically related research and preparing competitive research grant applications, (c) engage in productive collaborations with community healthcare organizations and other universities located in IDeA states and beyond, (d) recruit new members into the center, and (e) continue to secure the necessary financial support to sustain the VCBH beyond COBRE support. We propose that Stephen T. Higgins, PhD, continue as Director of this core with Philip A. Ades, MD continuing in the role of Associate Director. Accomplished UVM senior faculty will continue directing cores on (a) behavioral economics and intervention sciences, and (b) collaboration, dissemination, and education, while also mentoring early-career faculty in conducting COBRE-supported and thematically related research projects. We will continue collaborating with Vermont community healthcare leaders and investigators from other IDeA States and beyond in pursuing the VCBH mission. Program oversight will be guided by an External Advisory Committee of distinguished scientific leaders in the area of behavior and health. An Internal Advisory Committee composed of accomplished senior UVM investigators will continue advising the VCBH on scientific and organizational matters. A Community Advisory Committee of experts in Vermont health care delivery and policy will help assure that the VCBH remains responsive to community needs. This interdisciplinary team will work closely together to continue the overarching goal of establishing the VCBH as a nationally and internationally recognized center of research excellence.
CORE B- BEHAVIORAL ECONOMICS & INTERVENTION SCIENCE (BEIS) CORE: The Vermont Center on Behavior and Health (VCBH) is dedicated to researching relationships between personal behavior patterns and risk for chronic disease and premature death. The overarching purpose of the Behavioral Economics and Intervention Sciences (BEIS) Core is to provide VCBH investigators with scientific and technical expertise and research infrastructure in three key areas. First, our Core’s Decision-Making Module provides expertise in the study of behavioral choice and decision making, with an emphasis on investigating the core cognitive processes (e.g., executive functions) and biases in decision making that may increase vulnerability to risky health behaviors and undermine response to interventions. Toward this end, we have established the BEIS Core Assessment Service, wherein a highly-trained, mobile assessment team administers a comprehensive battery evaluating multiple domains of executive function and biased decision making that includes measures of attention, working memory, inhibition, error monitoring, and sensitivity to incentives, and temporal, probability, and social discounting of rewards. We customize assessment batteries so that they are tailored to the specific aims and population under investigation in individual studies, while also looking to facilitate and support thematically related research in behavioral economics across studies. Second, the BEIS Intervention Sciences Module provides unique expertise in the design and implementation of incentive-based and other behavioral and pharmacological interventions to promote health-related behavior change. We assist investigators in developing and tailoring interventions to the unique characteristics of the population and targeted risk behavior. We also have center expertise in the integration of technology with these interventions to increase their accessibility, while also potentially lowering treatment costs. Finally, our Core’s Economic Modeling Module provides assistance with econometric analyses of interventions and health outcomes, including help with the preparation for and conduct of cost-effectiveness, cost-utility and cost-benefit analyses. This includes assistance in calculating the cost-offset associated with treatment outcomes (e.g., cost per life year gained, cost per quality-adjusted life years gained, net savings per dollar invested, and dollars saved per hospitalization case prevented). Taken together, the BEIS Core and its dedicated service modules will continue to provide the expertise and access to the assessments, interventions and technology, and economic modeling central to the research proposed within the VCBH and also across the UVM campus.
CORE C- COLLABORATION, DISSEMINATION, & EDUCATION (CDE) CORE: VCBH is an interdisciplinary research center that investigates relationships between personal behavior and risk for chronic disease and premature death. The overarching aim of the VCBH Collaboration, Dissemination, and Education (CDE) Core is to nurture and coordinate relationships between the VCBH and leaders in Vermont health care policy and delivery as well as with collaborating university partners located in other IDeA states and beyond. We propose that Stephen T. Higgins, PhD, and Richard Rawson, PhD, continue as Co-directors, and Diann E. Gaalema, PhD, as Associate Director. Locally, we have established multiple collaborations with Vermont healthcare policy makers including the University of Vermont Medical Center, Vermont Department of Health, and public and private health insurers that we propose to continue and develop further. Nationally, we have established collaborations with colleagues at universities in other IDeA states (Brown University, University of Kentucky), and plan to expand them to include universities located in other IDeA states (Dartmouth College, University of Maine, University of Nebraska), non-IDeA states (Johns Hopkins University, State University of New York at Buffalo, Wayne State, Laureate Institute), and internationally (University of Glasgow, Oviedo University, Makerere University). These collaborations have already fostered substantive new research and funding opportunities and we are confident that they will continue to do so. To facilitate dissemination of advances in this research area we have established a UVM lecture series in behavior and health that is live streamed to collaborators and others, and also recorded and stored on the VCBH website, an annual national conference on behavior change, health, and health disparities, and a series of Special Issues of the peer-reviewed journal Preventive Medicine based on conference proceedings. VCBH scientists regularly participate in other national and international conferences and publish in peer-reviewed journals, a practice that in the past four years has resulted in 118 peer-reviewed publications. Overall, we are confident that continuation and further development of these practices will firmly establish the VCBH as a vibrant, interdisciplinary center of biomedical research excellence with local, national, and international impact, while also providing important career development opportunities for VCBH early-career faculty and predoctoral and postdoctoral fellows.