The Health Division offers research training in several substantive areas of Health Psychology. These research opportunities fall under the general headings of health disparities, cardiovascular disorders, psychoneuroimmunology and HIV/AIDS, psycho-oncology, chronic fatigue, and behavioral neuroscience. Much of this research is funded by the National Institutes of Health (NIH) through various mechanisms. In addition, the Health division is the recipient of two NIH training grants for the research training of predoctoral and postdoctoral fellows in the areas of cardiovascular behavioral medicine and psychoneuroimmunology and HIV/AIDS.

Graduate students and postdoctoral fellows have been actively involved in most of our research, they have presented research findings at scientific conferences, and have been authors on resulting publications.

Health Disparities

Hispanic Community Health Study Graphic

Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Study website
Faculty investigators Neil Schneiderman (Principal Investigator), Marc Gellman, Barry Hurwitz, Maria Llabre

The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a multi-site, interdisciplinary epidemiologic study in Hispanic populations in the U.S. sponsored by the National Heart, Lung, and Blood Institute (NHLBI). Its goals include studying the prevalence and development of disease in Hispanics, the role of acculturation, and identifying risk factors that play protective or harmful roles in Hispanics. The longitudinal study began in 2006 and enrolled a population of 16,000 persons of Hispanic origin, specifically Cuban, Puerto Rican, Mexican, and Central American. They were recruited through four Field Centers in Miami, Chicago, Bronx, NY, and San Diego. The Field Centers are associated with the University of Miami; University of Illinois, Chicago; Einstein College of Medicine of Yeshiva University; and San Diego State University. Each Field Center has already recruited over 4,000 participants at each site. Study participants aged 18-74 years at the beginning of the study underwent an extensive clinic examination and assessments to determine baseline risk factors (Visit 1). Distinctive factors hypothesized to influence risk of cardiovascular disease that were measured included social, behavioral, occupational and lifestyle characteristics (e.g., nutrition, physical activity) as well as acculturation, psychosocial factors and barriers to healthcare. Measures were taken of obesity, diabetes, lung function, cognitive function, hearing, dental status, sleep and cardiovascular risk factors. Annual follow-up interviews are ongoing to determine health outcomes of interest. Study results are being disseminated through scientific journals and also conveyed to the communities involved in the study in order to improve public health at the local level.

Prevalence of Major Cardiovascular Risk Factors and Cardiovascular Diseases Among Hispanic/Latino Individuals of Diverse Backgrounds in the United States

The study was renewed in 2013 and will continue at least until 2019. All of the 16,000 participants will be invited back to repeat many of the clinic examination and assessments (Visit 2). Currently several ancillary studies are collecting additional data from the 16,000 participants already enrolled in the main Hispanic study.

Echocardiographic Study of Latinos/Hispanics (ECHO-SOL)

Faculty investigators Barry Hurwitz (Principal Investigator-Miami Site), Martin Bilsker, Neil Schneiderman

Hispanics have are almost two-fold more likely than non-Hispanic whites to have abnormal cardiac structure indexed by left ventricular (LV) hypertrophy. Differences in abnormal cardiac structure among Hispanics are likely to deleteriously influence cardiac function and ultimately cardiovascular disease (CVD) risk. In addition, Hispanics often experience a high burden of stress, depression and anxiety as they adapt to the economic, social, and cultural challenges of life in the US. Despite their higher risk profile, strong familial and social ties (familismo) are thought to have a stress buffering effect and be potentially protective for Hispanic adults. Yet the longer Hispanics live in the U.S. and integrate into U.S. life (acculturation), the greater the risk of CVD. Psychosocial factors are known to predict intermediate determinants of cardiac structure and function, such as obesity and hypertension, but have not been studied in relation to cardiac endpoints among Hispanics. Therefore, the overall goal of ECHO-SOL is to establish a unique cohort that will permit study of cardiac structure and function in Hispanic adult men and women 45 years of age and older. ECHO-SOL is an ancillary study to the NIH-funded Hispanic Community Health Study-Study of Latinos (HCHS/SOL), a population-based study of 16,000 Hispanics. ECHO-SOL is being conducted on 1,800 participants already enrolled in HCHS/SOL across four US sites (Bronx, NY; Chicago; San Diego; Miami), using a balanced enrollment design to obtain near-equal numbers of Hispanic subgroup representation. ECHO-SOL is providing for the first time, the largest data set of echocardiographic parameters focused solely on U.S. Hispanics with strong subgroup representation (Central American, Cuban, Dominican, Mexican, Puerto Rican, South American). This study will allow for the determination of left ventricular (LV) hypertrophy prevalence among Hispanics sub-groups. The study will also be the first to untangle the relative importance of both the traditional and psychosocial/socioeconomic determinants (e.g., acculturation, familismo, SES) of differences in cardiac structure and function and thus CVD risk differences among Hispanic sub-groups.

Cardiovascular Disorders

The Health Division was the longstanding recipient of a Program Project, Biobehavioral Bases of CHD Risk and Management, and has a research training grant from the National Heart, Lung and Blood Institute (Neil Schneiderman, Principal Investigator) that funds research/training in the area of cardiovascular behavioral medicine. The objective of this research program is to train individuals in the conduct of integrated, multidisciplinary research into the biobehavioral bases of coronary heart disease (CHD) risk and management and into the pathophysiology of cardiovascular disorders. Close collaboration exists between the Division of Heath Psychology and the Department of Medicine.

Biobehavioral Bases of CHD Risk and Management

Faculty investigators Neil Schneiderman (Principal Investigator), Marc Gellman, Ronald Goldberg, Barry Hurwitz, Maria Llabre, Phil McCabe

The Program Project "Biobehavioral Bases of CHD Risk and Management" includes three projects. The major aims of Project 1 were to determine if compared to Standard Card (SC), a Community Approach to Lifestyle Modification for Diabetes (CALM-D) program including diet, physical activity and coping skills training, could decrease weight, HbA1c and depression in low income, minority, depressed overweight/obese, Type 2 diabetic patients. Major aims of Project 2 were to determine if compared to SC, a Community Health and Risk-reduction in Metabolic Syndrome (CHARMS) program also including diet, physical activity and coping skills training, could decrease weight, increase physical activity and reduce the frequency and severity of metabolic syndrome. The major aim of the third project was to assess the role of behavior in the progression of atherosclerosis in the Watanabe Heritable Hyperlipidemic Rabbit by examining the influence of social environment on hyperlipidemic, oxidative, and inflammatory disease processes. With permission of the Project Office, these issues were also pursued in ApoE-/- mice.

Obesity, Metabolic Syndrome, and Meal-related Glycemia

Faculty investigators Barry Hurwitz (Principal Investigator), Martin Bilsker, Ronald Goldberg, Maria Llabre, Jennifer Marks, Armando Mendez, Neil Schneiderman, William Wohlgemuth

Nearly two-thirds of adult Americans are overweight or obese. Despite the attention of the health profession, the media, the public and mass educational campaigns about the benefits of healthier diets and increased physical activity, the prevalence of obesity in the United States has more than doubled over the past four decades. Coronary Heart Disease (CHD) pathogenesis in persons with obesity is highly prevalent, occurs prematurely, and is accelerated by factors that are likely to be a combination of the established CHD risk factors, psychological distress, and diminished sleep function in the context of insulin and glucose metabolic dysfunction associated with Metabolic Syndrome. Studies indicate that the relationship between increased CHD risk and diminished vascular function may be mediated by diminished insulin-mediated glucose uptake. This finding is significant because it illustrates the importance of blood sugar control as a potential pathological mediator and in this context links it with the specific variance in CHD risk that is related to vascular function. This relationship would garner more significance if the putative mediator, i.e., blood sugar, were manipulated via food intake to observe a direct influence on vascular function. Therefore, the study will address a number of issues of importance to the understanding of CHD pathophysiology in both the overweight/obese and normal-weighted populations. Low and high CHD risk men and women, aged 18-55 years, came into the lab for a 3-day in-patient visit wherein they were served a fast-food style meal every 3 1/2 hours. The sugar content of the meals was manipulated so that on one day they received a normal amount and on another day they received double the amount per meal. Study questions included: 1) whether meal-related glycemia or insulinemia mediated vascular function in those with and without CHD risk; 2) whether psychological distress (depressive symptoms, anxiety, perceived stress) mediated differences in meal-related vascular responses as a function of CHD risk; and 3) the extent to which differences in sleep quality, efficiency and duration played a mediational role in meal-related vascular function.

Heart Smart Study GraphicHeart Smart

Study website
Faculty investigator Patrice Saab (Principal Investigator)

Heart Smart is a bilingual (English and Spanish) interactive health exhibition developed in collaboration with the Miami Science Museum where it has been on display since October 2009. The exhibition functions as a community-based intervention that enhances health literacy and educates general museum visitors about the impact of behavioral choices (related to nutrition, physical activity, and stress) on heart health in a relaxed and nonthreatening setting.  A unique feature of the exhibition is that it also invites visitors to anonymously contribute their data on body mass index, blood pressure, waist circumference, and self-reported health habits to the exhibition database through a series of interactives. The influence of the museum-based health exhibition and its related materials on cardiovascular health knowledge, readiness for healthy behavior change, and, self-efficacy for healthy behavior change has been examined in a randomized controlled trial of public high school students. The two-year follow-up of students investigates the extent that to which the exhibition can lead to improved health-related outcomes and address a primary prevention need. This project was supported by a Science Education Partnership Award from the National Center for Research Resources at National Institutes of Health.

Get in the GROOVE!

Faculty investigators Patrice Saab (Principal Investigator) and Maria Llabre

Get in the GROOVE! is a randomized controlled trial that brings together the research and informal science education community in an innovative effort to use informal learning environments as a delivery system for communicating key health messages. Middle school girls will be randomized to 3 week summer science enrichment programs where they will learn about nutrition, physical activity, healthy lifestyle, and health careers. The programs differ in the use of virtual world technology as a strategy to teach health-related science content. The research examines outcomes related to health knowledge, self-efficacy, positive health behavior change, and science interests. Summer programs are being conducted at the Miami Science Museum and New York Hall of Science. This project is supported by a Science Education Partnership Award from the Office of Research Infrastructure, Division of Program Coordination, Planning, and Strategic Initiatives (DPCPSI), Office of the Director, National Institutes of Health.

HIV treatment and prevention

Effectiveness of Nurse-Delivered Care for Adherence/Mood in HIV in South Africa‌HPAC Logo

Study Website Health Promotion and Care (HPAC) Projects
Faculty investigator Steven Safren, Ph.D.

This study is a two arm randomized effectiveness trial investigating whether a task shifting/sharing model of treating depression and improving adherence to ART in patients who fail first line antiretroviral therapy (ART) can occur using nurses in South Africa trained in cognitive behavioral therapy (CBT). South Africa is the country with the highest number of HIV infections in the world and the highest number of HIV/AIDS-related deaths, and where access to third line ART treatment is not currently available in the public healthcare system. Clinical depression, like elsewhere, is one of the highest comorbidities to HIV/AIDS, with estimated rates up to 34.9 percent. Depression, in the context of HIV, leads to poor self-care behavior such as non-adherence to ART and worse retention in care, which are critical for treatment success. Given that CBT is a validated treatment for depression, and that dissemination of evidenced-based interventions in HIV is a noted priority, this is a two-arm effectiveness RCT (stratified by antidepressant medication initiation/use or not) of nurse-delivered CBT for depression and adherence integrated into the HIV primary care setting in S. Africa. To ensure that those who need this intervention the most will receive it, participants will be patients with HIV who have failed first line ART, and have a unipolar depressive mood disorder. The primary outcomes (Aim 1) include adherence to ART (assessed by WisePill), depression (assessed by an independent evaluator), and proportion of (second line) treatment failures in each condition. Comparing this integrated care model to usual care (enhanced adherence counseling for first-line treatment-failures in this setting), will allow for an incremental cost-effectiveness analysis in Aim 2. This study is in collaboration with the University of Capetown (UCT) in S. Africa (John Joska and Lena Andersen), and Massachusetts General Hospital / Harvard Medical School (Conall O’Cleirigh and Ken Freedberg).

Addressing Psychosocial Comorbidities in HIV Treatment and PreventionHPAC Logo

Study Website Health Promotion and Care (HPAC) Projects
Faculty investigator Steven Safren, Ph.D.

This project involves various research studies as well as mentoring junior investigators in behavioral interventions related to HIV treatment and prevention, specifically focusing on associated psychosocial syndemics relevant to HIV prevention and care. Mental health problems, including substance abuse, are of the most frequent comorbidities to HIV and are consistently identified as barriers to adherence, engagement in care, and reductions in risk behavior. Typically these problems co-occur as "syndemics" (co-occurring psychosocial problems that interact with each other and with HIV risk). Studies have found exceptionally high levels of comorbidity in patients with HIV and depression. This has raised the need to address other syndemics (e.g. substance abuse, PTSD, other anxiety disorders) in addition to depression in the context of care. Studies for this project include 1) using cognitive behavioral therapy to address syndemics in the context of HIV care in patients with uncontrolled virus, 2) analyses of cohort data on syndemics in individuals living with HIV care who are in treatment, and 3) qualitative data to examine the impact of syndemics on HIV transmission risk and adherence in individuals living with HIV in care.

Fostering Resilience to Psychosocial and HIV Risk in Indian MSMHPAC Logo

Study Website Health Promotion and Care (HPAC) Projects
Faculty investigator Steven Safren, Ph.D.

India has the world's third largest HIV epidemic1, and given the population size, one of the largest, if not the largest, populations of men who have sex with men (MSM) in the world. MSM are hidden, stigmatized, and face considerable psychosocial stressors, including pressure to marry, which increases the risk for HIV transmission to their wives. In the current 2-arm randomized controlled trial, MSM in Chennai and Mumbai will be randomized to either: 1) a self-acceptance based HIV sexual risk reduction intervention and HIV/STI VCT, or 2) HIV/STI VCT. Those randomized to the experimental intervention will receive 4 group sessions focused on building self-acceptance, social support, and HIV risk reduction skills and 6 individual sessions focused on personalized HIV risk reduction plans and, as needed, prevention case management. Participants will be followed for one year, with STI incidence and HIV risk behavior as primary outcomes and psychosocial mediators secondary. Cost effectiveness of the intervention will be calculated compared to HIV/STI VCT alone, considering individual and public health benefits as well as downstream cost-savings due to infections averted. This study is in collaboration with the National Institute for Research In Tuberculosis in Chennai India (Drs. Beena Thomas and Soumya Swaminathan), The Humsafar Trust in Mumbai India (Alpana Dange, Vivek Anand, Shruta Rawat), Massachusetts General Hospital / Harvard Medical School (Drs. Conall O'Cleirigh, Ken Freedberg, C. Andres Bedoya), Brown University (Drs. Matthew Mimiaga and Katie Biello), and Fenway Health (Dr. Kenneth H. Mayer).

A Unified Intervention for Young Gay and Bisexual Men's Minority Stress, Mental Health, and HIV Risk‌HPAC Logo

Study Website Health Promotion and Care (HPAC) Projects
Faculty investigator Steven Safren, Ph.D.

Project IMPACT (Intervention with MSM to Prevent Acquisition of HIV through Crystal Methamphetamine Treatment) targets both stimulant use and sexual risk reduction in an effort to help individuals relearn how to enjoy safe but pleasurable activities with up to 14 sessions of individual therapy. The intervention integrates Behavioral Activation, a cognitive behavior therapy for improving mood and increasing activity, incorporated with HIV Risk Reduction counseling aimed to reduce risky sexual practices, and potential HIV acquisition. This randomized control trial is a three-arm efficacy trial, comparing Project IMPACT intervention efficacy to a (1) time and intensity matched control and a (2) Standard of Care arm. Our primary outcome is the number of condomless anal sex (CAS) acts with men without PrEP at baseline, four-, eight-, and 12-month follow ups. Our secondary outcome is the reductions in number of stimulant use episodes at baseline, four-, eight-, and 12-month follow ups. The second aim is to examine the degree to which: a) Reductions in sexual risk are mediated by reductions in stimulant use; b) Conceptual mediators, including increases in information, motivation, behavioral skills, and decreases in depressed mood, and decreases in polydrug use, are associated with increases in pleasurable (but safe) activities; and c) Reductions in sexual risk are associated with epidemiologically-identified moderators of sexual risk and stimulant use: age, race/ethnicity, and psychosocial factors. 4-, 8-, and 12-month follow up visits will determine if improvements in stimulant use precede and statistically mediate outcome improvements The third aim is to estimate the cost-effectiveness of the Project IMPACT intervention. Assessing the cost-effectiveness of this behavioral intervention will include evaluating the feasibility of scale-up and replicability in future efficacy trials. Project IMPACT is a Multiple Principal Investigator (MPI) study between Dr. Matthew Mimiaga at Brown University in Providence, RI and Dr. Steven Safren at the University of Miami in Miami, FL.

Intervention with MSM to Prevent Acquisition of HIV through Crystal Methamphetamine TreatmentHPAC Logo

Study Website Health Promotion and Care (HPAC) Projects
Faculty investigator Steven Safren, Ph.D.

ESTEEM (Effective Skills to Empower Effective Men) is a 10-session skills-building intervention designed to reduce young gay and bisexual men's (YGBM) co-occurring health risks by reducing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs YGBM's health. ESTEEM is based on the Unified Protocol, a cognitive-behavioral therapy (CBT) approach with efficacy across mental health and risk behaviors. The Unified Protocol changes underlying stress pathways using motivational interviewing, emotional and situational exposure, cognitive restructuring, mindfulness, and self-monitoring exercises. The first aim is to test the efficacy of ESTEEM against (1) community mental health treatment (CMHT) and (2) HIV voluntary counseling and testing (VCT). Our primary outcome is condomless anal sex in the absence of either PrEP or known undetectable viral load of HIV+ primary partners. Knowing whether ESTEEM yields greater improvement than time-matched CMHT will establish the benefit of our transdiagnostic approach. Comparing ESTEEM to VCT offers a strong test of ESTEEM's incremental cost-effectiveness. The second aim is to determinewhether ESTEEM works through its hypothesized cognitive, affective, and behavioral minority stress processes. 3-, 6-, and 12-month follow-ups will determine if improvements in minority stress processes precede and statistically mediate outcome improvements. Mediation will validate the minority stress theory of ESTEEM and provide transdiagnostic targets for future YGBM health interventions. The third aim is to estimate ESTEEM's incremental cost-effectiveness compared to VCT in terms of HIV infections averted and improved mental health. ESTEEM shows preliminary efficacy for improving the full spectrum of YGBM health. We will collect resource use and cost data to estimate return on investment of this transdiagnostic health approach compared to standard single outcome/stand-alone treatment approaches. The overall study PI is Dr. John Pachankis of Yale University School of Public Health.

Social Environment, Sympathetic Nervous System & Atherosclerosis in WHHL Rabbits

Faculty investigators Phil McCabe, Ph.D. (Principal Investigator) Armando Mendez, Ph.D., Neil Schneiderman, Ph.D., Maria Llabre, Ph.D., Leopoldo Raij, Ph.D. and Julia Zaias, D.V.M., Ph.D.

This research examines the role of social/emotional factors in atherosclerosis, and attempts to establish mechanistic links among biobehavioral risk factors, molecular mediators and clinical disease progression. This is accomplished through the use of the Watanabe Heritable Hyperlipidemic Rabbit (WHHL), a genetic animal model characterized by hyperlipidemia and severe atherosclerosis. We have demonstrated that social environment profoundly affects the course of disease in WHHLs, such that animals in stable relationships with littermates, as opposed to WHHLs in unstable social conditions or social isolation, showed a significant decrease in the progression of atherosclerosis. An unstable social environment, characterized by agonistic behavior and emotional stress, was associated with the development of severe, advanced atherosclerotic lesions. These findings suggest that biobehavioral factors are important in the progression of atherosclerosis, even in models of disease that have strong genetic determinants. It is well established that hyperlipidemia, inflammation and oxidative stress are the proximal vascular mechanisms in atherosclerosis, but the mediators linking social/emotional behavior to these drivers of disease are not clear. One of the most likely mediators linking social environment to disease is the sympathetic nervous system (SNS), and in preliminary work, we have observed that there is SNS hyperinnervation in atherosclerotic vascular tissue. This chronic SNS structural plasticity is proposed to exacerbate vascular inflammation, oxidative stress, and the progression of atherosclerosis. Our research examines whether this SNS remodeling occurs in response to social environment or to the presence of local disease. We are also assessing whether preventing this SNS hyperinnervation attenuates vascular inflammation and the progression of atherosclerosis. Therefore, the specific aims of the project are: 1a.) to examine SNS innervation density of vascular tissue in WHHLs vs normolipidemic control rabbits (New Zealand White; NZW) over time as a function of social environment, and to relate these differences to the progression of atherosclerosis, 1b.) to examine SNS innervation density of other peripheral tissue in WHHLs vs NZWs as a function of social environment, and 2.) to quantify vascular SNS innervation density, inflammation and atherosclerosis in WHHLs following pharmacological antagonism of NGF's target receptor, TrkA. This research represents a novel approach to understanding how known risk factors (e.g.,hyperlipidemia) may interact with behavioral variables to lead to the exacerbation or attenuation of disease. This type of SNS neuronal plasticity, and the resulting enhanced vascular inflammation/oxidative stress, may represent intervention targets for behavioral and/or pharmacological therapy in cardiovascular disease. The research is supported by the National Heart, Lung and Blood Institute of the NIH.

The Coping & Recovery Project

Stress Management for Women Undergoing Treatment for Breast Cancer

Faculty investigators Michael H. Antoni, Ph.D., Charles Carver, Ph.D., Suzanne Lechner, Ph.D., Bonnie Blomberg, Ph.D.

This program examines the effects of different forms of group-based stress management on psychological adaptation and physiological adaptation in women undergoing primary treatment for breast cancer. Previously we showed that a 10-week cognitive behavioral stress management (CBSM) intervention facilitated "recovery" or adaptation after adjuvant therapy using multiple indicators of psychosocial adaptation (less intrusive thoughts, sleep disruption, fatigue interference, and social disruption, and greater benefit finding, positive affect, and positive states of mind), and physiological adaptation (decreased cortisol and increased cellular immune function and Th1 cytokine production, and decreased leukocyte pro-inflammatory and pro-metaststic gene expression). Ongoing work involves an NCI-funded "dismantling" trial comparing the effects of two active treatment conditions-a 5-week version of cognitive behavioral (CB) intervention and a 5-week relaxation training (RT) intervention vs a 5-week attention-matched health education control. For this trial women who are newly diagnosed with Stages I-III breast cancer will be randomized to 5-week CB, 5-week RT-only or a attention control and monitored across indices of adaptation at 6 months and 12 months after the intervention. The interventions are hypothesized to improve adaptation, foster a faster return to pre-diagnosis quality of life, and better long-term health outcomes. Currently four graduate students in the Clinical Health Ph.D. program are working on this study conducting screening tests, psychosocial assessments, intervention protocols and data analyses.

Stress Management for Persons with Chronic Fatigue Syndrome

Faculty investigators Michael H. Antoni, Ph.D., Nancy Klimas, MD, Mary Ann Fletcher, Ph.D., Sara Czaja, Ph.D.

Chronic Fatigue Syndrome (CFS) is a poorly understood chronic illness characterized by fatigue, various neuromuscular and inflammatory symptoms, which may be exacerbated under physically or emotionally demanding circumstances. An inability to maintain regulation in the HPA axis may contribute to the pathophysiology of CFS via diminished control of pro-inflammatory cytokines and associated physical symptoms related to chronic immune activation and inflammation. If the patients' di-urnal cortisol profile is able to transition from a flat to a negatively pitched diurnal slope (decreasing from AM awakening period to PM period) as a result of the stress management intervention, this should help dampen their proinflammatory cytokine elevation, and this neuroimmune mechanism may explain how the intervention helps to control CFS symptoms. This program evaluates the effects of different forms of stress management on chronic fatigue syndrome symptoms and underlying neuroimmune pathways believed to mediate the effects of stress on CFS symptoms. In one NIH-funded trial we demonstrated that a 3-mo weekly group-based cognitive behavioral stress management (CBSM) intervention decreased perceived stress and CFS symptoms and improved quality of life in men and women diagnosed with CFS. Because many CFS patients are not able to attend structured groups we followed this with a trial demonstrating the effects of a 10-week telephone-based CBSM (T-CBSM) intervention on CFS defining symptoms in individuals with CFS relative to participants receiving a time-matched telephone-based health promotion (T-HP) control condition. We deliver the T-CBSM and T-HP interventions at the participant's home through a telecommunications system (i.e., Telecare). Our T-CBSM intervention is designed to enhance access to formal and informal care for a population that may have difficulty accessing traditional psychotherapeutic settings. A unique aspect of the Telecare system is that it uses the telephone to convene groups of individuals-thus it retains some of the supportive elements of a group-based intervention. In another NIH-funded trial we are testing the effects of a videophone-delivered group-based CBSM intervention for CFS patient-partner dyads. Plans are underway to modify the videophone-based intervention using a tablet-based modality to optimize remote delivery. Currently three graduate students in the Clinical Health Ph.D. program is working on this study conducting screening tests, psychosocial assessments, intervention protocols and data analyses.

Project CARE

Stress Management in Low-Income Black Women with Breast Cancer

Faculty investigators Suzanne Lechner Ph.D., Michael H. Antoni, Ph.D., Charles Carver, Ph.D., Erin Kobetz, Ph.D., Bonnie Blomberg, Ph.D.

This program investigated the effects of different forms of stress management and psychosocial intervention in minority women with breast cancer. Minority women are grossly underserved and suffer poorer quality of life during and after treatment for breast cancer. Despite greater need, interventions that are designed to attenuate poorer adaptation to disease among such women are scarce. Recent randomized trials demonstrated that psychosocial interventions facilitated "recovery" or adaptation after adjuvant therapy for breast cancer. As with most psychosocial oncology research, participants in previously conducted randomized trials were mostly non-Hispanic White women. Whether or not the results of the previous trials of psychosocial interventions in breast cancer are generalizable to the larger population that includes minority women needs to be tested. The Project CARE study aims to translate a widely tested form of cognitive behavioral stress management (CBSM) intervention into a format that will be acceptable and effective in a community setting and use community based participatory research methods to engage and assess participants for this study. In this NCI-funded trial we are targeting specifically low-income African American women diagnosed with Stages I-III breast cancer who are living in the greater Miami metropolitan area. Intervention participants are randomized to 10-week CBSM intervention or an attention time-matched Enhanced Breast Cancer Education (EE) control condition and monitored for 6 months after the intervention. Endpoints include: (a) acceptability of the intervention, (b) psychosocial adaptation, (c) physical symptom clusters, (d) economic implications and (e) an objective indicator of stress (diurnal salivary cortisol). The main goal of the proposed study is to test whether a successful stress-management intervention can be effectively implemented in natural settings in the community and will be acceptable to a community-dwelling, low-income population of African American women with breast cancer. In another trial funded by the American Cancer Society (ACS) we are testing whether a Spanish-language relaxation DVD improves adaptation and quality of life in Latinas undergoing chemotherapy treatment for cancer.

Center for Psycho-Oncology Research

Faculty investigators Michael Antoni, Ph.D., Charles Carver, Ph.D, Gail Ironson, MD., Ph.D., MaryAnnFletcher, Ph.D., Neil Schneiderman, Ph.D.

The Center for Psycho-oncology Research (CPOR) was funded by an NCI Center Grant that was designed to evaluate the effects of stress processes and stress management intervention sin different cancer populations. This Center conducted multiple clinical trials in patients with breast cancer, prostate cancer and women at risk for cervical cancer. Although these trials are all completed the CPOR offers a rich source of data for conducting analyses to explore the mechanisms underlying the biobehavioral processes that may account for the salutary effects of psychosocial intervention in cancer populations.

Behavioral Management and Stress Responses in HIV/AIDS

Faculty investigators Michael Antoni, Ph.D., Barry Hurwitz, Ph.D., Mahendra Kumar, Ph.D., Gail Ironson, MD., Ph.D., MaryAnn Fletcher, Ph.D., Maria Llabre, Ph.D., Neil Schneiderman, Ph.D.

The Stress Management and Relaxation Training (SMART) studies were conducted under the umbrella of projects funded by an NIMH Program Project that was designed to evaluate the effects of stress processes and stress management interventions in different populations affected by HIV/AIDS. This Program conducted multiple clinical trials in men who have sex with men, minority women, Spanish-speaking men and women, and substance abusing men and women with HIV. Although these trials are all completed the CPOR offers a rich source of data for conducting analyses to explore the mechanisms underlying the biobehavioral processes that may account for the salutary effects of psychosocial intervention in cancer populations.

FAMILY Project Study GraphicFAMILY Projects

The Facilitating Adjustment to Medical Illness in Your family (FAMILY) Research Lab focuses on various aspects of the quality of life of cancer survivors and their family members and close friends. These outcomes include psychological, physical, behavioral, and spiritual adjustment. Psychosocial correlates of these outcomes include coping with caregiving stress, gender, relationship quality, and cancer preventive behaviors. This program of research aims to examine the psychosocial, physical, and spiritual impact of cancer on the family both at a national and a community level. We investigate biobehavioral mechanisms of the link between cancer experiences and quality of life of cancer survivors and their family members, and develop programs and services to assist families in meeting their needs and to promote healthy lifestyle behaviors among cancer survivors and their family and friends.

Ethnic Disparities in the Impact of Cancer on Health Risk of CRC Patients and Their Caregivers

Faculty investigators Youngmee Kim, Ph.D. (Principal Investigator), Michael Antoni, Ph.D., Charles S. Carver, Ph.D., Maria Llabre, Ph.D., Armando Mendez, Ph.D.

This study examines the associations between characteristics of cancer-related stress and quality of life outcomes with emphasis on physical health, the roles of ethnicity and cultural factors in the associations, and the biobehavioral pathways of the links, among colorectal cancer patients and their family caregivers.  Specifically, this study examines cancer-related stress and physical health among colorectal cancer (CRC) patients and their family caregivers.  Both biological and behavioral factors will be explored as mediators of the relation between cancer-related stress and health.  Ethnicity and psychosocial factors associated with ethnicity will be explored as moderators of the relation between cancer-related stress and health.  Proposed mediators and outcomes will be measured at 2 months after diagnosis of the relative's cancer (T1) and again 9 (T2) and 18 months later (T3).  This corresponds to 2 months, 11 months, and 20 months post-diagnosis.  Three major ethnic/racial groups (Black, Hispanic, and non-Hispanic White) will be compared throughout.

Home-based Cancer Preventive Behaviors Intervention for CRC

Faculty investigator Youngmee Kim, Ph.D. (Principal Investigator)

Colorectal cancer (CRC) is the third most common cancer in both men and women in the U.S.  The immediate and ultimate goals of CRC patients are to recover from the treatments, ameliorate side effects, and alter lifestyle behaviors to recover and remain disease-free for the rest of their lives.  The latter goal is shared by the survivor's family members, because genetically related family members share genetic risks and the entire family shares environmental risks.  To fully understand cancer survivorship and to identify factors for optimal cancer prevention among persons at increased risk for CRC, it is essential to address family members along with survivors.  This project tests the effectiveness of an intervention targeting healthy lifestyle behavior change in this population, guided by self-determination theory.  The intervention aims to enhance cancer preventive behaviors -physical activity (increasing moderate to vigorous levels of physical activity and reducing sedentary behavior) and diet (increasing fruit and vegetable consumption and reducing that of red and processed meat) -among CRC survivors and their family members.  Colorectal cancer survivors who are diagnosed between 1 to 3 years prior to study participation will be recruited, when they are in transition from treatment to post-treatment.  Family members nominated by the survivor will also be recruited.  The intervention sessions are delivered using internet-based technology (Skype), so that participants receive the intervention at their home.

FAMILY Coregulation

Faculty investigator Youngmee Kim, Ph.D. (Principal Investigator)

Adult close relationship literature posits that humans are a social species, wherein better dyad relationships should induce greater protective benefit from the potentially harmful physical effects of stress.  The specific mechanism of dyadic regulation proposed is that the partners act as each others' hidden regulator in the presence of stress by engaging in psychological and physiological co-regulation.  The co-regulation effect is beyond the simple stress-buffering effect of having a relationship.  This phenomenon has been reported mostly from animal literature, although recent research in human caregiver-infant dyads has supported the hypothesis.  This study examines the co-regulation phenomenon in romantic relationships.  The findings will guide the development of a study with a population who is older and dealing with chronic illness such as cancer; and with diverse ethnic groups.  The work will also provide preliminary data elucidating the role of caregivers in minimizing the potential ill-effect of stress of the patient by co-regulating endocrine and autonomic reactivity of the patient and exploring whether these processes differ between an ethnic minority and non-minorities.

Quality of Life of Cancer Survivors and Their Family Caregivers

Faculty investigator Youngmee Kim, Ph.D. (Principal Investigator)

Cancer affects the quality of life not only of persons with the disease but also of their family members and close friends.  The impact on various aspects of caregivers' quality of life (QOL) is significant throughout the trajectory of the illness (the time of diagnosis and treatment, mid- to long-term survivorship, and bereavement).  My program of research aims to fill gaps in our knowledge about this impact.  One of my projects, the National Quality of Life Survey for Caregivers, has already documented indicators of caregivers' QOL (psychosocial, physical, spiritual, and behavioral) at 2-year post-diagnosis.  This project has also identified psychosocial correlates (personality, relationship quality, social support, gender) of better or poorer outcomes.  Follow-up assessments at 5 and 8 years post-diagnosis provide evidence of the long-term impact of cancer on family caregivers facing each of three situations: One is caregivers whose care recipients now are in remission; second is caregivers whose care recipients are undergoing treatment for recurrence, second cancer, or late side-effects; and third is caregivers whose care recipients are deceased.

Another project, the Study of Informal Cancer Care, was conducted at community hospitals and targeted the early phase of cancer caregivership and survivorship (from the time of diagnosis to 18-month post-diagnosis).  Yet another project, the Hope Lodge Study, examined the psychosocial mechanisms of social support effects on patients' and their family caregivers' quality of life while they are away from home for cancer treatment.

Cognitive and Behavioral Neuroscience

Strong Project Study GraphicSchofield Barracks Training and Research on Neurobehavioral Growth (STRONG) Project

Study website
Faculty investigator Amishi Jha (Principal Investigator)

The Schofield Barracks Training and Research on Neurobehavioral Growth (STRONG) project is a multi-site study in military and civilian populations in the U.S. sponsored by the Department of the Army. In this study we are comparing and contrasting the neural, cognitive, affective, and somatic effects of the pre-deployment Battlemind program, the US Army's current program for mental training, with a novel pre-deployment program, Mindfulness-based Mind Fitness Training (MMFT) and an active (control) comparison intervention focused on the tenets of positive psychology and positive emotions, referred to as Positive Emotion Resilience Training (PERT). Also being investigated is what amount of training, 8, 16, or 24 hours, is necessary to see effects of the novel MMFT. Beginning in 2009, soldiers preparing for deployment were recruited from military bases at Schofield Barracks, Hawaii and Fort Drum, New York. Soldiers were randomly assigned to groups receiving either Mindfulness-based Mind Fitness Training (MMFT), Positive-Emotion Resilience Training (P-ERT), or no-intervention controls. Measures were taken of attention, working memory, mood, deployment history, cognitive function, brain injury, and mental health. At least 3 time points were taken for each participant: Time 1 pre-intervention training, Time 2 post-intervention-training (8 weeks after Time 1), and Time 3 after deployment. By comparing types of training over time this study hopes to determine the best course of training as well as the neural mechanisms underlying mental resilience. This study is funded by the Department of the Army.

Brain Train Project Study GraphicBrain Train

Faculty investigator Amishi Jha (Principal Investigator)

In order to determine the optimal delivery of Mindfulness-based training, we are testing the feasibility and efficacy of extremely low-dose training in mindfulness meditation in civilian cohorts on attention, working memory, and self-reported mood and stress. Funding for this project was a grant from the Department of the Army.

Starr Project Study GraphicStrength Training for Attention and Resilience in ROTC Cadets (STARR)

Faculty investigator Amishi Jha (Principal Investigator)

The predominant model of dissemination of mindfulness-based training makes it a poor candidate for large-scale, rapid dissemination to service members. Training requires direct instruction from a long-term mindfulness expert, and the training programs are time intensive (e.g., 31-hour course duration), and call for extensive daily practice. The STARR Project has two aims. The first aim is to test the impact of a "train-the-trainer" delivery system of mindfulness-based training in ROTC personnel. These ROTC personnel then become the trainers for the second aim of the study, which is to optimize delivery of shorter, low-dose mindfulness-based military training in ROTC cadets. Measures of attention and working memory will be used to assess the effects of mindfulness-based training in both trainers and ROTC cadets. Funding for this project was from the Department of the Army.

Strong Spouses Project Study GraphicSTRONG Spouses

Faculty investigator Amishi Jha (Principal Investigator)

This project aim is to investigate the proximal effects of offering mindfulness training using a modified version of the SMART (Stress Management and Resilience Training) project (developed and delivered by Margaret Cullen) on cognitive and affective functioning in military spouses. The 8-week "SMART" course, developed and delivered by Margaret Cullen, teaches mindfulness-based emotional balance, which incorporates emotion regulation skills and practices into the MBSR curriculum, and has been adapted for military families. Funding for this project was by the 1440 Foundation.

HIV Prevention and Trauma Treatment for MSM with Childhood Sexual Abuse Histories Project THRIVE

Faculty investigator Gail Ironson

Research shows that risky sex reduction programs alone are not enough for MSM who are practicing risky sex and have a history of childhood sexual abuse (CSA). This study, which is funded by NIMH, is a two site study (at UM and Harvard; C. O'Cleirigh PI; G. Ironson Miami site PI). It investigates the efficacy of a CPT (Cognitive Processing Therapy) oriented trauma treatment for CSA in combination with risky sex reduction compared to an interpersonal supportive therapy approach combined with risky sex reduction. Its ultimate aim is for HIV prevention.

Spirituality and Health Research

Landmark Study of Spirituality and Health

Faculty investigator Gail Ironson

The Landmark study of Spirituality and Health is a study of spirituality and health conducted at numerous sites throughout the nation. Previous studies have determined that initially healthy people who are attend church are less likely to develop a myriad of illnesses and have a lower mortality rate. The aim of this study is to determine why and to investigate other aspects of spirituality/religion. It is funded by the Templeton foundation, N. Krause, PI; G. Ironson Miami P.I.

HIV and Spirituality Studies

Spiritual Coping with Trauma in HIV and Impact of Compassionate Love in HIV

Faculty investigators Gail Ironson and Heidemarie Kremer

These studies investigate the relationship between Spiritual Coping with Trauma, and Compassionate Love in relationship with health behaviors, disease progression and mortality in an existing longitudinal study of stress and coping HIV. Funding is through the Templeton and Fetzer foundations.