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We trace the evolution of digital health industry careers for behavioral medicine specialists. We discuss the current misalignment of career opportunities in the private sector with the predominant graduate education training model that emphasizes the pursuit of academic positions. We describe the potential risks to the profession and public health if the field does not adapt professional training models to be inclusive of private sector industry roles. Finally, we offer a series of recommendations aimed at trainees, faculty advisors, and training programs to better prepare trainees for meaningful careers in industry.This commentary focuses on the career paths available for behavioral medicine scientists in the private sector digital health industry. Although this field has exciting and impactful career options, graduate training models have been slow to adapt to prepare graduates for these opportunities. We describe many actionable steps that trainees, advisors, and graduate programs can take to help training programs to evolve to prepare graduate for more diverse career paths.

OBJECTIVE Patients with type 2 diabetes are encouraged to lose weight, but excessive weight loss in older adults may be a marker of poor health and subsequent mortality. We examined weight change during the postintervention period of Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) with diabetes support and education (DSE) (control) in overweight/obese individuals with type 2 diabetes and sought to identify predictors of excessive postintervention weight loss and its association with mortality. RESEARCH DESIGN AND METHODS These secondary analyses compared postintervention weight change (year 8 to final visit; median 16 years) in ILI and DSE in 3,999 Look AHEAD participants. Using empirically derived trajectory categories, we compared four subgroups: weight gainers (n = 307), weight stable (n = 1,561), steady losers (n = 1,731), and steep losers (n = 380), on postintervention mortality, demographic variables, and health status at randomization and year 8. RESULTS Postintervention weight change averaged −3.7 ± 9.5%, with greater weight loss in the DSE than the ILI group. The steep weight loss trajectory subgroup lost on average 17.7 ± 6.6%; 30% of steep losers died during postintervention follow-up versus 10–18% in other trajectories (P < 0001). The following variables distinguished steep losers from weight stable: baseline, older, longer diabetes duration, higher BMI, and greater multimorbidity; intervention, randomization to control group and less weight loss in years 1–8; and year 8, higher prevalence of frailty, multimorbidity, and depressive symptoms and lower use of weight control strategies. CONCLUSIONS Steep weight loss postintervention was associated with increased risk of mortality. Older individuals with longer duration of diabetes and multimorbidity should be monitored for excessive unintentional weight loss.

OBJECTIVE: This study examined the feasibility, acceptability, and preliminary outcomes of iTRAC (internet-based Talking About Risk and Adolescent Choices), a tablet intervention designed to promote emotion regulation (ER) skills among middle schoolers as a strategy for reducing risk behaviors. METHOD: Adolescents (12–14 years) were recruited from three urban U.S. schools for advisory groups (n=15), acceptability testing (n=11), and pilot testing (n=85). Youth advisory boards and expert panels tailored content, resulting in an animated intervention of instructional videos, games, and activities designed to teach ER strategies to young adolescents. Eighty-five adolescents were randomized to the 4-module digital iTRAC intervention or a wait-list control group. Adolescents and one parent completed baseline and 3-month follow-up questionnaires examining ER attitudes and behaviors; adolescents also completed behavioral tasks related to distress tolerance. RESULTS: Among those randomized to iTRAC, 88% completed all modules. Moderate effect sizes (d ≥ .36) were found from baseline to follow-up on adolescents’ beliefs in the controllability of emotions, awareness of emotions, self-efficacy for managing emotions, perceived access to ER strategies, and use of ER strategies. Parent measures of adolescent regulation showed mixed results. CONCLUSION: A digital intervention to enhance ER skills for youth in early adolescence was feasible and demonstrated promising indicators of impact on emotional competence. Increasing adolescents’ awareness of and access to ER strategies could reduce decisions driven by transient emotions, which in turn may reduce engagement in risk behaviors and resultant negative health outcomes. This brief, tablet-based intervention has the potential to be self-administered and used to increase emotional competency.

BACKGROUND Students who are targets of bullying and who witness bullying are at high risk for negative mental health outcomes. Bystander training is essential to reduce bullying and the negative associated consequences for targets and bystanders. Resources necessary for program delivery, however, pose significant barriers for schools, particularly those in rural, low-income communities. Technology-based programs can reduce health disparities for students in these communities through cost-effective, easy-to-disseminate programming. OBJECTIVE The aim of this study is to conduct usability testing of a bystander bullying web app prototype, STAC-T (technology-based STAC, which stands for the 4 bystander strategies Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion) as an initial step in the development of a full-scale STAC-T intervention. Objectives include assessing usability and acceptability of the STAC-T prototype, understanding school needs and barriers to program implementation, and assessing differences in usability between school personnel and students. METHODS A sample of 16 participants, including school personnel and students recruited from 3 middle schools in rural, low-income communities, completed usability testing followed by a qualitative interview. Descriptive statistics, 2-tailed independent sample t tests, and consensual qualitative research were used to assess usability and program satisfaction and to extract themes related to acceptability, feasibility, needs, barriers, and feedback for intervention development. RESULTS Usability testing indicated that the app was easy to use, acceptable, and feasible. Both school personnel (mean rating 89.6, SD 5.1) and students (mean rating 91.8, SD 7.0) rated the app well above the standard cutoff score for above-average usability (ie, 68), and both school personnel (mean rating 5.83, SD 0.41) and students (mean rating 6.10, SD 0.57) gave the app high user-friendliness ratings (0-7 scale, with 7 as high user-friendliness). The overall ratings also suggested that school personnel and students were satisfied with the program. Of the 6 school personnel who said they would recommend the program, 1 (17%), 4 (66%), and 1 (17%) rated the program as 3, 4, and 5 stars, respectively; 80% (8/10) of students said they would recommend the program; and 60% (6/10) and 40% (4/10) rated the program as 4 stars and 5 stars, respectively. Qualitative data revealed that school personnel and students found the STAC-T app to be useful, user-friendly, and relevant, while providing feedback related to the importance of digital learning activities that engage the user. Data from school personnel also indicated positive perceptions regarding program feasibility and probability of program adoption, with the most significant barrier being cost, suggesting the importance of considering the financial resources available to schools in rural, low-income communities when setting the price point for the full-scale STAC-T intervention. CONCLUSIONS This study provides support for the full-scale development of the STAC-T app and provides key information for revision to enhance used engagement. CLINICALTRIAL ClinicalTrials.gov NCT04681495; https://clinicaltrials.gov/ct2/show/NCT04681495

U.S. HPV vaccine uptake remains below the Healthy People 2030 goal of 80% series completion. Parental concerns and misinformation about the efficacy and safety of the Human Papillomavirus (HPV) vaccine remain, and may be addressed by digital interventions tailored to their concerns. Reported here are results from a small scale randomized trial testing a mobile web app for parents and their adolescent daughters (ages 11–14 years) encouraging HPV vaccination in New Mexico, an ethnically-diverse U.S. state.Methods: A clinic-cluster randomized trial where pediatric clinics (n = 9) were recruited and randomized, and parent-adolescent pairs (n = 82) within clinics received either the Vacteens.org/Vacunadolescente.org mobile web app or Usual and Customary (UC) HPV Vaccination information. Parents completed online surveys at baseline and 3-months. Daughters' HPV vaccine data were collected from the New Mexico State Immunization Information System 1 year post baseline.Results: Three month survey results found Vacteens.org/Vacunadolescente.org parents to have higher positive HPV vaccine beliefs, informed decision making, intent to vaccinate and vaccine confidence outcomes than UC parents. HPV vaccine data found higher first dose HPV vaccination (Pearson χ2 = 6.13, p = 0.013, Vacteens.org/Vacunadolescente.org group 59.4%, UC group 40.6%), and higher HPV vaccination series completion (Pearson χ2 = 6.49, p = 0.011, Vacteens.org/Vacunadolescente.org group 68.4%, UC group 31.6%).Conclusions: The small trial results showed the Vacteens.org/Vacunadolescente.org web app prompted positive vaccine-related attitudes and beliefs, and more HPV vaccination initiation and series completion. Mobile web apps can make decision-making tools for HPV vaccination widely available on digital platforms, reducing vaccine hesitancy, and confusion and increase HPV vaccine uptake.

Objective We address cancer communication by creating and assessing the impacts of a theatrical production, When Cancer Calls… ( WCC… ), anchored in conversations from the first natural history of a patient and family members talking through cancer on the telephone. Methods A national study was conducted using a multi-site and randomized controlled trial. An 80-minute video was produced to assess viewing impacts across cancer patients, survivors, and family members. Comparisons were made with a control video on cancer nutrition and diet. Pretest–posttest sample size was 1006, and 669 participants completed a 30-day follow-up impacts assessment. Results All five family and communication indices increased significantly for WCC… . When compared to the placebo, average pretest–posttest change scores were higher for self-efficacy (775%), family fabric (665%), outside support (189%), and family communication (97%). One month following viewings, WCC… participants reported 30% more conversations about cancer among patients and family members about cancer. Conclusion A new genre of Entertainment–Education (E–E) was created that triggers positive reactions from audience members. Managing delicate and often complex communication about the trials, tribulations, hopes, and triumphs of cancer journeys is fundamentally important for everyday living. Practice implications Unique opportunities exist to make WCC… available to national and global audiences, create tailored curricula, and integrate these viewings into educational programs for patients, family members, and care-provider teams across diverse health, corporate, and governmental systems.

BACKGROUND: African American men experience health disparities across a number of chronic diseases. mHealth technology is widely utilized to address lifestyle factors that contribute to these conditions. Participation of African American men in qualitative and quantitative studies of mHealth is low. Therefore, little is known regarding the acceptability of mHealth interventions and few interventions have been specifically developed for this population. The purpose of the current study is to describe the development of a smartphone application, MobileMen, to promote the maintenance of physical activity (PA) in African American men and to report on app feasibility when applied to the target population. METHODS: We used a mixed methods study design including formative research, user-centered design, and a feasibility study. Focus groups (n=26) were conducted to inform the acceptability of the app and desired features. Lab usability (n=19) was used to develop the app through an iterative process. A feasibility study was conducted to assess utilization of the app over a 1-month timeframe. Measures of usability and user-friendliness were collected during lab usability sessions. Satisfaction and app usage were collected following the feasibility study. RESULTS: The focus groups revealed that African American men use smartphone apps and that they are willing to utilize an app to maintain PA habits. The MobileMen app was subsequently developed and contained a dashboard, rewards, a learning component, a prompting system, and activity tracking. Scores increased between the first and last lab sessions for usability [5.0 (0.0) vs. 4.3 (1.0)] and user-friendliness [74.2 (17.0) vs. 70.6 (12.4)]. Participants reported acceptable satisfaction (mean values >3.5 on a 1–5 Likert scale) with most app components. CONCLUSIONS: African American men are willing to utilize mHealth to improve their health behavior, including PA. An initial version of the MobileMen app has been developed that is acceptable and user-friendly. However, there are several components requested by African American men could not be included in the current app but warrant future app development.

W hy do some organizations struggle or plateau with diversity management programs while other organizations flourish and excel? The authors became interested in this question as part of a larger research project exploring diversity management competencies in organizations.We are especially interested in this issue within the context of the health care industry. Well-documented demographic shifts, resulting in the browning and graying of America, pose extraordinary challenges for health care on two fronts. First, a shrinking and aging talent pool will result in shortages among primary care physicians, nurses, lab technicians, and physical therapists. Some will be replaced with more racially and ethnically diverse workers. Yet, womenandpeopleof colorhaveonlymade incremental advances into management and professional roles. On the patient side, increasing racial and ethnic diversity heightens the importance of culturally appropriate care. The swelling ranks of seniors needing extended care for age-related chronic diseases (e.g., cancer, heart disease, musculoskeletal disorders) will increase exponentially. Yet persistent quality problems and racial disparities in care indicate that the industry has been slow to respond to this perfect storm. Diversity management is a means to address these health care challenges. Effective diversity management involves valuing and utilizing the collective talents and contributionsof all individuals, regardlessofdifferences and similarities, in ways that significantly enhance organizational performance. In health care, this entails cultivating skills that integrate quality improvement and cultural sensitivity to meet the needs of diverse patients. Therefore, diversitymanagement practices are embedded into the organization’s overall strategy, not just confined to human resource practices. However, like other sectors, health care organizations struggle with effective diversity management. Why? Some contend that diversity is viewed as a nuisance and threat to the status quo, rather than a resource to leverage. This dim view of diversity results in inadequate funding, staffing, support, and therefore stalled success. Yet, we wondered what makes leaders view diversity positively, as a resource to achieve their goals? Emerging research shows that when senior leaders articulate a sincere and strategic commitment to diversity management, supported by their actions, organizations reap the benefits. We believe there is a need to understand how such leaders navigate the change process to ensure the successful diffusion and implementation of diversity management throughout a health care organization. We selected SSM Health Care as the focal organization for this case study because of its reputation for excellence, consistently satisfying the majority of its stakeholders, and a historic, leading edge commitment to managing diversity. In 2002, SSM Health Care was the first health care system to win the prestigious Malcolm Baldrige National Quality Award. SSM Health Care earned acclaim because of its exceptional performance on critical success factors: leadership, strategic planning, process measurement and management, human resource management, and high quality of patient care. Through this case study, we examine how SSM Health Care’s generative view of diversity management practices was interwoven throughout the organization to produce extraordinary results.

This study explores the relative importance of everyday racism, empathic concern, communalism, and religiosity as predictors of pro-social involvement (i.e., volunteerism and membership in political/social justice organizations) among a sample of African American men (N = 151). Church involvement emerged as a positive predictor of the likelihood that these men were involved in volunteer work as well as the number of hours that men dedicated to volunteer work. Communalism positively predicted the amount of time (in hours per year) that men were involved in volunteer work. Subjective religiosity and the stress of everyday racism were associated with a greater likelihood of being a member of a political–social justice organization. Implications of these findings are discussed.

Background: Research suggests that the degree of food desirability may have an impact on successful weight loss. Defined as susceptibility to eating when presented with environmental stimuli, hedonic hunger is related to increased food consumption. Individuals with higher hedonic hunger may be less able to successfully maintain weight loss and, therefore, may have more weight loss attempts (WLA). The purpose was to examine associations between the number of WLA and the PFS total scale and subscale scores, controlling for race, sex, BMI, and age. Methods: Participants were obese adults enrolled in Heads Up, an insurance-sponsored observational study examining surgical and non-surgical weight loss techniques. Individuals completed the Power of Food Scale (PFS) and demographic information, including the number of WLA. The PFS was developed to assess hedonic hunger when food is: 1) available, 2) present, and 3) tasted. Results: Of the 705 participants, 409 (57.8%) were Caucasian, 597 (84.3%) were female, and had attempted to lose weight 9.13 (SD=9.8) times. The number of WLA significantly predicted PFS total scores and subscale scores except for the “Food Tasted” subscale. The full linear regression models accounted for 4.7%, 4.1%, and 6.2% of the variance in the total PFS, Food Available subscale, and Food Present subscale scores, respectively. Conclusions: Results demonstrate that hedonic hunger may be a factor in repeated WLA. Future research should examine the temporal sequence to fully explain this relationship to provide additional tailoring of behavioral weight loss interventions to address hedonic hunger as a hindrance to successful weight maintenance.

BACKGROUND: Caveolins are scaffolding proteins that are integral components of caveolae, flask-shaped invaginations in the membranes of all mammalian cells. Caveolin-1 and -2 are expressed ubiquitously, whereas caveolin-3 is found only in muscle. The role of caveolin-3 in heart muscle disease is controversial. METHODS AND RESULTS: The present study was undertaken to assess the effects of left ventricular dysfunction on the expression of caveolin proteins using 2 well characterized models of murine heart failure and failing human heart. Transgenic mice with constitutive overexpression of A(1)-adenosine receptor (A(1)-TG) demonstrated cardiac dilatation and decreased left ventricular function at 10 weeks of age. This was accompanied by a marked decrease in caveolin-3 mRNA and protein levels compared with non-TG control mice. The change in caveolin-3 expression was selective, because levels of caveolin-1 and -2 did not change. Confocal imaging of myocytes isolated from A(1)-TG mice demonstrated a loss of the plate-like appearance of T tubules. Caveolin-3 levels were also reduced in hearts from mice overexpressing tumor necrosis factor ?. There was a direct relationship between caveolin-3 expression and fractional shortening in all mice that were studied (r�= 0.65; P < .001). Although we could not demonstrate a significant decrease in caveolin-3 levels in failing human heart, we did find a direct correlation (r = 0.7; P < .05) between levels of caveolin-3 protein and Ca(2+)-adenosine triphosphatase, a marker of the heart failure phenotype. CONCLUSIONS: These results suggest a relationship between left ventricular dysfunction and caveolin-3 levels and suggest that caveolin-3 may provide a novel target for heart failure therapy.

Activation of the A2Aadenosine receptor (A2AR) has been shown to be cardioprotective. We hypothesized that A2AR overexpression could protect the heart from adriamycin-induced cardiomyopathy. Transgenic (TG) mice overexpressing the A2AR and wild-type mice (WT) were injected with adriamycin (5 mg·kg−1·wk−1ip, 4 wk). All WT mice survived adriamycin treatment while A2AR TG mice suffered 100% mortality at 4 wk. Telemetry showed progressive prolongation of the QT interval, bradyarrhythmias, heart block, and sudden death in adriamycin-treated A2AR TG but not WT mice. Both WT and A2AR TG demonstrated similar decreases in heart function at 3 wk after treatment. Adriamycin significantly increased end-diastolic intracellular Ca2+concentration in A2AR TG but not in WT myocytes ( P < 0.05). Compared with WT myocytes, action potential duration increased dramatically in A2AR TG myoctyes ( P < 0.05) after adriamycin treatment. Expression of connexin 43 was decreased in adriamycin treated A2AR TG but not WT mice. In sharp contrast, A2AR overexpression induced after the completion of adriamycin treatment resulted in no deaths and enhanced cardiac performance compared with WT adriamycin-treated mice. Our results indicate that the timing of A2AR activation is critical in terms of exacerbating or protecting adriamycin-induced cardiotoxicity. Our data have direct relevance on the clinical use of adenosine agonists or antagonists in the treatment of patients undergoing adriamycin therapy.

Health services administrators need a range of competencies to manage diverse workers and serve diverse patients. This article describes cutting edge research used to create the theoretical foundation for a competency-based approach to diversity management education in the health services administration curriculum. Detailed implementation steps of the course pilot are provided, including pedagogical methods and outcome evaluations, which are largely absent from the diversity management education literature. Recommendations for refinement and replication of the class are also discussed.

Behavioral weight loss interventions achieve short-term success, but re-gain is common.To compare 2 weight loss maintenance interventions with a self-directed control group.Two-phase trial in which 1032 overweight or obese adults (38% African American, 63% women) with hypertension, dyslipidemia, or both who had lost at least 4 kg during a 6-month weight loss program (phase 1) were randomized to a weight-loss maintenance intervention (phase 2). Enrollment at 4 academic centers occurred August 2003-July 2004 and randomization, February-December 2004. Data collection was completed in June 2007.After the phase 1 weight-loss program, participants were randomized to one of the following groups for 30 months: monthly personal contact, unlimited access to an interactive technology-based intervention, or self-directed control. Main Outcome Changes in weight from randomization.Mean entry weight was 96.7 kg. During the initial 6-month program, mean weight loss was 8.5 kg. After randomization, weight regain occurred. Participants in the personal-contact group regained less weight (4.0 kg) than those in the self-directed group (5.5 kg; mean difference at 30 months, -1.5 kg; 95% confidence interval [CI], -2.4 to -0.6 kg; P = .001). At 30 months, weight regain did not differ between the interactive technology-based (5.2 kg) and self-directed groups (5.5 kg; mean difference -0.3 kg; 95% CI, -1.2 to 0.6 kg; P = .51); however, weight regain was lower in the interactive technology-based than in the self-directed group at 18 months (mean difference, -1.1 kg; 95% CI, -1.9 to -0.4 kg; P = .003) and at 24 months (mean difference, -0.9 kg; 95% CI, -1.7 to -0.02 kg; P = .04). At 30 months, the difference between the personal-contact and interactive technology-based group was -1.2 kg (95% CI -2.1 to -0.3; P = .008). Effects did not differ significantly by sex, race, age, and body mass index subgroups. Overall, 71% of study participants remained below entry weight.The majority of individuals who successfully completed an initial behavioral weight loss program maintained a weight below their initial level. Monthly brief personal contact provided modest benefit in sustaining weight loss, whereas an interactive technology-based intervention provided early but transient benefit.clinicaltrials.gov Identifier: NCT00054925.