For over a decade, beginning with studies of angioplasty patients, our research team has focused on developing strategies to motivate patients with chronic cardiovascular disease to change health behaviors. We will continue to develop and refine interventions targeted at social epidemics such as obesity, hypertension, asthma, diabetes, and the underlying biological and behavioral phenomena. The angioplasty trials were led by Dr. Charlson and Dr. Peterson. The hypertension investigations were led by Dr. Gbenga Ogedegbe, who now leads the Center for Healthful Behavior at NYU.
Center for Behavioral Research in Obesity - "SCALE: Small Changes and Lasting Effects" (PI: Mary Charlson, MD; Erica Phillips Caesar, MD, MS, James Hollenberg, MD, Martin Wells, PhD, Janey Peterson, EdD, NIH, $5,579,004)
Dr. Mary Charlson developed the Center for Behavioral Research in Obesity, as a partnership between the Departments of Sociology, Behavioral Psychology, Nutrition, and Statistics in Ithaca, and Renaissance Health System and Lincoln Medical Center in NYC. It focuses on developing individual, family, and faith-based mindful eating interventions targeted at reducing obesity in minority communities. It builds on the work of Dr. Phillips-Caesar, as well as on the work of Drs. Devine, Wansink, Wethington, and Wells. The project is designed to develop and test different multi-level interventions in proof of concept trials to lay the basis for evaluating the effectiveness in large scale clinical trials. The total five year funding from NHLBI is $5,579,004, with $3,684,000 in direct costs.
Healthy Behaviors (PI: Mary Charlson, MD)
In our trial involving 660 angioplasty patients, we found that patients had an average of 6 risk factors that were recommended for change. The most common risk factors chosen for change were overall physical activity, smoking and weight loss. Only 39% (204/525) of patients who selected physical activity actually increased physical activity and then only 26% were able to sustain it. In total, 33% of patients reached maintenance on one behavior and 17% reached maintenance on two or more behaviors. Successful maintenance of behavior change significantly reduces morbidity by 2 years in angioplasty patients. Specifically, outcome rates were significantly lower among patients who initiated and sustained increased physical activity (29%) vs. 39% in those who started physical activity but stopped; and 49% among those who never started.
Medication Adherence in Poorly Controlled Hypertensives (Co-PI: Godwin Ogedegbe, MD, NHLBI 1RO1 HL 67439-01, 2001-2006)
The primary goal was to test the effectiveness of self-telemonitoring of home blood pressure, with feedback to both the patient and to health care provider, in 288 hypertensive patients whose blood pressure was poorly controlled.
Motivational interviewing in hypertensive African-Americans (PI: Godwin Ogedegbe, MD, MS, MPH NHLBI 1RO1 HL 69408-01-05, 2001-2005, $900,078)
The primary goal of this randomized clinical trial was to test the effectiveness of motivational interviewing versus routine counseling of 190 African-American patients with poorly controlled hypertension to improve medication adherence. Motivational interviewing is a brief and directive patient-centered counseling approach for initiating and maintaining behavior change. Motivational interviewing led to steady maintenance of medical adherence compared to a decline in adherence for usual care patients.
Medication adherence in African American hypertensives: The Role of Perceived Racism and Stress (PI: Joseph Ravenell MD, MIGRS, NHLBI, $222,802)
The overall goal of this study was to assess, in a longitudinal cohort study of hypertensive African-American patients, whether there is a relationship between perceived racism and medication adherence, while examining the role of psychological stress and depression. The Perceived Racism Scale is used to measure racism. The study assessed whether psychological stress and depression mediate the relationship between perceived racism and medication adherence.
The combined findings of these studies, focused on angioplasty and hypertension, and the asthma studies led our team to develop an intervention combining positive affect and self affirmation to help motivate behavior change in patients with chronic cardiovascular disease. This $10 million NHLBI sponsored Consortium conducted three parallel studies, with a qualitative phase, pilot phase and randomized trial phase and was conducted under auspices of the Center for Complementary and Integrative Medicine. A trial to intensify the positive affect intervention effect in angioplasty patients has been developed by Dr. Peterson and Dr. Charlson under the auspices of the Center, and is pending review at NIH.