Transcript Experiential Education and Public Health: The Potential to

Experiential Education
and Public Health:
The Potential to MOVE
America toward Health
Aleta L. Meyer, Ph.D.
National Institute on Drug Abuse
5th Annual Research and Evaluation on Adventure Programs
Symposium
Atlanta, GA
March 18, 2009
Overview
 REAP 2008 – Federal Funding to Support
Research on Adventure Programs – Focus on
Drug Use
 Casting the Net to Other Health Areas
 Experiential Approaches (NIH-funded)
 The “State” of Best Practices
 Type I and Type II Translation Research
 Federal Funding for Research & Training
 Positive Risk-Taking Adventure for Thought
NIDA-funded Prevention and
Prevention Services Research
 National Institute on Drug Abuse (NIDA)
 NIDA’s Prevention Research Branch supports a
theory driven program of basic, clinical, and
services research across the lifespan to reduce
risks and prevent the initiation and progression
of drug use to abuse and prevent drug-related
HIV acquisition, transmission and progression.
Additional Outcomes of
Interest
 Proximal problems related to substance
use (e.g., early aggression, academic
failure, association with deviant peers,
poor peer relationships, family conflict
and poor parental management skills);
 Conditions which are co-morbid with
drug use (e.g., psychiatric disorder); or
 Conditions which share etiology with
drug use (e.g., interpersonal violence).
Development
Family
Peers
School
Surrounding Context
Cultural, Economic and Political Factors
Guiding Principles for Substance Use
Prevention that Link to Other Health
Outcomes
 Development in context / Experimental etiology
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Intervening Early in Families
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To address problematic trajectories (e.g., early aggression)
To promote successful transition to school (e.g., improved regulation and
social-emotional functioning)
School-Based Approaches (Universal, Selected, Indicated)
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During key developmental transitions (e.g., transition into school, early
adolescence)
Address risk and protective factors relevant to drug use, violence, and other
outcomes
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Evidence for short-term, long-term, and cross-over effects
 Increase Reach of Evidence-based Programs (Type 2 Translation)
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Research on factors associated with the adoption and utilization of scientifically
validated interventions by service systems and settings under controlled,
uncontrolled or uncontrollable conditions
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Impact of implementation quality on outcomes
Strategies for optimal adaptation of curriculum
Economic analysis of evidence-based programs
Development of community coalitions and examination of impact
Behavioral Interventions that Impact
Underlying Biological Processes
Related to Regulation
 Multidimensional Treatment Foster Care
- designed to improve foster parent skills
(increase reinforcement relative to
discipline) (Chamberlain et al.)
 Fisher et al. examined its impact on HPA
axis dysregulation in preschoolers
Effects of disruptions on the brain
 Maltreated children tend to have dysregulated cortisol rhythms
 They display lower cortisol levels upon awakening and lower
declines from morning to evening
 Under routine conditions in regular foster care, placement changes
appear to disrupt the regulation of the HPA axis resulting in less
stable, more blunted HPA activity
 It appears this can be mitigated by interventions that focus on
providing stability, routine, nurturing, and planned transitions
 Children in MTFC-P maintained a more normal diurnal rhythm
during the 6 months after transition into a new placement
Fisher, Van Ryzin, & Gunnar (submitted)
HPA axis dysregulation associated with early life
stress
typical
ug/dl
typical daytime HPA activity
1
0.8
0.6
0.4
0.2
0
wakeup
mid morning
bedtime
chronically elevated daytime
ug/dl
HPA activity
1
0.8
0.6
0.4
0.2
0
wake up
midmorning
bedtime
(downregulation via chronic stress)
Anxiety and
affective
disorders
stress-induced
‘blunted’
patterns
ug/dl
low daytime HPA activity
1
0.8
0.6
0.4
0.2
0
wake up
midmorning
bedtime
Developing interventions that
mitigate risk
Fisher, Van Ryzin, & Gunnar (submitted)
New Approach for NIDA
Physical Activity as Prevention
 Potential Mechanisms of Change (experimental
etiology)
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Emotion-regulation
Attention processes and executive control
Sensation-seeking / Reward-pleasure mechanisms
Sensory-motor coordination
Healthy lifestyles
Adult-child relationships
Science Meeting Agenda
 Panel 1: Physical Activity in Prevention Interventions
 Panel 2: Technological Tools for Assessing Physical Activity
 Panel 3: Informing Drug Abuse Prevention Through Research on
the Epidemiology and Etiology of Physical Activity and Substance
Use
 Panel 4: Physical Activity and Mood — Implications for Prevention
 Panel 5: The Potential Role of Physical Activity on Attention and
Other Cognitive Processes — A New Paradigm for Drug Abuse
Prevention?
 Panel 6: Physical Activity and Reward Mechanisms — A Model for
Prevention Intervention Development
Funding Opportunity
Announcement
 Interactions between Physical Activity
and Drug Abuse
RFA-DA-09-013 (R01), RFA-DA-09-014
(R03)
 Receipt Date: January 29,2009
 Over 70 applications
Program Officials
(e.g., research cheerleaders)
Advice and Guidance
What’s Hot: New initiatives
Answer your scientific questions
Review Issues: Dos and Don’ts
Discuss funding alternatives
In other words, send a 2-3 page concept!
[email protected]
Casting the Net to Other
Health Areas
 Experiential Education and Public
Health: The Potential to MOVE America
toward Health
Scary Health Costs
 In 2007, the U.S. spent over $2.2 trillion on
health care, and 75 cents of every dollar
went towards treating patients with one or
more chronic diseases
 If the prevalence of obesity was the same
today as in 1987, health care spending in
America would nearly be 10 % lower per
person – about $200 billion less
The Preventable Behaviors that
Cause Scary Health Costs
 The CDC estimates
that
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80% of heart disease
and stroke
80% of Type 2
diabetes
40% of cancer
 Could be prevented if
American’s did these
three things:
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Stop smoking
Start eating healthy
Get in shape
Marijuana, Inhalants, and Prescription Drugs
Are Top Three Substances Abused by Teens
Percentage of U.S. Teens (Grades 7 to 12) Reporting Ever
Trying Drugs, 2008
(N=6,518)
Marijuana
33%
Inhalants
19%
Prescription Drugs
19%
OTC Cough Medicine
10%
Crack/Cocaine
9%
Ecstasy
LSD
Meth
8%
7%
6%
Ketamine
5%
Heroin
5%
G HB
0%
4%
5% 10% 15% 20% 25% 30% 35%
Number and Percent Distribution of
Victim to Offender Relationships,
All Violent Crimes, 1995
Relationship
Family member
Number
59,361
Percentage
23%
Offender and
victim
12,949
5%
Acquaintance
122,691
48%
Stranger
39,006
15%
Unknown
Relationship
20,308
8%
Universal, School-Based
Violence Prevention as an
Example
 Failure of educational and attitude-only
programs to sustain behavior change
 Skills and small group interaction based
approaches
 Responding in Peaceful and Positive
Ways
Appeal of Experiential
Approaches
 Four categories of adventure programs
(Priest, Gass & Gillis, 2000/2003)
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Recreational  feelings
Educational  thinking and feelings
Developmental  social behaviors, thinking,
and feelings
Treatment or therapy  decreasing
dysfunctional behaviors and improving functional
behaviors, social behaviors, thinking and feeling
Active approaches that are fun
 How to teach diffuse? 
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Tenkan
 Appeal of moving beyond fun activities to
intentional, experiential approaches 
“…simply going camping with juvenile
offenders may produce youth more
capable of living in the wilderness, but
not necessarily youth more capable of
succeeding in society.”
Consider the cumulative effects of
inactivity, quick fix orientation to
discomfort, and negative interactions with
those we care about….
 What can Adventure teach U.S. about…
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Physical activity?
Healthful eating?
Natural highs?
Social support?
Coping with stress?
Conflict resolution?
Adventure as Prevention or
Treatment?
 Potential Mechanisms of Change (experimental
etiology)
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Emotion-regulation
Attention processes and executive control
Sensation-seeking / Reward-pleasure mechanisms
Sensory-motor coordination
Healthy lifestyles
Adult-child relationships
Experiential Intervention Processes
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Immediate feedback (e.g., reinforcement and
consequences)
Skill development (e.g., behavioral enactment and
rehearsal)
Emotion-affect link to real-life experiences (e.g.,
building a personal history of experience)
Social interaction
Development of specific competencies
Becoming teachable and coachable
Experiential Approaches
Funded by NIH
 Across NIH institutes
 Different funding mechanisms
 R03
 R21
 R34
 R01
 P and U mechanisms
 K’s and supplements
HealthWise South
Africa: Life Skills for
Young Adults
Funded by National Institute
on Drug Abuse
Promoting healthy development and
reducing risky behavior at a crucial
developmental time point: early to middle
adolescence
 Examined the impact of the HealthWise school-based
curriculum on substance use, violence, and sexual risk
behaviors among low-income 8th and 9th grade students in
South Africa.
 The HealthWise program builds upon Botvin’s Life Skills
Training and is designed:
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To help youth understand the benefits of leisure
To avoid boredom and develop interests
To teach youth leisure skills (such as how to plan for leisure and
overcome constraints)
To encourage youth to take personal responsibility around making
healthy, meaningful, and developmentally productive choices in
one’s free time.
Reduce risk behaviors by increasing the
influence of protective factors
 Comprehensive intervention
In-school curriculum
 After school strategy
 Targeted risk behaviors -substance use, sexual risk
behavior, and enacting
violence
 12 lessons in grade 8
 3 50-min. classes per
lesson
 6 booster lessons in grade 9
 2-3 50-min classes per
lesson
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 Implemented by trained
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teachers
Linkages with recreation and
health providers
Skills to make leisure more
positive and meaningful
Self-management skills (e.g.,
reduce anger, anxiety, stress)
Negotiating relationships
Identifying and avoiding risky
situations
Learning facts about sexual
risk behavior and substance
misuse
Past Month Alcohol Use
(Beg. Grade 8)
(Beg. Grade 10)
Results of HealthWise in South
Africa
 Positive effects on cigarette and alcohol use (and
condom use self-efficacy) are very encouraging
and indicate the program is a potentially promising
efficacious program that may be helpful in
reducing some risk behaviors among low-income
adolescents in South African and elsewhere.
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Smith, E., Palen, L., Caldwell, L., Flisher, A., Graham,
J., Mathews, C., Wegner, L., & Vergnani,T. (2008).
Prevention Science e pub.
Physical Activity in Adults and
Early Adolescence
 Improving Safety and Access for
Physical Activity – D. Wilson (R01NIDDK)
 Self-Determination for Increasing
Physical Activity – D. Wilson (R01NICHD)
Experiential Approaches for
Normative Transitions
 Community Partnership to Affect
Cherokee Adolescent Substance Abuse
– J. Lowe (R01 – NIDA)
 The Senior Odyssey: A Test of the
Engagement Hypothesis of Cognitive
Aging Stine-Morrow R01-NIA
Early Childhood
 The CIA (Children in Action) Program –
T. Nicklas R21-NICHD
 Measuring Physical Activity Affordances
in Preschool Outdoor Environments R.
Moore R21-ES
Stress and Trauma
 Stress Reduction: Impact on BP in
African American Youth F-Treiber R01NHLBI
 Mindful Awareness in Body-Oriented
Therapy for Women's Substance Abuse
Treatment C. Price R21-NIDA
 A First-Line Community-Based
Mindfulness Trauma Intervention M.
Dutton R34 - NIMH
Cessation and Relapse
Prevention
 Group Therapy for Nicotine Dependence
D. Wetter R01-NIDA
 Experiential Avoidance and Substance
Use Relapse N. Chawla F31-NIDA
The State of “Best Practices”
 Although there has been tremendous
progress in the area of evidence-based
practices, prevention and treatment
efforts to sustain health behavior change
have not had the hoped for impact on
public health.
A Familiar Story
 Despite great outcomes in efficacy and
effectiveness trials, dissemination and
sustainability not happening.
 NIDA and SAMSHA efforts
 Steve Aos at University of Washington
Percent of US High Schools Using Evidencebased Substance Use Prevention Programs
(based on SAMHSA NREPP)
60%
56.5%
50%
40%
30%
20%
10.3%
10%
5.7%
NREPP Programs:
•ATLAS*
•Keepin’ it REAL*
•Positive Action*
•Project Toward No Drug
Abuse*
•Project Toward No
Tobacco Use+
•Too Good for Drugs
0%
Use of EBP
Primary use of
EBP
Use of any
Program#
# Regardless of evidence-base
* NIDA funded research
+ NCI funded research
Ringwalt et al. The prevalence of substance use prevention curricula in the nation’s high schools. J Primary
Prevent, 29, pp. 479-488, 2008.
Type One and Type Two
Translation Research
 Type One  Applies basic science discoveries to the
development of interventions for the prevention and
treatment of drug abuse, i.e., clinical research. Usually
called “bench to bedside.”
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Families that have dinner together….
Link this to Russell’s concurrent model…
Role of bursts of exercise on academic performance
Role of motivation in physical activity (Presidential
Guidelines)
Drug preferences change….natural highs??
Type One and Type Two
Translation Research
 Type Two  Research on factors associated with the
adoption and utilization of scientifically validated
interventions by service systems under controlled,
uncontrolled or uncontrollable conditions, i.e., services
research.
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CLINICAL PROCESSES IN DRUG ABUSE PREVENTION –
D. Coatsworth R01-NIDA
Implementation of Adventure Programs
Implementation is Key:
Core implementation components are
integrated and compensatory (NIRN)
Center Tests
NIH Funding Opportunities
 American Recovery Act (ARRA)
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Challenge Grants
Additional RFA’s
 Existing Program Announcements
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Drug Abuse Prevention Intervention Research
PA-08-217 (R01), PA-08-218 (R21), PA-08-219 (R03)
Reducing Risk Behaviors by Promoting Positive Youth
Development PA-08-241 (R01), PA-08-242 (R03)
 Training Opportunities
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Diversity Supplements
Transition Awards
Educators, Scientists and Contemplatives
Dialogue on Cultivating a Healthy Mind,
Brain, and Heart
Because experiences can effect
individuals on all levels…
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Physiological
Emotional
Cognitive
Psychological
Social
Historical
 …the experiential approach has tremendous
potential to sustain behavior change over time
Compared to didactic, skillsbased, and educational
modalities…
 Experiential modalities…
Have naturally-occurring behavioral
reinforcement built-in
 Can provide metaphors to promote transfer of
learning
 Offer a learning style favored by many
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