NIH research opportunities for the prevention and treatment for chronic conditions

NIH research opportunities for the prevention and treatment for chronic conditions Abstract Chronic conditions constitute the leading cause of death and disability in the USA and constitute 86 per cent of the nation’s annual healthcare expenses. Approximately half of all American adults have at least one chronic condition; 25 per cent of these Americans have two or more chronic conditions. The National Institutes of Health have funded many projects that explain epidemiology, risk factors, and prevention and treatment of chronic conditions, though research questions remain. This commentary discusses some past projects, current areas of interest, and funding opportunities from many NIH Institutes, Centers, and Offices. INTRODUCTION Chronic conditions are the leading cause of death and disability in the USA and constitute 86 per cent of the nation’s annual healthcare expenses [1]. Approximately half of all American adults have at least one chronic condition; 25 per cent of these Americans have two or more chronic conditions [2, 3, 4, 5, 6]. In 2014, two chronic conditions, heart disease and cancer, comprised more than 45 per cent of all deaths [3]. Arthritis, cancer, cardiovascular disease, dental caries, depression and other mental illness, diabetes mellitus, kidney disease obesity, stroke, and urinary tract symptoms are the more frequently occurring chronic conditions across ages, economic statuses, and races/ethnicities and can be ameliorated, managed, or even prevented through patient and provider behaviors. For example, the Framingham Heart Study distinguished the risk and protective factors for cardiovascular disease. Although heart disease remains the leading cause of death nationwide, the death rate for heart disease has dropped by more than 60 per cent since 1940. The death rate for stroke, the third most common cause of death, declined by 70 per cent over the same period [7, 8]. Another well-known example is the Diabetes Prevention Program (DPP), a multisite study with profound early findings like healthier eating and physical activity was more effective at preventing diabetes mellitus than metformin and has been disseminated effectively through settings as broad as e-interventions, healthcare settings, and YMCAs [9, 10, 11, 12]. Nevertheless, multiple research opportunities remain. Most NIH Institutes, Centers, and Offices (ICOs) support research in chronic disease management. Below are perspectives from a sample of NIH Institutes. NATIONAL CANCER INSTITUTE Based on the most recent estimates, 5-year relative survival rates for the five most common cancers are as follows: breast, 90 per cent; prostate, 100 per cent; lung, 16 per cent; colorectal, 67 per cent; and bladder, 81 per cent, thanks to improved prevention efforts, cancer screening, and advances in surgical, radiological, and pharmaceutical treatments. By 2014, the USA is expected to have 20-million cancer survivors [13]. Despite this success, cancer survivors experience many problems resulting from cancer and/or its treatment, which may include medical nonadherence, fatigue, depression, decreased cognitive and physical functioning, and adverse body composition changes. National Cancer Institute (NCI) has an ongoing interest to support research that improves behavioral prevention and management of cancer outcomes. Recent studies implicate the sympathetic and parasympathetic components of the autonomic nervous system in the regulation of cancers, for example, chronic lymphocytic leukemia and prostate, gastric, and pancreatic cancers [13]. Two funding opportunity announcement (FOAs; PAR-16-245 and PAR-16-246) seek studies to leverage relevant technologies and neuroscience research knowledge to accelerate understanding of the neural mechanisms that modulate cancer formation, progression, and metastasis and could prove essential in developing or improving the prevention and treatment of cancer. Two FOAs, PAR-16-317 and PAR-16-318, encourage submissions for testing interventions to support caregivers of adult cancer patients and thereby optimize patient health care utilization, improve caregiver well-being, and improve patient health and psychosocial outcomes. More recent FOAs, PA-17-060 and PA-17-061, solicit projects that evaluate the current state of oral anticancer medical use, delivery, and adherence. One focus is to identify structural, systemic, and psychosocial barriers, emotional factors, motivational factors, factors that influence decision making, social factors, to adherence. NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH (NIDCR) The dental, oral, and craniofacial health fields face challenges related to chronic conditions, all of which have significant behavioral or social components, and so present an opportunity for translation of behavioral and social science principles to tackle these challenges. A few examples follow, and we hope that the community views these as a call to action to apply expertise to tackling important public health challenges you may not have considered before. Dental caries is among the most common chronic conditions in significantly both children and adults. It is largely preventable, and the prevalence has decreased for many Americans, but there still are communities that bear an unequal burden of untreated caries disease. Black and Hispanic children and those living in families with lower incomes have more dental decay [14]; this pattern continues across the lifespan, culminating with 18 per cent of seniors 65 and older having untreated decay [15]. A class of conditions referred to as temporomandibular joint and muscle disorders (TMJDs) are the second most common chronic musculoskeletal condition resulting in pain and disability (after chronic low back pain), affecting approximately 5%–12% of the population, with some annual cost estimates of $4 billion. We know that patients with chronic TMJD have alterations in several genes, including some known to influence stress response, psychological well-being, and inflammation [16]. Periodontal diseases are another potentially chronic condition that affect many, and in their most serious forms lead to tooth loss, systemic infection, and even mortality. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from diagnosis on. More rare instances of chronic dental and oral conditions—but no less important—are salivary gland autoimmune diseases such as Sjogren’s syndrome, which ranks second only to the autoimmune disease rheumatoid arthritis, and affect an estimate of 1 million to 4 million people. Women outnumber men by 9:1 in Sjogren’s diagnoses. In Sjögren’s syndrome, salivary and tear glands are the major targets of the attack, which results in a decrease or near-elimination in production of saliva causing symptoms of dry mouth (known as xerostomia), difficulties with speech and swallowing food, extensive tooth decay, tooth loss, oral sores, and fungal infections in the mouth [17]. NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES Substantial opportunity exists to expand our understanding of sociobehavioral approaches to the prevention and treatment of diseases and conditions under the National Institute of Diabetes and Digestive and Kidney Diseases’s (NIDDK) purview. Despite a strong evidence base for behavioral approaches in preventing and managing both diabetes and obesity, gaps remain. In diabetes, improved understanding of socioecological influences on behavior is needed to inform novel intervention models, as well as strategies for scaling-up, tailoring, and spreading existing efficacious interventions. Additionally, strategies for integrating emerging scientific knowledge in behavioral interventions are needed, such as the role of psychosocial and socioecological stress in the development and progression of diabetes. In obesity, improved understanding of behavioral and psychological phenotypes that explain individual variability in adherence and response to lifestyle interventions is needed to personalize interventions and potentially enhance treatment response. A FOA (PAR-16-034) for ancillary studies that identify behavioral or psychological phenotypes that contribute to obesity encourages the collection of measures in relevant domains in extant studies. The evidence for the role of self-management in improving chronic kidney disease (CKD) outcomes is growing [18], but further research is needed to understand the scope of behavioral interventions in slowing progression of CKD and preventing acute kidney injury (AKI). Additionally, the recently launched Kidney Precision Medicine Project—which seeks to individualize care to patients with CKD and AKI by identifying disease subtypes and developing targeted treatments—will require cultural and behavioral changes in patients, nephrologists, and pathologists surrounding ascertainment of kidney biopsies that are expected to drive this research [19]. Behavioral approaches to urinary (kidney) stone prevention are being explored through the Urinary Stone Disease Research Network’s Prevention of Urinary Stones with Hydration (PUSH) study, a randomized clinical trial to assess whether a program of behavioral interventions, including increased fluid intake, will help prevent stone disease recurrence or progression. First line treatments for many lower urinary tract symptoms (LUTS) include behavioral strategies, such as pelvic floor muscle therapy, timed voiding, and fluid management. Yet, recent research relating to treatment of LUTS has focused primarily on pharmaceutical and surgical interventions. NIDDK leadership recognizes a need to better understand the role of self-management in the treatment of LUTS [20], and the Institute is encouraging a comprehensive approach to LUTS research that considers behavioral, cognitive, and social determinants of health [21]. Such research will be integral to interdisciplinary efforts needed to enable better targeting of LUTS treatments based on individual biological, cognitive, and social characteristics of the patient [22]. NIDDK encourages interdisciplinary teams to develop and submit investigator-initiated research projects that enable individualized treatment in LUTS [22]. As stated earlier, chronic conditions share common challenges associated with their management including dealing with symptoms and disability; monitoring physical indicators; managing complex medication regimens; maintaining proper levels of nutrition, diet, and exercise; adjusting to psychological and social demands, and engaging in effective interactions with health care providers. Regardless of the condition, a generic set of skills has proven successful in allowing individuals to effectively manage their illness and improve health outcomes: self-management [23, 24, 25]. NATIONAL HEART, LUNG, AND BLOOD INSTITUTE There are four goals on which the National Heart, Lung, and Blood Institute (NHLBI) Strategic Vision rests, including improving understanding of normal biological function, reducing human disease, furthering investigation of translational research, and cultivating and maintaining a high-quality scientific workforce and resources [26]. NHLBI supports behavioral and social sciences research within each of its three scientific Divisions (Division of Cardiovascular Sciences, Division of Lung Diseases, and Division of Blood Diseases and Disorders) and two Centers (Center for Translational Research and Implementation Science, and the National Center on Sleep Disorders Research). Genetics, individual behaviors and lifestyle, psychosocial factors, health care availability and access, and the environment operate together to influence the initiation, progression, and management of the myriad chronic conditions relevant to NHLBI. These conditions include hypertension, obesity, heart failure, asthma, sickle cell disease, and obstructive sleep apnea, among others. Behavioral and lifestyle factors are key to effective management of many of these conditions. Management of chronic conditions is an important focus of research at NHLBI, and understanding the role of patient and provider adherence is key. For example, adherence to asthma control medications is relatively low especially in children, and interventions to improve adherence rates are often cumbersome and not cost-effective. NHLBI-funded investigators have tested ways to improve adherence rates using mHealth and other new technologies, as well as phone-based coaching [27]. These have proven to be effective and cost-effective strategies that can be implemented in a variety of patient populations and families, in a wide array of settings, and cannot only improve adherence but also decrease asthma morbidity. Although hypertension has significant influence on all-cause and cardiovascular mortality in the USA, about half of all patients with hypertension are inadequately controlled. Understanding how to best implement evidence-based interventions in primary care and other real-world settings for optimal blood pressure control is important. NHLBI funds studies to identify and test strategies that lead to better control, including team-based care incorporating primary care providers, nurses, and clinical pharmacists. These strategies are effective in improving blood pressure control, including among patients in racial minority groups and medically underserved individuals. Primary and secondary prevention strategies play an important role in decreasing the risk of chronic disease development and mitigating the impact of chronic conditions. NHLBI supports clinical research on implementation of smoking cessation interventions, and mechanistic research on the pathophysiological effects of inhaled nicotine on the respiratory and cardiovascular systems in the context of noncancer heart and lung diseases, as well as research to increase our understanding of the physiological impact of e-cigarettes on cardiovascular and pulmonary health. The alarming increase in the rates of obesity and overweight suggests that a more informed understanding of the characteristics of community programs and policies that are related to lower childhood obesity rates, healthy eating, and physical activity behaviors may be important. Racial and ethnic disparities in heart, lung, blood, and sleep diseases remain substantial. Although there have been significant efforts to address disparities, the barriers are complex. NHLBI is supporting research to understand the role of environmental, psychosocial, and behavioral factors in contributing to, and alleviating, health disparities. Studies include investigation of the role of parks and recreation facilities to address health disparities by encouraging health-promoting behaviors; understanding the impact of the built and social environment in contributing to health outcomes, how these are mediated by risk factors such as sleep behaviors and obesity; investigating how to implement effective interventions to support healthy eating patterns among low income individuals; and testing strategies to improve adherence to treatment for chronic disease conditions such as hypertension. In addition, although research in early-stage translational research to uncover fundamental knowledge regarding basic physiological phenomenon and test interventions in well-controlled settings has been highly successful, fewer efforts have been devoted to later stage implementation science. NHLBI has been a leader in implementation research, which tests strategies for delivering effective interventions in real-world environments among unselected, and often multi-comorbid, populations. NATIONAL INSTITUTE OF NURSING RESEARCH Self-management is an approach to help individuals with chronic conditions and their caregivers better understand and manage their illness and improve their health behaviors. Research supported by National Institute of Nursing Research (NINR) helps individuals from diverse backgrounds and their families live with chronic illnesses by developing effective approaches to self-management that can improve quality of life while reducing the burden for caregivers and the health care system [28]. For example, NINR has a long-standing interest in supporting research on caregivers who need help with managing their own health while making sure the needs of the care recipient are being met. As a disease agnostic institute, NINR is uniquely positioned to support science pertaining to self-management of multiple comorbid conditions, self-management across the life cycle, and interventions that work across chronic conditions. Although much important work is already underway, there remain many challenges in improving health and the quality of life through self-management of chronic conditions. Included among the many research gaps are identifying sustainable self-management interventions for individuals faced with chronic conditions; defining positive influences for self-management of chronic conditions in underserved environments, improving the self-management of chronic pain, and promoting caregiver health. As one means to encourage nursing science in the realm of self-management and chronic conditions, NINR engaged stakeholders in a dialogue to identify novel scientific questions (the Innovative Questions Initiative) that could guide the research over the next 5–10 years. OFFICE OF BEHAVIORAL AND SOCIAL SCIENCES RESEARCH Like NINR, Office of Behavioral and Social Sciences Research (OBSSR) does not focus on specific diseases or somatic components. Rather, this office strives to increase the impact of social and behavioral sciences across health-related research and to foster emerging scientific areas and topics that span and complement multiple NIH Institutes and Centers (ICs). For example, OBSSR facilitated a multi-IC FOA to stimulate interventions that substantively improve medication adherence for one or more chronic conditions and to collect self-reported data, biomarkers, or clinical assessments when identified biomarkers do not exist. Prescriptions are not necessarily sufficient for the healthiest possible lives of people with chronic conditions. Accordingly, OBSSR cofounded the NIH Adherence Research Network to promote adherence as the extent to which human behaviors including taking medication, following a diet, modifying habits, and attending healthcare appointments, coincide with evidence-based medical or health advice. The Network fosters internal workshops and work sessions and a seminar series to promote the broad body of NIH-funded biobehavioral adherence and related research. For example, the OBSSR-led trans-NIH FOAs to promote population health interventions solicit proposed projects that integrate biological and clinical measures as they account for social, economic, and environmental conditions to improve overall health and reduce disease burden. Simply put, OBSSR strives to integrate behavioral and social sciences throughout the biomedical research enterprise to promote interdisciplinary biopsychosocial research that improves the human condition (Table 1). Table 1 Select ICO-led funding opportunity announcements (FOAs) Participating Institute(s) Title Mechanism Number Expiration date NIDDK Pragmatic Research in Healthcare Settings to Improve Diabetes and Obesity Prevention and Care R18 PAR-17-177 11/02/2019 NIDDK Addressing Health Disparities in NIDDK Diseases R01 PA-17-021 01/08/2020 NIDDK NINR Health Promotion Among Racial and Ethnic Minority Males R01 PA-16-428 01/08/2020 NIDDK ODP OBSSR Ancillary Studies to Identify Behavioral and/or Psychological Phenotypes Contributing to Obesity R01 PAR-16-304 03/01/2019 NIDDK NICHD NIMHD OBSSR NHLBI Understanding Factors in Infancy and Early Childhood (Birth to 24 months) That Influence Obesity Development R01 PA-16-169 05/08/2019 NIDDK NCI NIA NICHD ODP OBSSR Obesity Policy Evaluation Research R01 PA-16-165 05/08/2019 NINR Promoting Caregiver Health Using Self-management R01 PA-17-062 05/08/2020 NINR Chronic Condition Self-management in Children and Adolescents R01 R21 PA-17-115 PA-17-116 05/08/2020 OBSSR NCI NIAAA NIDCR NIDA NIDCD Population Health Interventions: Integrating Individual and Group Level Evidence R01 R21 PA-16-146 PA-16-147 05/08/2019 NCI Oral Cancer Agents, Utilization, Adherence and Health Care Delivery R01 R21 PA-17-060 PA-17-061 01/08/2020 NCI Neural Regulation of Cancer R01 R21 PAR-16-245 PAR-16-246 06/28/2019 NCI Innovative Approaches to Studying Cancer Communication in the New Media Environment R01 R21 PAR-16-249 PAR-16-248 06/14/2019 NCI Intervening with Cancer Caregivers to Improve Patient Health Outcomes and Optimize Health Care Utilization R01 R21 PAR-16-317 PAR-16-318 04/12/2019 NCI Improving Outcomes in Cancer Treatment- Related Cardiotoxicity R01 PA-18-003 PA-18-013 01/08/2019 NHLBI Single-Site Investigator-Initiated Clinical Trials R61/R33 PAR-18-406 9/14/2019 NIDDK NCI NIAAA NCCIH NHLBI ODS Diet and Physical Activity Assessment Methodology R01 PA-18-010 5/8/2019 Participating Institute(s) Title Mechanism Number Expiration date NIDDK Pragmatic Research in Healthcare Settings to Improve Diabetes and Obesity Prevention and Care R18 PAR-17-177 11/02/2019 NIDDK Addressing Health Disparities in NIDDK Diseases R01 PA-17-021 01/08/2020 NIDDK NINR Health Promotion Among Racial and Ethnic Minority Males R01 PA-16-428 01/08/2020 NIDDK ODP OBSSR Ancillary Studies to Identify Behavioral and/or Psychological Phenotypes Contributing to Obesity R01 PAR-16-304 03/01/2019 NIDDK NICHD NIMHD OBSSR NHLBI Understanding Factors in Infancy and Early Childhood (Birth to 24 months) That Influence Obesity Development R01 PA-16-169 05/08/2019 NIDDK NCI NIA NICHD ODP OBSSR Obesity Policy Evaluation Research R01 PA-16-165 05/08/2019 NINR Promoting Caregiver Health Using Self-management R01 PA-17-062 05/08/2020 NINR Chronic Condition Self-management in Children and Adolescents R01 R21 PA-17-115 PA-17-116 05/08/2020 OBSSR NCI NIAAA NIDCR NIDA NIDCD Population Health Interventions: Integrating Individual and Group Level Evidence R01 R21 PA-16-146 PA-16-147 05/08/2019 NCI Oral Cancer Agents, Utilization, Adherence and Health Care Delivery R01 R21 PA-17-060 PA-17-061 01/08/2020 NCI Neural Regulation of Cancer R01 R21 PAR-16-245 PAR-16-246 06/28/2019 NCI Innovative Approaches to Studying Cancer Communication in the New Media Environment R01 R21 PAR-16-249 PAR-16-248 06/14/2019 NCI Intervening with Cancer Caregivers to Improve Patient Health Outcomes and Optimize Health Care Utilization R01 R21 PAR-16-317 PAR-16-318 04/12/2019 NCI Improving Outcomes in Cancer Treatment- Related Cardiotoxicity R01 PA-18-003 PA-18-013 01/08/2019 NHLBI Single-Site Investigator-Initiated Clinical Trials R61/R33 PAR-18-406 9/14/2019 NIDDK NCI NIAAA NCCIH NHLBI ODS Diet and Physical Activity Assessment Methodology R01 PA-18-010 5/8/2019 At the time of publication, NIDCR FOAs were under revision to comply with NIH clinical trial policies. View Large Table 1 Select ICO-led funding opportunity announcements (FOAs) Participating Institute(s) Title Mechanism Number Expiration date NIDDK Pragmatic Research in Healthcare Settings to Improve Diabetes and Obesity Prevention and Care R18 PAR-17-177 11/02/2019 NIDDK Addressing Health Disparities in NIDDK Diseases R01 PA-17-021 01/08/2020 NIDDK NINR Health Promotion Among Racial and Ethnic Minority Males R01 PA-16-428 01/08/2020 NIDDK ODP OBSSR Ancillary Studies to Identify Behavioral and/or Psychological Phenotypes Contributing to Obesity R01 PAR-16-304 03/01/2019 NIDDK NICHD NIMHD OBSSR NHLBI Understanding Factors in Infancy and Early Childhood (Birth to 24 months) That Influence Obesity Development R01 PA-16-169 05/08/2019 NIDDK NCI NIA NICHD ODP OBSSR Obesity Policy Evaluation Research R01 PA-16-165 05/08/2019 NINR Promoting Caregiver Health Using Self-management R01 PA-17-062 05/08/2020 NINR Chronic Condition Self-management in Children and Adolescents R01 R21 PA-17-115 PA-17-116 05/08/2020 OBSSR NCI NIAAA NIDCR NIDA NIDCD Population Health Interventions: Integrating Individual and Group Level Evidence R01 R21 PA-16-146 PA-16-147 05/08/2019 NCI Oral Cancer Agents, Utilization, Adherence and Health Care Delivery R01 R21 PA-17-060 PA-17-061 01/08/2020 NCI Neural Regulation of Cancer R01 R21 PAR-16-245 PAR-16-246 06/28/2019 NCI Innovative Approaches to Studying Cancer Communication in the New Media Environment R01 R21 PAR-16-249 PAR-16-248 06/14/2019 NCI Intervening with Cancer Caregivers to Improve Patient Health Outcomes and Optimize Health Care Utilization R01 R21 PAR-16-317 PAR-16-318 04/12/2019 NCI Improving Outcomes in Cancer Treatment- Related Cardiotoxicity R01 PA-18-003 PA-18-013 01/08/2019 NHLBI Single-Site Investigator-Initiated Clinical Trials R61/R33 PAR-18-406 9/14/2019 NIDDK NCI NIAAA NCCIH NHLBI ODS Diet and Physical Activity Assessment Methodology R01 PA-18-010 5/8/2019 Participating Institute(s) Title Mechanism Number Expiration date NIDDK Pragmatic Research in Healthcare Settings to Improve Diabetes and Obesity Prevention and Care R18 PAR-17-177 11/02/2019 NIDDK Addressing Health Disparities in NIDDK Diseases R01 PA-17-021 01/08/2020 NIDDK NINR Health Promotion Among Racial and Ethnic Minority Males R01 PA-16-428 01/08/2020 NIDDK ODP OBSSR Ancillary Studies to Identify Behavioral and/or Psychological Phenotypes Contributing to Obesity R01 PAR-16-304 03/01/2019 NIDDK NICHD NIMHD OBSSR NHLBI Understanding Factors in Infancy and Early Childhood (Birth to 24 months) That Influence Obesity Development R01 PA-16-169 05/08/2019 NIDDK NCI NIA NICHD ODP OBSSR Obesity Policy Evaluation Research R01 PA-16-165 05/08/2019 NINR Promoting Caregiver Health Using Self-management R01 PA-17-062 05/08/2020 NINR Chronic Condition Self-management in Children and Adolescents R01 R21 PA-17-115 PA-17-116 05/08/2020 OBSSR NCI NIAAA NIDCR NIDA NIDCD Population Health Interventions: Integrating Individual and Group Level Evidence R01 R21 PA-16-146 PA-16-147 05/08/2019 NCI Oral Cancer Agents, Utilization, Adherence and Health Care Delivery R01 R21 PA-17-060 PA-17-061 01/08/2020 NCI Neural Regulation of Cancer R01 R21 PAR-16-245 PAR-16-246 06/28/2019 NCI Innovative Approaches to Studying Cancer Communication in the New Media Environment R01 R21 PAR-16-249 PAR-16-248 06/14/2019 NCI Intervening with Cancer Caregivers to Improve Patient Health Outcomes and Optimize Health Care Utilization R01 R21 PAR-16-317 PAR-16-318 04/12/2019 NCI Improving Outcomes in Cancer Treatment- Related Cardiotoxicity R01 PA-18-003 PA-18-013 01/08/2019 NHLBI Single-Site Investigator-Initiated Clinical Trials R61/R33 PAR-18-406 9/14/2019 NIDDK NCI NIAAA NCCIH NHLBI ODS Diet and Physical Activity Assessment Methodology R01 PA-18-010 5/8/2019 At the time of publication, NIDCR FOAs were under revision to comply with NIH clinical trial policies. View Large CHALLENGES AND OPPORTUNITIES For approximately half the American population, daily life includes a chronic condition. Although people with chronic diseases must perform most, if not all, tasks to maintain optimal health and wellbeing, their lives hardly exist in a vacuum. Such individuals are at the crux of multiple social/human networks, families, friendships, neighborhoods, workplaces, peers, and healthcare providers. The structure and function of those networks not only influence emotional wellbeing but also can extend, impede, or support myriad behaviors that comprise management of their health and respective conditions. Sequelae from each condition, the interactions among conditions, and biomedical interactions among treatments for the conditions can have myriad effects. Behavioral and social researchers complement biomedical researchers to understand the effects of chronic medical conditions on human health and how human behavior to treat and manage a given condition in turn influences biological sequelae, interactions with others, and personally perceived health and wellbeing. Compliance with Ethical Standards Conflict of Interest: None declared. Primary Data: This manuscript represents original work and has not been published elsewhere. It has not and will not be published elsewhere until Translational Behavioral Medicine decides on its acceptability for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH) or the United States Government. Ethical Approval: This work is a commentary on current federally funded initiatives; no animals, human subjects, or data were used in this work. References 1. Gerteis J , Izrael D , Deitz D et al. Multiple Chronic Conditions Chartbook . Rockville, MD : Agency for Healthcare Research and Quality ; 2014 . 2. Ward BW , Schiller JS , Goodman RA . Multiple chronic conditions among US adults: A 2012 update . Prev Chronic Dis . 2014 ; 11 : E62 . Google Scholar PubMed 3. National Center for Health Statistics . Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities . Hyattsville, MD : Centers for Disease Control and Prevention , 2016 . 4. Ogden CL , Carroll MD , Fryar CD , Fegal KM . Prevalence of obesity among adults and youth: United States, 2011–2014 . NCHS Data Brief . 2015 ; 219 : 1 – 8 . 5. Kupelian V , Wei JT , O’Leary MP et al. ; BACH Survery Investigators . Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: The Boston Area Community Health (BACH) Survey . Arch Intern Med . 2006 ; 166 ( 21 ): 2381 – 2387 . Google Scholar CrossRef Search ADS PubMed 6. 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Yeh MC , Heo M , Suchday S et al. Translation of the Diabetes Prevention Program for diabetes risk reduction in Chinese immigrants in New York City . Diabet Med . 2016 ; 33 ( 4 ): 547 – 551 . Google Scholar CrossRef Search ADS PubMed 11. Knowler WC , Fowler SE , Hamman RF et al. ; Diabetes Prevention Program Research Program . 10-year follow-up of diabetes incidence and weight loss in the diabetes prevention program outcomes study . The Lancet 2009 ; 372 (9102) : 1677 – 1686 . 12. Chambers EC , Wylie-Rosett J , Blank AE et al. Increasing referrals to a YMCA-based diabetes prevention program: effects of electronic referral system modification and provider education in Federally Qualified Health Centers . Prev Chronic Dis . 2015 ; 12 : E189 . Google Scholar CrossRef Search ADS PubMed 13. National Institutes of Health . NIH Fact Sheets: Cancer . Available at https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=75. Accessibility verified November 13, 2017 . 14. 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Google Scholar CrossRef Search ADS PubMed 18. Star RA , Norton JM , Dayal S . Nephrology of the future: How do we get there ? Kidney News 2017 ; 3 . 19. Norton JM , Bavendam TG , Elwood WN et al. Research needs to understand self-management in Men with LUTS: A review and summary of a NIDDK workshop . J Uro 2017 ; doi:10.1016/j.juro.2017.11.079 20. Bavendam TG , Norton JM , Kirkali Z et al. Advancing a comprehensive approach to the study of lower urinary tract symptoms . j Urol . 2016 ; 196 ( 5 ): 1342 – 1349 . Google Scholar CrossRef Search ADS PubMed 21. Norton JM , Bradley CS , Brady SS et al. Individualizing Treatment: Broadening the Framework for Urinary Incontinence Research Meeting Summary, 2017 . Available at https://www.niddk.nih.gov/news/events-calendar/Pages/Individualizing-Treatment-Broadening-the-Framework-for-Urinary-Incontinence-Research.aspx. Accessibility verified October 13, 2017 . 22. Grady PA , Gough LL . Self-management: A comprehensive approach to management of chronic conditions . Am j Public Health . 2014 ; 104 ( 8 ): e25 – e31 . Google Scholar CrossRef Search ADS PubMed 23. Richardson J , Loyola-Sanchez A , Sinclair S et al. Self-management interventions for chronic disease: A systematic scoping review . Clin Rehabil . 2014 ; 28 ( 11 ): 1067 – 1077 . Google Scholar CrossRef Search ADS PubMed 24. Creer TL , Holroyd KA . Self-management . In Ayers S , Baum A , McManus C , Newman S , Wallson K , Weinman J , West R . eds. Cambridge Handbook of Psychology, Health, and Medicine . New York : Cambridge University Press ; 255 – 258 . 25. National Heart, Lung and Blood Institute . Strategic Vision, 2016 . Available at https://www.nhlbi.nih.gov/about/documents/strategic-vision. Accessibility verified November 14, 2017 . 26. Bender BG , Cvietusa PJ , Goodrich GK et al. 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This work is written by (a) US Government employee(s) and is in the public domain in the US. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Translational Behavioral Medicine Oxford University Press

NIH research opportunities for the prevention and treatment for chronic conditions

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Abstract

Abstract Chronic conditions constitute the leading cause of death and disability in the USA and constitute 86 per cent of the nation’s annual healthcare expenses. Approximately half of all American adults have at least one chronic condition; 25 per cent of these Americans have two or more chronic conditions. The National Institutes of Health have funded many projects that explain epidemiology, risk factors, and prevention and treatment of chronic conditions, though research questions remain. This commentary discusses some past projects, current areas of interest, and funding opportunities from many NIH Institutes, Centers, and Offices. INTRODUCTION Chronic conditions are the leading cause of death and disability in the USA and constitute 86 per cent of the nation’s annual healthcare expenses [1]. Approximately half of all American adults have at least one chronic condition; 25 per cent of these Americans have two or more chronic conditions [2, 3, 4, 5, 6]. In 2014, two chronic conditions, heart disease and cancer, comprised more than 45 per cent of all deaths [3]. Arthritis, cancer, cardiovascular disease, dental caries, depression and other mental illness, diabetes mellitus, kidney disease obesity, stroke, and urinary tract symptoms are the more frequently occurring chronic conditions across ages, economic statuses, and races/ethnicities and can be ameliorated, managed, or even prevented through patient and provider behaviors. For example, the Framingham Heart Study distinguished the risk and protective factors for cardiovascular disease. Although heart disease remains the leading cause of death nationwide, the death rate for heart disease has dropped by more than 60 per cent since 1940. The death rate for stroke, the third most common cause of death, declined by 70 per cent over the same period [7, 8]. Another well-known example is the Diabetes Prevention Program (DPP), a multisite study with profound early findings like healthier eating and physical activity was more effective at preventing diabetes mellitus than metformin and has been disseminated effectively through settings as broad as e-interventions, healthcare settings, and YMCAs [9, 10, 11, 12]. Nevertheless, multiple research opportunities remain. Most NIH Institutes, Centers, and Offices (ICOs) support research in chronic disease management. Below are perspectives from a sample of NIH Institutes. NATIONAL CANCER INSTITUTE Based on the most recent estimates, 5-year relative survival rates for the five most common cancers are as follows: breast, 90 per cent; prostate, 100 per cent; lung, 16 per cent; colorectal, 67 per cent; and bladder, 81 per cent, thanks to improved prevention efforts, cancer screening, and advances in surgical, radiological, and pharmaceutical treatments. By 2014, the USA is expected to have 20-million cancer survivors [13]. Despite this success, cancer survivors experience many problems resulting from cancer and/or its treatment, which may include medical nonadherence, fatigue, depression, decreased cognitive and physical functioning, and adverse body composition changes. National Cancer Institute (NCI) has an ongoing interest to support research that improves behavioral prevention and management of cancer outcomes. Recent studies implicate the sympathetic and parasympathetic components of the autonomic nervous system in the regulation of cancers, for example, chronic lymphocytic leukemia and prostate, gastric, and pancreatic cancers [13]. Two funding opportunity announcement (FOAs; PAR-16-245 and PAR-16-246) seek studies to leverage relevant technologies and neuroscience research knowledge to accelerate understanding of the neural mechanisms that modulate cancer formation, progression, and metastasis and could prove essential in developing or improving the prevention and treatment of cancer. Two FOAs, PAR-16-317 and PAR-16-318, encourage submissions for testing interventions to support caregivers of adult cancer patients and thereby optimize patient health care utilization, improve caregiver well-being, and improve patient health and psychosocial outcomes. More recent FOAs, PA-17-060 and PA-17-061, solicit projects that evaluate the current state of oral anticancer medical use, delivery, and adherence. One focus is to identify structural, systemic, and psychosocial barriers, emotional factors, motivational factors, factors that influence decision making, social factors, to adherence. NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH (NIDCR) The dental, oral, and craniofacial health fields face challenges related to chronic conditions, all of which have significant behavioral or social components, and so present an opportunity for translation of behavioral and social science principles to tackle these challenges. A few examples follow, and we hope that the community views these as a call to action to apply expertise to tackling important public health challenges you may not have considered before. Dental caries is among the most common chronic conditions in significantly both children and adults. It is largely preventable, and the prevalence has decreased for many Americans, but there still are communities that bear an unequal burden of untreated caries disease. Black and Hispanic children and those living in families with lower incomes have more dental decay [14]; this pattern continues across the lifespan, culminating with 18 per cent of seniors 65 and older having untreated decay [15]. A class of conditions referred to as temporomandibular joint and muscle disorders (TMJDs) are the second most common chronic musculoskeletal condition resulting in pain and disability (after chronic low back pain), affecting approximately 5%–12% of the population, with some annual cost estimates of $4 billion. We know that patients with chronic TMJD have alterations in several genes, including some known to influence stress response, psychological well-being, and inflammation [16]. Periodontal diseases are another potentially chronic condition that affect many, and in their most serious forms lead to tooth loss, systemic infection, and even mortality. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from diagnosis on. More rare instances of chronic dental and oral conditions—but no less important—are salivary gland autoimmune diseases such as Sjogren’s syndrome, which ranks second only to the autoimmune disease rheumatoid arthritis, and affect an estimate of 1 million to 4 million people. Women outnumber men by 9:1 in Sjogren’s diagnoses. In Sjögren’s syndrome, salivary and tear glands are the major targets of the attack, which results in a decrease or near-elimination in production of saliva causing symptoms of dry mouth (known as xerostomia), difficulties with speech and swallowing food, extensive tooth decay, tooth loss, oral sores, and fungal infections in the mouth [17]. NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES Substantial opportunity exists to expand our understanding of sociobehavioral approaches to the prevention and treatment of diseases and conditions under the National Institute of Diabetes and Digestive and Kidney Diseases’s (NIDDK) purview. Despite a strong evidence base for behavioral approaches in preventing and managing both diabetes and obesity, gaps remain. In diabetes, improved understanding of socioecological influences on behavior is needed to inform novel intervention models, as well as strategies for scaling-up, tailoring, and spreading existing efficacious interventions. Additionally, strategies for integrating emerging scientific knowledge in behavioral interventions are needed, such as the role of psychosocial and socioecological stress in the development and progression of diabetes. In obesity, improved understanding of behavioral and psychological phenotypes that explain individual variability in adherence and response to lifestyle interventions is needed to personalize interventions and potentially enhance treatment response. A FOA (PAR-16-034) for ancillary studies that identify behavioral or psychological phenotypes that contribute to obesity encourages the collection of measures in relevant domains in extant studies. The evidence for the role of self-management in improving chronic kidney disease (CKD) outcomes is growing [18], but further research is needed to understand the scope of behavioral interventions in slowing progression of CKD and preventing acute kidney injury (AKI). Additionally, the recently launched Kidney Precision Medicine Project—which seeks to individualize care to patients with CKD and AKI by identifying disease subtypes and developing targeted treatments—will require cultural and behavioral changes in patients, nephrologists, and pathologists surrounding ascertainment of kidney biopsies that are expected to drive this research [19]. Behavioral approaches to urinary (kidney) stone prevention are being explored through the Urinary Stone Disease Research Network’s Prevention of Urinary Stones with Hydration (PUSH) study, a randomized clinical trial to assess whether a program of behavioral interventions, including increased fluid intake, will help prevent stone disease recurrence or progression. First line treatments for many lower urinary tract symptoms (LUTS) include behavioral strategies, such as pelvic floor muscle therapy, timed voiding, and fluid management. Yet, recent research relating to treatment of LUTS has focused primarily on pharmaceutical and surgical interventions. NIDDK leadership recognizes a need to better understand the role of self-management in the treatment of LUTS [20], and the Institute is encouraging a comprehensive approach to LUTS research that considers behavioral, cognitive, and social determinants of health [21]. Such research will be integral to interdisciplinary efforts needed to enable better targeting of LUTS treatments based on individual biological, cognitive, and social characteristics of the patient [22]. NIDDK encourages interdisciplinary teams to develop and submit investigator-initiated research projects that enable individualized treatment in LUTS [22]. As stated earlier, chronic conditions share common challenges associated with their management including dealing with symptoms and disability; monitoring physical indicators; managing complex medication regimens; maintaining proper levels of nutrition, diet, and exercise; adjusting to psychological and social demands, and engaging in effective interactions with health care providers. Regardless of the condition, a generic set of skills has proven successful in allowing individuals to effectively manage their illness and improve health outcomes: self-management [23, 24, 25]. NATIONAL HEART, LUNG, AND BLOOD INSTITUTE There are four goals on which the National Heart, Lung, and Blood Institute (NHLBI) Strategic Vision rests, including improving understanding of normal biological function, reducing human disease, furthering investigation of translational research, and cultivating and maintaining a high-quality scientific workforce and resources [26]. NHLBI supports behavioral and social sciences research within each of its three scientific Divisions (Division of Cardiovascular Sciences, Division of Lung Diseases, and Division of Blood Diseases and Disorders) and two Centers (Center for Translational Research and Implementation Science, and the National Center on Sleep Disorders Research). Genetics, individual behaviors and lifestyle, psychosocial factors, health care availability and access, and the environment operate together to influence the initiation, progression, and management of the myriad chronic conditions relevant to NHLBI. These conditions include hypertension, obesity, heart failure, asthma, sickle cell disease, and obstructive sleep apnea, among others. Behavioral and lifestyle factors are key to effective management of many of these conditions. Management of chronic conditions is an important focus of research at NHLBI, and understanding the role of patient and provider adherence is key. For example, adherence to asthma control medications is relatively low especially in children, and interventions to improve adherence rates are often cumbersome and not cost-effective. NHLBI-funded investigators have tested ways to improve adherence rates using mHealth and other new technologies, as well as phone-based coaching [27]. These have proven to be effective and cost-effective strategies that can be implemented in a variety of patient populations and families, in a wide array of settings, and cannot only improve adherence but also decrease asthma morbidity. Although hypertension has significant influence on all-cause and cardiovascular mortality in the USA, about half of all patients with hypertension are inadequately controlled. Understanding how to best implement evidence-based interventions in primary care and other real-world settings for optimal blood pressure control is important. NHLBI funds studies to identify and test strategies that lead to better control, including team-based care incorporating primary care providers, nurses, and clinical pharmacists. These strategies are effective in improving blood pressure control, including among patients in racial minority groups and medically underserved individuals. Primary and secondary prevention strategies play an important role in decreasing the risk of chronic disease development and mitigating the impact of chronic conditions. NHLBI supports clinical research on implementation of smoking cessation interventions, and mechanistic research on the pathophysiological effects of inhaled nicotine on the respiratory and cardiovascular systems in the context of noncancer heart and lung diseases, as well as research to increase our understanding of the physiological impact of e-cigarettes on cardiovascular and pulmonary health. The alarming increase in the rates of obesity and overweight suggests that a more informed understanding of the characteristics of community programs and policies that are related to lower childhood obesity rates, healthy eating, and physical activity behaviors may be important. Racial and ethnic disparities in heart, lung, blood, and sleep diseases remain substantial. Although there have been significant efforts to address disparities, the barriers are complex. NHLBI is supporting research to understand the role of environmental, psychosocial, and behavioral factors in contributing to, and alleviating, health disparities. Studies include investigation of the role of parks and recreation facilities to address health disparities by encouraging health-promoting behaviors; understanding the impact of the built and social environment in contributing to health outcomes, how these are mediated by risk factors such as sleep behaviors and obesity; investigating how to implement effective interventions to support healthy eating patterns among low income individuals; and testing strategies to improve adherence to treatment for chronic disease conditions such as hypertension. In addition, although research in early-stage translational research to uncover fundamental knowledge regarding basic physiological phenomenon and test interventions in well-controlled settings has been highly successful, fewer efforts have been devoted to later stage implementation science. NHLBI has been a leader in implementation research, which tests strategies for delivering effective interventions in real-world environments among unselected, and often multi-comorbid, populations. NATIONAL INSTITUTE OF NURSING RESEARCH Self-management is an approach to help individuals with chronic conditions and their caregivers better understand and manage their illness and improve their health behaviors. Research supported by National Institute of Nursing Research (NINR) helps individuals from diverse backgrounds and their families live with chronic illnesses by developing effective approaches to self-management that can improve quality of life while reducing the burden for caregivers and the health care system [28]. For example, NINR has a long-standing interest in supporting research on caregivers who need help with managing their own health while making sure the needs of the care recipient are being met. As a disease agnostic institute, NINR is uniquely positioned to support science pertaining to self-management of multiple comorbid conditions, self-management across the life cycle, and interventions that work across chronic conditions. Although much important work is already underway, there remain many challenges in improving health and the quality of life through self-management of chronic conditions. Included among the many research gaps are identifying sustainable self-management interventions for individuals faced with chronic conditions; defining positive influences for self-management of chronic conditions in underserved environments, improving the self-management of chronic pain, and promoting caregiver health. As one means to encourage nursing science in the realm of self-management and chronic conditions, NINR engaged stakeholders in a dialogue to identify novel scientific questions (the Innovative Questions Initiative) that could guide the research over the next 5–10 years. OFFICE OF BEHAVIORAL AND SOCIAL SCIENCES RESEARCH Like NINR, Office of Behavioral and Social Sciences Research (OBSSR) does not focus on specific diseases or somatic components. Rather, this office strives to increase the impact of social and behavioral sciences across health-related research and to foster emerging scientific areas and topics that span and complement multiple NIH Institutes and Centers (ICs). For example, OBSSR facilitated a multi-IC FOA to stimulate interventions that substantively improve medication adherence for one or more chronic conditions and to collect self-reported data, biomarkers, or clinical assessments when identified biomarkers do not exist. Prescriptions are not necessarily sufficient for the healthiest possible lives of people with chronic conditions. Accordingly, OBSSR cofounded the NIH Adherence Research Network to promote adherence as the extent to which human behaviors including taking medication, following a diet, modifying habits, and attending healthcare appointments, coincide with evidence-based medical or health advice. The Network fosters internal workshops and work sessions and a seminar series to promote the broad body of NIH-funded biobehavioral adherence and related research. For example, the OBSSR-led trans-NIH FOAs to promote population health interventions solicit proposed projects that integrate biological and clinical measures as they account for social, economic, and environmental conditions to improve overall health and reduce disease burden. Simply put, OBSSR strives to integrate behavioral and social sciences throughout the biomedical research enterprise to promote interdisciplinary biopsychosocial research that improves the human condition (Table 1). Table 1 Select ICO-led funding opportunity announcements (FOAs) Participating Institute(s) Title Mechanism Number Expiration date NIDDK Pragmatic Research in Healthcare Settings to Improve Diabetes and Obesity Prevention and Care R18 PAR-17-177 11/02/2019 NIDDK Addressing Health Disparities in NIDDK Diseases R01 PA-17-021 01/08/2020 NIDDK NINR Health Promotion Among Racial and Ethnic Minority Males R01 PA-16-428 01/08/2020 NIDDK ODP OBSSR Ancillary Studies to Identify Behavioral and/or Psychological Phenotypes Contributing to Obesity R01 PAR-16-304 03/01/2019 NIDDK NICHD NIMHD OBSSR NHLBI Understanding Factors in Infancy and Early Childhood (Birth to 24 months) That Influence Obesity Development R01 PA-16-169 05/08/2019 NIDDK NCI NIA NICHD ODP OBSSR Obesity Policy Evaluation Research R01 PA-16-165 05/08/2019 NINR Promoting Caregiver Health Using Self-management R01 PA-17-062 05/08/2020 NINR Chronic Condition Self-management in Children and Adolescents R01 R21 PA-17-115 PA-17-116 05/08/2020 OBSSR NCI NIAAA NIDCR NIDA NIDCD Population Health Interventions: Integrating Individual and Group Level Evidence R01 R21 PA-16-146 PA-16-147 05/08/2019 NCI Oral Cancer Agents, Utilization, Adherence and Health Care Delivery R01 R21 PA-17-060 PA-17-061 01/08/2020 NCI Neural Regulation of Cancer R01 R21 PAR-16-245 PAR-16-246 06/28/2019 NCI Innovative Approaches to Studying Cancer Communication in the New Media Environment R01 R21 PAR-16-249 PAR-16-248 06/14/2019 NCI Intervening with Cancer Caregivers to Improve Patient Health Outcomes and Optimize Health Care Utilization R01 R21 PAR-16-317 PAR-16-318 04/12/2019 NCI Improving Outcomes in Cancer Treatment- Related Cardiotoxicity R01 PA-18-003 PA-18-013 01/08/2019 NHLBI Single-Site Investigator-Initiated Clinical Trials R61/R33 PAR-18-406 9/14/2019 NIDDK NCI NIAAA NCCIH NHLBI ODS Diet and Physical Activity Assessment Methodology R01 PA-18-010 5/8/2019 Participating Institute(s) Title Mechanism Number Expiration date NIDDK Pragmatic Research in Healthcare Settings to Improve Diabetes and Obesity Prevention and Care R18 PAR-17-177 11/02/2019 NIDDK Addressing Health Disparities in NIDDK Diseases R01 PA-17-021 01/08/2020 NIDDK NINR Health Promotion Among Racial and Ethnic Minority Males R01 PA-16-428 01/08/2020 NIDDK ODP OBSSR Ancillary Studies to Identify Behavioral and/or Psychological Phenotypes Contributing to Obesity R01 PAR-16-304 03/01/2019 NIDDK NICHD NIMHD OBSSR NHLBI Understanding Factors in Infancy and Early Childhood (Birth to 24 months) That Influence Obesity Development R01 PA-16-169 05/08/2019 NIDDK NCI NIA NICHD ODP OBSSR Obesity Policy Evaluation Research R01 PA-16-165 05/08/2019 NINR Promoting Caregiver Health Using Self-management R01 PA-17-062 05/08/2020 NINR Chronic Condition Self-management in Children and Adolescents R01 R21 PA-17-115 PA-17-116 05/08/2020 OBSSR NCI NIAAA NIDCR NIDA NIDCD Population Health Interventions: Integrating Individual and Group Level Evidence R01 R21 PA-16-146 PA-16-147 05/08/2019 NCI Oral Cancer Agents, Utilization, Adherence and Health Care Delivery R01 R21 PA-17-060 PA-17-061 01/08/2020 NCI Neural Regulation of Cancer R01 R21 PAR-16-245 PAR-16-246 06/28/2019 NCI Innovative Approaches to Studying Cancer Communication in the New Media Environment R01 R21 PAR-16-249 PAR-16-248 06/14/2019 NCI Intervening with Cancer Caregivers to Improve Patient Health Outcomes and Optimize Health Care Utilization R01 R21 PAR-16-317 PAR-16-318 04/12/2019 NCI Improving Outcomes in Cancer Treatment- Related Cardiotoxicity R01 PA-18-003 PA-18-013 01/08/2019 NHLBI Single-Site Investigator-Initiated Clinical Trials R61/R33 PAR-18-406 9/14/2019 NIDDK NCI NIAAA NCCIH NHLBI ODS Diet and Physical Activity Assessment Methodology R01 PA-18-010 5/8/2019 At the time of publication, NIDCR FOAs were under revision to comply with NIH clinical trial policies. View Large Table 1 Select ICO-led funding opportunity announcements (FOAs) Participating Institute(s) Title Mechanism Number Expiration date NIDDK Pragmatic Research in Healthcare Settings to Improve Diabetes and Obesity Prevention and Care R18 PAR-17-177 11/02/2019 NIDDK Addressing Health Disparities in NIDDK Diseases R01 PA-17-021 01/08/2020 NIDDK NINR Health Promotion Among Racial and Ethnic Minority Males R01 PA-16-428 01/08/2020 NIDDK ODP OBSSR Ancillary Studies to Identify Behavioral and/or Psychological Phenotypes Contributing to Obesity R01 PAR-16-304 03/01/2019 NIDDK NICHD NIMHD OBSSR NHLBI Understanding Factors in Infancy and Early Childhood (Birth to 24 months) That Influence Obesity Development R01 PA-16-169 05/08/2019 NIDDK NCI NIA NICHD ODP OBSSR Obesity Policy Evaluation Research R01 PA-16-165 05/08/2019 NINR Promoting Caregiver Health Using Self-management R01 PA-17-062 05/08/2020 NINR Chronic Condition Self-management in Children and Adolescents R01 R21 PA-17-115 PA-17-116 05/08/2020 OBSSR NCI NIAAA NIDCR NIDA NIDCD Population Health Interventions: Integrating Individual and Group Level Evidence R01 R21 PA-16-146 PA-16-147 05/08/2019 NCI Oral Cancer Agents, Utilization, Adherence and Health Care Delivery R01 R21 PA-17-060 PA-17-061 01/08/2020 NCI Neural Regulation of Cancer R01 R21 PAR-16-245 PAR-16-246 06/28/2019 NCI Innovative Approaches to Studying Cancer Communication in the New Media Environment R01 R21 PAR-16-249 PAR-16-248 06/14/2019 NCI Intervening with Cancer Caregivers to Improve Patient Health Outcomes and Optimize Health Care Utilization R01 R21 PAR-16-317 PAR-16-318 04/12/2019 NCI Improving Outcomes in Cancer Treatment- Related Cardiotoxicity R01 PA-18-003 PA-18-013 01/08/2019 NHLBI Single-Site Investigator-Initiated Clinical Trials R61/R33 PAR-18-406 9/14/2019 NIDDK NCI NIAAA NCCIH NHLBI ODS Diet and Physical Activity Assessment Methodology R01 PA-18-010 5/8/2019 Participating Institute(s) Title Mechanism Number Expiration date NIDDK Pragmatic Research in Healthcare Settings to Improve Diabetes and Obesity Prevention and Care R18 PAR-17-177 11/02/2019 NIDDK Addressing Health Disparities in NIDDK Diseases R01 PA-17-021 01/08/2020 NIDDK NINR Health Promotion Among Racial and Ethnic Minority Males R01 PA-16-428 01/08/2020 NIDDK ODP OBSSR Ancillary Studies to Identify Behavioral and/or Psychological Phenotypes Contributing to Obesity R01 PAR-16-304 03/01/2019 NIDDK NICHD NIMHD OBSSR NHLBI Understanding Factors in Infancy and Early Childhood (Birth to 24 months) That Influence Obesity Development R01 PA-16-169 05/08/2019 NIDDK NCI NIA NICHD ODP OBSSR Obesity Policy Evaluation Research R01 PA-16-165 05/08/2019 NINR Promoting Caregiver Health Using Self-management R01 PA-17-062 05/08/2020 NINR Chronic Condition Self-management in Children and Adolescents R01 R21 PA-17-115 PA-17-116 05/08/2020 OBSSR NCI NIAAA NIDCR NIDA NIDCD Population Health Interventions: Integrating Individual and Group Level Evidence R01 R21 PA-16-146 PA-16-147 05/08/2019 NCI Oral Cancer Agents, Utilization, Adherence and Health Care Delivery R01 R21 PA-17-060 PA-17-061 01/08/2020 NCI Neural Regulation of Cancer R01 R21 PAR-16-245 PAR-16-246 06/28/2019 NCI Innovative Approaches to Studying Cancer Communication in the New Media Environment R01 R21 PAR-16-249 PAR-16-248 06/14/2019 NCI Intervening with Cancer Caregivers to Improve Patient Health Outcomes and Optimize Health Care Utilization R01 R21 PAR-16-317 PAR-16-318 04/12/2019 NCI Improving Outcomes in Cancer Treatment- Related Cardiotoxicity R01 PA-18-003 PA-18-013 01/08/2019 NHLBI Single-Site Investigator-Initiated Clinical Trials R61/R33 PAR-18-406 9/14/2019 NIDDK NCI NIAAA NCCIH NHLBI ODS Diet and Physical Activity Assessment Methodology R01 PA-18-010 5/8/2019 At the time of publication, NIDCR FOAs were under revision to comply with NIH clinical trial policies. View Large CHALLENGES AND OPPORTUNITIES For approximately half the American population, daily life includes a chronic condition. Although people with chronic diseases must perform most, if not all, tasks to maintain optimal health and wellbeing, their lives hardly exist in a vacuum. Such individuals are at the crux of multiple social/human networks, families, friendships, neighborhoods, workplaces, peers, and healthcare providers. The structure and function of those networks not only influence emotional wellbeing but also can extend, impede, or support myriad behaviors that comprise management of their health and respective conditions. Sequelae from each condition, the interactions among conditions, and biomedical interactions among treatments for the conditions can have myriad effects. Behavioral and social researchers complement biomedical researchers to understand the effects of chronic medical conditions on human health and how human behavior to treat and manage a given condition in turn influences biological sequelae, interactions with others, and personally perceived health and wellbeing. Compliance with Ethical Standards Conflict of Interest: None declared. Primary Data: This manuscript represents original work and has not been published elsewhere. It has not and will not be published elsewhere until Translational Behavioral Medicine decides on its acceptability for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH) or the United States Government. Ethical Approval: This work is a commentary on current federally funded initiatives; no animals, human subjects, or data were used in this work. References 1. Gerteis J , Izrael D , Deitz D et al. 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Yeh MC , Heo M , Suchday S et al. Translation of the Diabetes Prevention Program for diabetes risk reduction in Chinese immigrants in New York City . Diabet Med . 2016 ; 33 ( 4 ): 547 – 551 . Google Scholar CrossRef Search ADS PubMed 11. Knowler WC , Fowler SE , Hamman RF et al. ; Diabetes Prevention Program Research Program . 10-year follow-up of diabetes incidence and weight loss in the diabetes prevention program outcomes study . The Lancet 2009 ; 372 (9102) : 1677 – 1686 . 12. Chambers EC , Wylie-Rosett J , Blank AE et al. Increasing referrals to a YMCA-based diabetes prevention program: effects of electronic referral system modification and provider education in Federally Qualified Health Centers . Prev Chronic Dis . 2015 ; 12 : E189 . Google Scholar CrossRef Search ADS PubMed 13. National Institutes of Health . NIH Fact Sheets: Cancer . Available at https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=75. Accessibility verified November 13, 2017 . 14. 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Pragmatic trial of health care technologies to improve adherence to pediatric asthma treatment: A randomized clinical trial . jama Pediatr . 2015 ; 169 ( 4 ): 317 – 323 . Google Scholar CrossRef Search ADS PubMed 27. Garbutt JM , Yan Y , Highstein G , Strunk RC . A cluster-randomized trial shows telephone peer coaching for parents reduces children’s asthma morbidity . j Allergy Clin Immunol . 2015 ; 135 ( 5 ): 1163 – 1170.e1 . Google Scholar CrossRef Search ADS PubMed 28. National Institute of Nursing Research . Self-Management: Improving Quality of Life for Individuals with Chronic Illness . Available at https://www.ninr.nih.gov/aboutninr/ninr-mission-and-strategic-plan/themes-self-management#.UyNMhM7N4f_. Accessibility verified October 13, 2017 . Published by Oxford University Press on behalf of the Society of Behavioral Medicine 2018. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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Translational Behavioral MedicineOxford University Press

Published: May 23, 2018

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