Experiential Education and Public Health: The Potential to MOVE America toward Health

1. 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

2. 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

3. 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.

4. 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).

6. Guiding Principles for Substance Use Prevention that Link to Other Health Outcomes • Development in context / Experimental etiology • Intervening Early in Families • 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) • During key developmental transitions (e.g., transition into school, early adolescence) • Address risk and protective factors relevant to drug use, violence, and other outcomes • Evidence for short-term, long-term, and cross-over effects • Increase Reach of Evidence-based Programs (Type 2 Translation) • Research on factors associated with the adoption and utilization of scientifically validated interventions by service systems and settings under controlled, uncontrolled or uncontrollable conditions • 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

7. 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

8. 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)

9. Anxiety and affective disorders HPA axis dysregulation associated with early life stress (downregulation via chronic stress)

10. Developing interventions that mitigate risk Fisher, Van Ryzin, & Gunnar (submitted)

11. New Approach for NIDA

12. Physical Activity as Prevention • Potential Mechanisms of Change (experimental etiology) • Emotion-regulation • Attention processes and executive control • Sensation-seeking / Reward-pleasure mechanisms • Sensory-motor coordination • Healthy lifestyles • Adult-child relationships

13. 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

14. Funding Opportunity Announcement • Interactions between Physical Activity and Drug AbuseRFA-DA-09-013 (R01), RFA-DA-09-014 (R03) • Receipt Date: January 29,2009 • Over 70 applications

15. 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! meyera2@nida.nih.gov

16. Casting the Net to Other Health Areas • Experiential Education and Public Health: The Potential to MOVE America toward Health

17. 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

18. The Preventable Behaviors that Cause Scary Health Costs • The CDC estimates that • 80% of heart disease and stroke • 80% of Type 2 diabetes • 40% of cancer • Could be prevented if American’s did these three things: • Stop smoking • Start eating healthy • Get in shape

19. Marijuana, Inhalants, and Prescription Drugs Are Top Three Substances Abused by TeensPercentage of U.S. Teens (Grades 7 to 12) Reporting Ever Trying Drugs, 2008(N=6,518)

20. Number and Percent Distribution of Victim to Offender Relationships,All Violent Crimes, 1995

21. 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

23. Appeal of Experiential Approaches • Four categories of adventure programs (Priest, Gass & Gillis, 2000/2003) • 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

24. Active approaches that are fun • How to teach diffuse?  • 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.”

25. 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… • Physical activity? • Healthful eating? • Natural highs? • Social support? • Coping with stress? • Conflict resolution?

26. Adventure as Prevention or Treatment? • Potential Mechanisms of Change (experimental etiology) • Emotion-regulation • Attention processes and executive control • Sensation-seeking / Reward-pleasure mechanisms • Sensory-motor coordination • Healthy lifestyles • Adult-child relationships

27. Experiential Intervention Processes • 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

28. Experiential Approaches Funded by NIH • Across NIH institutes • Different funding mechanisms • R03 • R21 • R34 • R01 • P and U mechanisms • K’s and supplements

29. HealthWise South Africa: Life Skills for Young Adults • Funded by National Institute • on Drug Abuse

30. 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: • 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.

31. 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 • Implemented by trained 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

32. Past Month Alcohol Use (Beg. Grade 8) (Beg. Grade 10)

33. 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. • Smith, E., Palen, L., Caldwell, L., Flisher, A., Graham, J., Mathews, C., Wegner, L., & Vergnani,T. (2008). Prevention Science e pub.

34. Physical Activity in Adults and Early Adolescence • Improving Safety and Access for Physical Activity – D. Wilson (R01-NIDDK) • Self-Determination for Increasing Physical Activity – D. Wilson (R01-NICHD)

35. 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

36. Early Childhood • The CIA (Children in Action) Program – T. Nicklas R21-NICHD • Measuring Physical Activity Affordances in Preschool Outdoor Environments R. Moore R21-ES

37. Stress and Trauma • Stress Reduction: Impact on BP in African American Youth F-Treiber R01-NHLBI • 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

38. Cessation and Relapse Prevention • Group Therapy for Nicotine Dependence D. Wetter R01-NIDA • Experiential Avoidance and Substance Use Relapse N. Chawla F31-NIDA

39. 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.

40. 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

41. Percent of US High Schools Using Evidence-based Substance Use Prevention Programs (based on SAMHSA NREPP) • NREPP Programs: • ATLAS* • Keepin’ it REAL* • Positive Action* • Project Toward No Drug • Abuse* • Project Toward No • Tobacco Use+ • Too Good for Drugs # 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.

42. 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.” • 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??

43. 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. • CLINICAL PROCESSES IN DRUG ABUSE PREVENTION – D. Coatsworth R01-NIDA • Implementation of Adventure Programs

44. Implementation is Key: Core implementation components are integrated and compensatory (NIRN)

45. Center Tests

46. NIH Funding Opportunities • American Recovery Act (ARRA) • Challenge Grants • Additional RFA’s • Existing Program Announcements • Drug Abuse Prevention Intervention ResearchPA-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 • Diversity Supplements • Transition Awards

47. Educators, Scientists and Contemplatives Dialogue on Cultivating a Healthy Mind, Brain, and Heart

48. Because experiences can effect individuals on all levels… • Physiological • Emotional • Cognitive • Psychological • Social • Historical • …the experiential approach has tremendous potential to sustain behavior change over time

49. Experiential modalities… Have naturally-occurring behavioral reinforcement built-in Can provide metaphors to promote transfer of learning Offer a learning style favored by many Compared to didactic, skills-based, and educational modalities…