Plenary Session III: Common Pathways to and Impact On Disease Prevention and Health Promotion

Common Pathways to and Impact on Disease Prevention and Health Promotion

Chair: Leslie Leve, PhD, Oregon Social Learning Center

Organizers: George W. Howe, PhD, George Washington University, Leslie Leve, PhD, Oregon Social Learning Center, Eve Reider, PhD, Prevention Research Branch, National Institute on Drug Abuse

Presenters: Megan R Gunnar, PhD, Regents Professor, Director, Institute of Child Development, University of Minnesota, Irwin Sandler, PhD,  Director, Prevention Research Center, Arizona State University, COL Carl Castro, Research Area Director, U.S. Army Medical Research and Materiel Command

Identifying common pathways associated with multiple disease and health outcomes is an effective and cost effective strategy to prevent disease and promote health and well-being. It also relates to several of the recent reports and strategies for prevention. For example, the 2009 Institute of Medicine Report on Preventing Mental, Emotional, and Behavioral Disorders Among Young People has called for a focus on examining the impact of preventive interventions across a broad array of health outcomes. Indeed, results of several randomized controlled trials of prevention interventions have shown long-term effects on many areas of health, including outcomes not targeted by the intervention.  This plenary session features three speakers whose work collectively spans basic science, preventive intervention, and policy-focused prevention research related to health promotion, with a unifying theme of stress mechanisms as a common pathway to disease and health outcomes. In the first presentation, Dr. Megan Gunnar will apply a biosocial model to the identification of common pathways to health outcomes and describe work on stress neurobiology and development. In the second presentation, Dr. Irwin Sandler will describe preventive intervention work with children and families weathering major stressors. In the third presentation, Colonel Carl Castro will describe research on stress contexts within the military and how research and interventions on common pathways can be translated into policy in military contexts. Speakers will connect their work to the importance of examining impact across a broad array of health outcomes.

Early Life Stress:  Basic Research on Common Pathways to Multiple Physical and Mental Health Outcomes

Presenter: Megan R Gunnar, PhD

This presentation will provide a brief overview of the physiology of stress as a final common pathway between adverse life conditions and a variety of mental and physical health outcomes. In this presentation we will also caution that what looks like a common pathway is actually a complex set of stress mediating systems that have non-linear associations. Having acknowledged that, the presentation will focus on studies using the hypothalamic-pituitary-adrenocortical axis and the sympathetic adrenomedullary systems as two critical stress mediating systems that are involved in transducing the impact of early adversity into physical and mental health outcomes. 

Megan R. Gunnar, PhD, is a Regents Professor and Director of the Institute of Child Development at the University of Minnesota.  She has spent her career studying how infants and young children respond to potentially stressful situations.  With her students, she has documented the powerful role that relationships play in regulating stress physiology in young children and the impact that early neglect and deprivation have on the development of the brain and behavior. Professor Gunnar directs a national research center for the study of Early Experience, Stress and Neurobehavioral Development and is a member of the program of the  Canadian Institute for Advanced Research that studies how early experience “gets under the skin” to affect life-long health and disease. She is the Associate Director of the Center for Neurobehavioral Development and a member of the National Scientific Council on the Developing Child. In addition to several early- and mid-career awards, Professor Gunnar recently received lifetime research achievement awards from the American Psychological Association and the Society for Child Development.

Long-term Effects of Promoting Effective Parenting: Implications for Theory and Public Health

Presenter: Irwin Sandler, PhD

Prevention Science has made remarkable progress in demonstrating the effectiveness of programs to promote effective parenting in a wide range of populations. This presentation will review findings from long-term follow-up studies of parenting focused prevention programs. These studies demonstrate that parenting programs have effects to prevent a wide range of problems including reducing substance abuse, depression, externalizing problems as well as improving positive outcomes such as academic achievement. Progress is also being made in teasing out the pathways through which prevention parenting programs have their effects. Findings from long-term follow-up studies of several prevention programs will be presented to illustrate these effects. The presentation will also discuss implications of this research for the public health and critical issues for future research.

Irwin Sandler, PhD, is a Research Professor and Regents’ Professor Emeritus at the Prevention Research Center in the Department of Psychology at Arizona State University. He served as the Founding Direction of the ASU Prevention Center from 1984 through 2010. He is the recipient of the Presidential Award and the Friends of the ECPN award from the Society for Prevention Research and has served as a member of the Board of Directors from 2005-2007. He was a member of the National Research Council/Institute of Medicine committee that developed the landmark 2009 report Prevention of Emotional, Behavioral and Mental Disorders of Children and Young People: Progress and Possibilities. He has served on advisory committees to the National Institute of Drug Abuse and the National Institute of Mental Health as well as SAMHSA and numerous foundations on the development of strategic plans for prevention science. He received his Ph.D. in 1971 under the mentorship of Emory L. Cowen, one of the pioneers in the development of prevention science.

Sandler’s research over the past 40 years has focused on understanding sources of resilience for children in high stress situations and on the development, evaluation and dissemination of interventions to promote resilience. His theoretical research includes studies of processes by which children adapt to life stress including the measurement of stressful events, social support, coping and parenting processes and testing models by which these processes lead to disorder or healthy adaptation. His intervention research has involved the development of theoretically based resilience promotion programs for children of divorce and bereaved children and conducting randomized trials and long-term follow-ups to assess their impact to changed trajectories of development over time. His current work focuses on translating evidence-based programs into community based services in collaboration with community partners.

Brief Mental Health Training to Enhance Psychological Health among Military Personnel: Implications for Policy

Presenter: COL Carl Castro

We know from previous wars that combat can dramatically impact the mental health and wellbeing of service members.  Early in the wars in Iraq and Afghanistan we conducted numerous surveys and interviews of soldiers from brigade combat teams to determine as precisely as possible how combat affects their mental health and well-being.  Based on these studies we were able to identify specific challenges that soldiers face when going to war, the stressors they face during combat and deployment, and the challenges they confront when returning home.  Much of what we learned, we already knew; yet, new aspects of combat and its impact on mental health was uncovered.  Using this information, along with scientific theory and applied training/education principles, we developed a mental health training program to prepare soldiers to deploy to combat and to assist them in returning home from combat.  We called this program, Battlemind Training.  Through a series of group randomized trials, we demonstrated that this mental health training program lasting only one hour could significantly reduce the mental health symptoms associated with post-traumatic stress disorder, depression, and sleep disruptions, with the effects lasting out to eight months.  To date, this is the only demonstration that a single hour of mental health training intervention can reduce the psychological symptoms associated with combat.   

Col. Carl Castro, Ph.D.  Col. Castro was most recently appointed Director of Military Operations, Medicine Research Program, Headquarters, US Army Medical Research and Materiel Command, Fort Detrick, Maryland. He formerly served as the chief of military psychiatry at the Walter Reed Army Institute of Research, and was the Commander of the U.S. Army Medical Research Unit-Europe in Heidelberg,

Germany. In addition to serving in multiple deployments to Bosnia, he has been chief and program manager of several different medical research programs. He is a graduate of Wichita State University and holds an M.A. and Ph.D. in psychology from the University of Colorado. He is the author of over 50 scientific publications, including a major study published in the New England Journal of Medicine. The study, which involved 6,200 soldiers and Marines and was conducted by a team at the Walter Reed Army Institute of Research, is the first attempt to understand the psychological effects of a U.S. war while it is ongoing. Most of the participants were screened within three or four months of returning from battle. The result, Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care (Charles W. Hoge, M.D., Carl A. Castro, Ph.D., Stephen C. Messer, Ph.D., Dennis McGurk, Ph.D., Dave I. Cotting, Ph.D., and Robert L. Koffman, M.D., M.P.H.) is a seminal study in the effects of combat on mental health.