Center for Population Health and Aging Spotlight Booklet

Texas A&M School of Public Health Marcia G. Ory, PhD, MPH, Founding Director Matthew Lee Smith, PhD, MPH, Co-Director

2019

Table of Contents Page #

3

Welcome to the Center

4

Center Views

8-9 10-21

Mission, Vision, and Center Infographic Who We Are Center Faculty & Affiliates Internal Advisory Group Senior Fellows Center Staff & Students

22

Center Highlights

23-29

Ongoing Projects Infrastructure Building and Training Community Research Center for Senior Health Establish Self-Management Programs and Wellness using Evidence-Based Designs Evaluating Evidence-Based Fall Prevention and Disease Self-Management Programs Geriatric Care & Education Healthy South Texas Texas A&M Triads for Transformation Opioid Epidemic’s Impact on Older Adults Behaviorally-based Evidence-based Life-style Programs Brief Intervention to Evidence-Based Programs to Combat Malnutrition among Older Adults Evidence-Based Programs and Healthcare Utilization in Florida No Falls Partnership (NFP) Putting CDSMP to Work: Implementation of the Live Healthy, Work Healthy Program Supporting, Unifying and Streamlining in Texas through Active Integrated Networks (SUSTAIN) Policy and Environmental Assessments and Interventions Dementia Friendly Communities to Promote Active Aging Development of a National Brief Screener to Assess Risk for Social Isolation among Older Adults Fighting Obesity by Reinventing Public Transportation Intersection of Health and Place: Barriers and Facilitators of Health Service Utilization among Men with Chronic Conditions Physical Activity Impacts of a Planned Activity-Friendly Community Technology Interventions Assessment of the Utility of Dementia Patient Monitoring Technology GamePlan4 Care: Web-based Delivery System for Reach II

30-49

Completed Projects

50

Funding Sources

51

Contact Information

Welcome from Our Center Co-Directors We are pleased to share our Center activities and accomplishments with you. We address the challenges and opportunities of a rapidly aging world by serving as a centralized hub for population health and aging. While formally recognized as a Texas A&M Board of Regents Center in 2016, we have been engaged in a variety of aging-related research, education, and practice projects for more than a decade under our predecessor Program on Healthy Aging. Center status has brought increased visibility and partnerships. We now have affiliates from more than 15 colleges, institutes and agencies within the Texas A&M system and collaborating partners from community, clinical and corporate settings. Consistent with our mission, we take a life-course approach to improve the lives of Texans and others throughout the nation and world. We strongly believe that being Active for Life® is possible and involves every one, at every age, every day.

Changing prior stereotypes of aging requires a paradigm shift where healthy aging is seen as the ‘new normal’. Center activities focus on social, behavioral, economic, environmental, and technological innovations to positively impact aging individuals, their families, health care professionals and service providers, and communities. Our research, education, and practice activities are highly intertwined with a goal of translating research to practice as well as providing training for the next generation of scholars and practitioners.

With over $50,000,000 in research expenditures, we have engaged in over 50 projects since 2001. For example, our local, state and national evaluations of evidence-based programs have documented that chronic disease self-management programs, fall prevention programs, and physical activity programs can improve the triple aims of better health, better health care, and better value. We have demonstrated how programs are not monolithic—but uniquely impact different populations and settings. Pushing our academic boundaries, we have learned that to achieve long lasting population health and aging gains, programs must be embedded within existing delivery structures to maximize scalability and sustainability. We have also explored how policies and environmental strategies can facilitate or impede engagement in healthy lifestyle behaviors. To further our dissemination of evidence-based programming, we have created the Texas Active for Life Coalition, a statewide network to expand evidence-based programming, influence policy change, and unify partners and efforts across the state.

We invite you to join us on this journey to make “healthy aging the new normal”.

-Dr. Marcia Ory & Dr. Matthew Lee Smith

3

CELEBRATORY EVENTS

RESEARCH CAFÉS

SENIOR EXPO

2018 AFL CONFERENCE

Vision To be a recognized Center of Excellence for promoting

population health and successful aging throughout the life-course that will improve the lives of Texans and others throughout the nation and world.

Mission To promote population health and successful aging through innovations in

research, education, and practice that examine clinical social, behavioral, economic, environmental, and technological solutions linking academic and real-world health care and community settings.

8

Demographic Imperative

Rapid aging of the American population

Leads to challenges in care needs & burdens

Opportunities for Action Postpone or manage age-related chronic conditions

Provide age-friendly environments to extend health and wellbeing

Ease burdens of care

Focal Areas for Research, Education and Practice

Technical assistance

Community & worksite wellness

Geriatric care

Healthy communities

Mobile health technologies

Economics & policy

Demonstrated Impacts of Evidence-Based Programs Better Health

Improving access to healthy foods Improving access to safe and convenient places for physical activity Reduced numbers of unhealthy days and less depression Improved overall quality of life

Better Health Care

More activated patients Better doctor-patient communication Less medication non-compliance

Better Value

Potential health care savings of $364/person enrolled in program >$3.3 billion if reaching 5% of all adults with at least one chronic illness

9

Directors, Center for Population Health and Aging Marcia Ory, PhD, MPH

Matthew Smith, PhD, MPH

School of

School of

Public Health

Public Health

Texas A&M Faculty, School of Public Health Mark Benden, PhD, CPE

Jane Bolin, PhD, JD, RN

James Burdine, DrPH

Genny Carillo, MD, ScD

Diane Dowdy, PhD

Alicia Hong, PhD

10

Texas A&M Faculty, School of Public Health Bita Kash, PhD, MBA

Carly McCord, PhD

Ranjana Mehta, PhD

Nelda Mier, PhD

Oscar Pinzon

Adam Pickens, PhD, MPH

Gilbert Ramirez, DrPH, MPH

Preeti Zanwar, PhD, MPH

11

Texas A&M Faculty (Other Colleges & Schools) Changbum Ryan Ahn, PhD College of

Gerianne Alexander, PhD Psychology

Architecture

Raymond J. Carroll, PhD Institute for Applied Mathematics and

Gerard Cote, PhD Biomedical Engineering

Computational Science

Kate Creevy, MS, DVM

Nicolaas Deutz, PhD

College of Veterinary

Center for Translational

Medicine

Research in Aging & Longevity

Dana Gaddy, PhD

Ricardo Gutierrez-Osuna, PhD

College of Veterinary

Computer Science &

Medicine

Engineering

12

Texas A&M Faculty (Other Colleges & Schools) Tracy Hammond, PhD Sketch Recognition Lab

Laura Higgins, MS Transportation

Shevon Harvey, PhD Health & Kinesiology

Sriram Iyengar, PhD College of Medicine

Institute

Roozbeh Jafari, PhD

Biomedical Engineering

Vani Mathur, PhD

John Lawler, PhD

Health & Kinesiology

Rich Metters, PhD

Department of Psychological & Brain Sciences

Mays Business School

13

Texas A&M Faculty (Other Colleges & Schools) Michael J. Miller, DrPH, RPH

Victoria Pho, PharmD College of Pharmacy

College of Pharmacy

David Potter, PhD

Susan Rodiek, PhD Landscape

College of Pharmacy

Architecture & Urban Planning

Wanda Seaback, MS, RN

Ipek Sener, PhD Texas A&M

College of Nursing

Transportation Institute

Farida Sohrabji, PhD

Bree Watzak, PharmD, BCPS A&M Rural &

College of Medicine

Community Health Institute

14

Texas A&M Faculty (Other Colleges & Schools) Lisa Wigfall, PhD

Tim Woods, PhD Center for Community Health Development

Sociology

Lixian Zhong, PhD

College of Pharmacy

15

Adjunct Faculty & Affiliates Lola Adepoju, PhD

SangNam Ahn, PhD,

United Healthcare

University of Memphis

Houston

Angela Alaniz

Caroline Bergeron, DrPH, MSc Bexar County

Strategic Partnerships

Community Health

& Initiatives

Jinmyoung Cho, PhD

Collaborative

John E. Fitch

Baylor Scott & White

Birkeland

Health

Current LLC

Samuel N. Forjuoh, DrPH, MD

Angie Hochhalter, PhD

Baylor Scott & White

Baylor Scott & White

Health

Health

16

Adjunct Faculty & Affiliates Matthew Minson, MD

John D. Holland II Birkeland

College of Medicine

Current LLC

Nicole Pardo, MD, MSM, MBA IntechHealth LLC

Samuel Towne Jr., PhD, MPH, CPH University of Central Florida

Sandhya Sanghi Baylor Scott & White Health

Judith Warren, PhD

AgriLife Extension

Armin Weinberg, PhD Life Beyond Cancer Foundation

17

Internal Advisory Group Mark Lawley, PhD Texas A&M Industrial & Systems Engineering

Ninfa Pena-Purcell, PhD, CHES

Chanam Lee, PhD Landscape Architecture & Urban Planning

Alan Stevens, PhD

Texas A&M

Baylor Scott & White

AgriLife Extension

Healthcare

Arnold Vedlitz, PhD Bush School of Government

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Senior Fellows: Practice & Policy Deborah Vollmer Dahlke, DrPH, MPAff DVD Associates LLC

Nora Janjan, MD, MPSA

Policy Consultant

Stephen Popovich

Clairvoyant Networks

Community engagement occurs across a continuum that includes patients, healthcare providers, caregivers, industry and nonprofit entities throughout the research process from gaining input for planning studies, recruiting participants and disseminating results. Dr. Deborah Vollmer Dahlke created her firm, DVD Associates, LLC, to help early-stage entrepreneurial biotech firms apply for CPRIT and SBIR/STTR grants, helping to secure over $135 million in non-dilutive funds for her clients in cancer and other chronic diseases. Dr. Vollmer Dahlke is a serial technology entrepreneur and has worked with the Center to develop mobile applications for chronic disease patient “self-management”. She is a mentor to early-stage biotech companies and also a frequent speaker on cancer survivorship and care as well as applications of technology, robotics and AI in healthcare She is also a Komen Advocate in Science and a frequent reader for PCORI grant applications. As a Center Fellow, she will advise on innovative methods of community engagement, collaborate with Center investigators, and encourage a culture of entrepreneurship among investigators, faculty, and students.

Practice and policy issues that affect health care delivery for our aging population are major Center foci. Serving on national and international panels, Dr. Nora Janjan has contributed to the development of various healthcare standards. Among these are the Agency for Healthcare Quality, National Comprehensive Cancer Network, National Quality Forum, American Society of Clinical Oncology, and American College of Radiology. Additionally, Dr. Janjan has extensive regulatory experience that includes appointment to the Medicare Evidence Development & Coverage Advisory Committee, expert panelist for the Institute for Clinical and Economic Research [ICER], and Vice-Chair on the Texas Radiation Advisory Board. Currently, Dr. Janjan is a Senior Fellow at the Goodman Institute for Public Policy Research, and an Adjunct Professor in the Department of Environmental and Occupational Health, School of Public Health at Texas A&M University. As a Center Fellow, she will advise the Center on policy issues, especially around the implementation, scalability, and sustainability of evidence-based practices for promoting health among older adults.

The growing numbers of older Americans signal a need for new approaches to caregiving. Citing the lack of useful technology for caregivers that leverages the latest in technology advancements, Stephen Popovich founded Clairvoyant Networks, LLC to help improve the lives of those aging in place, in independent living, and older adults with memory care needs, and their caregivers. Mr. Popovich’s technical expertise combined with his focus on caregiving addresses a key Center focal area. For the past two years, he has been sharing ideas with the Center on how to harness technological solutions to help caregivers in the face of an increasing elder care crisis. Clairvoyant’s line of Theora® Care remote monitoring solutions include ultra-wideband sensors, wearables communication hardware and cloud connectivity with streaming analytics. As a leader in the business world having spearheaded several technology companies, Mr. Popovich is a frequent speaker on elder care technology and trends. As a Center Fellow, he will advise on the use of technology, and collaborate with Center investigators on an innovative caregiving study supported by the Texas Alzheimer Research and Care Consortium.

19

Center Staff Tiffany R. Bond

Operations Manager

Jill Crouch, MPH

Education & Training Specialist

Cindy Quinn

Program Manager

Ashley Wilson, MPH

Assistant Director

Daunte Cauley, MS

Program Coordinator

Sayah Lee, MPH

Research Assistant

Tiffany Sodolak

Program Coordinator

Wendy Creighton, RN, BSN

Registered Nurse

ShinDuk Lee, MSPH

Postdoctoral Research Associate

Katharine Tuck

Program Assistant

Aya Yoshikawa, PhD

Postdoctoral Research Associate

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Student Affiliates Tyrone Bethune

Travis Burdick

Annalisa Garza

Sagar Jani

Claire Leslie

Chinelo Nsobundu

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Highlights Promoting Health & Wellness Throughout Affiliated with the Center for Population Health & Aging, the SPH Health & Wellness Committee’s mission is to emphasize, encourage, and engage the SPH community to make healthy choices through individual and organizational change. This committee meets monthly and is comprised of staff, faculty, and students. In addition to sponsored events such as Lunch & Learns and community events, our committee has provided health and wellness resources through newsletters, social media, print materials, and signage. We have also made improvements to our physical space at the School of Public Health by adding a refrigerator for students, a water filtration system, and partnering with the Sustainable Environmental Group to provide a community garden.

Achieving CEO Gold Standard In an effort to help organizations seek accreditation and reduce the risk of cancer for their employees and families, the Texas A&M School of Public Health and Texas A&M AgriLife Extension

Service

have

produced

the

Going

for

the

Gold:

Achieving

CEO

Cancer

Gold Standard™ Accreditation Guidebook. Eradicating cancer is the goal of the CEO Cancer Gold Standard™, a workplace wellness initiative. The CEO Roundtable on Cancer, a nonprofit organization of chief executive officers of major U.S. companies founded by former President George H.W. Bush, developed this initiative in collaboration with the National Cancer Institute. To earn Gold Standard accreditation, an organization must establish programs to reduce cancer risk by eliminating tobacco use; encouraging physical activity; promoting healthy diet and nutrition; detecting cancer at its earliest stages; and providing access to quality care.

Developing and Disseminating Mobile Health Technology Patient and provider access to, and awareness of, community resources for an increasing number of Americans suffering from chronic conditions can improve population health.

After polling providers across the U.S., we found that many still rely on paper and print-outs to locate resources. Mobile health technology can help meet the triple aims of better health, better care, and better value, providing a more efficient mechanism to more holistically address the health needs of entire populations. MyHealthFinder is a mobile web resource locator designed to help individuals, families, caregivers, healthcare professionals, and more locate resources for healthy living. This unique tool’s map allows users to search by location or by categories such as Community Services, Food and Nutrition, Counseling Support, Faith-Based Services, and more.

Promoting Center Research & Practice Housed within the Texas A&M Center for Population Health and Aging (CPHA), the Texas Active for Life® Coalition (TALC) is a statewide coalition with an overarching mission to keep Texans “Active for Life”. This is primarily accomplished by providing evidence-based programs (EBP) for older adults. TALC is committed to expanding and promoting evidence-based programming, influencing policy change, and unifying partners and efforts across the state. In an effort to make our vision a reality, the TALC focuses its efforts on the following: (1) increasing awareness about health issues impacting older Texans and prevention/management strategies; (2) increasing

provider participation in

prevention/management practices; (3) increasing funding opportunities and investments for prevention/management; (4) enhance data surveillance collection, analysis, and system linkages; (5) increase availability and accessibility of community programs and services.

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Ongoing Projects Infrastructure Building and Training “Meeting the needs and preferences of older Americans requires infrastructure resources and commitment to conduct translational research, provide education and training, and to deliver age-appropriate and culturally relevant services.”

Community Research Center for Senior Health The

Community

Research

Center

for

Senior

Health

develops,

implements,

evaluates,

and

disseminates

evidence-based interventions that address multiple social and behavioral determinants of senior health. The Center provides a sustainable infrastructure that promotes an interdisciplinary approach to senior health intervention research, develops community-academic health center relationships that fosters community participation, and provides guidance and support to investigators and community leaders in research design, evaluation, and data analytic techniques. This project is a three-way partnership between Scott & White HealthCare, The Temple–Belton Aging and Disability Research Center, and the Texas A&M Health Science Center School of Public Health. A major project is the development of an online tool to help community organizations translate research to practice (www.evidencetoprograms.com).

Establish Self-Management Programs Using Evidence-Based Designs The Texas Health and Human Services Commission (HHSC) received federal funding through the Centers for Medicaid and Medicare’s (CMS) to implement an 1115 Transformation Waiver project with the goal of providing quality care for low -income Texans at a reduced cost. The Center for Population Health and Aging provides a centralized resource for training, implementing, and evaluating evidence-based self-management and wellness programs. In conjunction with the Texas Active for Life Coalition (TALC), the Center seeks to facilitate health care providers and agencies’ capacity to select and implement evidence-based health promotion/disease prevention to reduce the burden of illness in our nine-county Regional Healthcare Partnership (RHP) 17 region. Current activities are centered on disseminating Making Moves with Diabetes, a program that has the potential to improve clinical outcomes and result in health care cost savings.

Evaluating Evidence-Based Fall Prevention and Disease SelfManagement Programs Despite the plethora of evidence-based programs for older adults, there is limited peer-reviewed literature on their implementation and dissemination. Working with the National Council on Aging (NCOA) Center for Healthy Aging, this project utilizes national data collected by Administration for Community Living (ACL) grantees to evaluate the reach, adoption, and effectiveness of evidence-based programs fall prevention and chronic disease self-management education programs. This initiative has resulted in numerous peer-reviewed publications and presentations to guide research, practice, and policy efforts associated with the evidence-based movement for older adult health and wellness in America.

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Geriatric Care & Education With the opening

of

an Active Senior

Health Center

focused

around

a newly designed

senior

living

community adjacent to the Health Science Center campus, there is an opportunity to develop strong community-clinical collaborations for education, research, and healthcare services to improve the health and functioning of the growing number of seniors in the Brazos Valley. This will provide an opportunity for both Health Science Center faculty and students to engage in a variety of integrated efforts for promoting healthy living, active lifestyles, and managing chronic conditions.

Healthy South Texas Recognizing the combined strengths of Texas A&M University AgriLife Extension and the Health Sciences Center, the Texas legislature set aside approximately $20,000,000 for a Healthy South Texas Initiative. The focus of this initiative is on the delivery of prevention and outreach services to 27 counties in Texas. Diabetes, Asthma, Infectious Disease, and Well baby promotion are the initial priority areas for a proposed ten-year planning cycle. The Health Science Center is responsible for adding health content and infrastructure to expanded outreach activities, and for creating educational opportunities to enhance the pipeline of professional and lay experts focused on prevention and management strategies improving the health and well-being of Texas residents. The School of Public Health is responsible for the evaluation of the ten-points of action. Healthy South Texas serves as the pilot project for an expanded Healthy Texas.

Texas A&M Triads for Transformation Opioid Epidemic’s Impact on Older Adults While public health officials recognize the devastating nationwide impacts of the opioid epidemic on Americans of all socio-demographic backgrounds, scant attention is paid to the impact of opioid use/misuse among older adults, especially those in rural areas. This preliminary research funded through the President’s Excellence Award will: 1) Identify older adults who are at high risk of negative impacts due to the opioid crisis; 2) Understand the myriad ways in which older adults may be affected; 3) evaluate the costs of the epidemic in terms of needed medical care and social

services,

both personally and to the health care system; and 4) conduct an environmental scan of effective clinical, educational, behavioral, technological and/or policy solutions for mitigating impacts of the opioid epidemic on older adults and their families.

“Whether delivered at the national, state, or local levels, the Center provides needed technical assistance and evaluation to improve the reach and effectiveness of evidence-based programs.”

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Ongoing Projects Behaviorally-based Evidence-based Life-style Programs “Our center seeks to create a knowledge base for the demands associated with chronic diseases and the benefits of a healthier lifestyle to help older persons learn to take responsibility for day-to-day health management.”

Brief Intervention to Evidence-Based Programs to Combat Malnutrition among Older Adults One of every two older Americans is at risk for malnutrition. Despite a cadre of evidence-based programs (EBPs) available to older adults nationwide, few specifically focus on nutrition and malnutrition prevention. Because EBPs have defined implementation parameters and cannot be substantially altered, pairing brief interventions to EBP (as a session zero) is a promising strategy to introduce additional content and build relevant skills. This project formalized the development of Stepping Up Your Nutrition (SUYN), a 2.5-hour workshop to reduce malnutrition risk, and is evaluating its effectiveness as an innovative method of joining a brief intervention with two EBP (i.e., Stepping On and Chronic Disease Self-Management Program) to increase positive nutrition behavior among older adults and enhance EBP workshops attendance.

Evidence-Based Programs and Healthcare Utilization in Florida New efforts are underway for insurance agencies and managed care organizations to assess the financial returns on investment (ROI) for delivering evidence-based programs for fall prevention, disease self-management, and depression for their patients in Florida. This series of robust studies examines retrospective and prospective healthcare utilization and costs for older adults before and after participating in the programs to identify associated health improvements.

Additionally, the overall goal is to increase support for these programs in Florida and other areas of the country within healthcare entities.

No Falls Partnership (NFP) Falls continue to be a public health problem impacting older adults, their families, and health care systems, and the aging services network. The purpose of the No Falls Partnership (NFP) Project is to decrease the number of falls and fall-related injuries in the 16-county greater Dallas/ Fort Worth Metroplex by increasing the number of low-income, minority adults with disabilities, and adults over the age of 60 who complete evidence-based falls prevention programs. NFP will enhance the 2015-2017 Falls Reduction Education and Empowerment (FREE) project into an integrated network of 15 partners who will provide screening, referral, and participation opportunities for A Matter of Balance (AMOB). NFP will increase capacity by adding Spanish and Vietnamese AMOB to the current system. NFP’s goals are to 1) increase number of low-income and minority participants in AMOB; 2) increase number of AMOB Master Trainers and Volunteer Lay Leaders; 3) increase underserved population by 15%, especially in falls “hotspots”; 4) create sustainable funding throughout integrated health care and managed care partnerships; and 5) utilize geo-mapping to enhance falls prevention infrastructure.

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Putting CDSMP to Work: Implementation of the Live Healthy, Work Healthy Program Employee health and wellness is at the forefront of employers’ minds because a healthy employee is also a productive employee. This grant from the National Heart, Lung, and Blood Institute (NHLBI) to translate the Chronic Disease Self-Management Program (CDSMP) for increased use in workplace settings. The overall aims of this research project are to examine the influence of CDSMP workshops specifically tailored to workplace settings on health outcomes, work performance, and productivity indicators. Additionally, the project will estimate the costs of implementing the program and assess cost-effectiveness and return on investment for employers and communities.

Supporting, Unifying and Streamlining in Texas through Active Integrated Networks (SUSTAIN) Widespread dissemination of evidence-based programs for older adults requires coordinated local and regional efforts.

This project will serve as a central hub to embed a suite of Stanford Patient Education Chronic Disease Self-Management Education (CDSME) within a 59 county region in Central and East Texas. SUSTAIN’s goal is to leverage the combined resources of Area Agencies on Aging (AAA), integrated healthcare systems (HIS), and managed care organizations (MCO) to better scale and sustain CDSMEs. Objectives are 1) establish partnerships among seven Texas AAAs, a minimum of two IHSs (Catholic Health Initiatives and Baylor Scott & White), and a minimum of one MCO (United HealthCare) to support sustainable program delivery; 2) increase the number of graduates from CDSME programs delivered; and 3) develop and evaluate models of best practice through memoranda of understanding and/or business plans to create a systematic healthcare referral model for linking clinical and community sectors.

“Generic public health strategies can be tailored to specific populations, settings, and diseases to improve the health and functioning of seniors with specific concerns.”

26

Ongoing Projects Policy and Environmental Assessments and Interventions

“Expanding evidence-based programs (EBP) for older adults means a commitment to influencing policy change and unifying partners and efforts across the state.�

Dementia-Friendly Communities to Promote Active Living Little is known about the role of different environmental domains (i.e. built, natural, and social) on physical activity, social activity, and overall independence for persons with Dementia. This is an administrative supplement to an ongoing NIH study of environmental impacts on physical activity. Funded through the National Institute on Aging, this project has three specific aims, centered on advancing the understanding of various housing and neighborhood environments for persons with AD/ADRD. By identifying the significant barriers and facilitators in the built, natural, and social environments in which people with AD/ADRD live, and by collaborating with dementia experts and built environmental professionals, this research aims to identify environmental strategies to promote physical activity, social interaction, and independence of people with AD/ADRD and reduce burdens on their caregivers. This project will be utilized to refine study protocols and obtain pilot data for more extensive research in this understudied area.

Development of a National Brief Screener to Assess Risk for Social Isolation among Older Adults There is growing recognition of the prevalence and harm of social isolation for older adults. Through an initiative driven

by AARP, this project aims to develop a screening instrument to identify upstream risk for social isolation and an algorithm to link older adults to needed services and resources based on their responses. Data collection will inform an online tool that can be embedded in community and clinical settings. In addition to identifying upstream risk factors for social isolation, this tool can also assist older adults and those that serve them to identify relevant and appropriate services, resources, and programs to improve connectivity with others.

Fighting Obesity by Reinventing Public Transportation The use of public transit has been associated with increased physical activity and considered a promising approach to reducing the risk of obesity and other age-related chronic conditions such as cancer, diabetes, and heart disease. This timely study uses a pre-post case-comparison design to examine the causal impact of Bus Rapid Transport (BRT) and other supporting strategies on residents’ physical activity. The specific aims are to (1) determine physical activity impacts of BRT; (2) examine physical activity impacts of additional educational and cost reduction strategies, and ;(3) explore benefits and costs of BRT implementation and barriers and facilitators of BRT use.

27

“The physical environment is increasingly recognized as a major social determinant of health and functioning.”

Intersection of Health and Place: Barriers and Facilitators of Health Service Utilization among Men with Chronic Conditions This project is intended to advance understanding of inequities associated with men’s utilization of health services for disease self-management. This study will develop an internet-delivered survey to collect data from over 1,000 men about their service utilization and perceived barriers/facilitators to disease self-management.

Then, based on the survey

responses, participants’ proximity to health-related services and organizations will be explored relative to their self-reported barriers to service utilization and disease management (using Geographic Information systems). Findings from this project will inform future multi-level interventions to improve disease self-management among men and reduce sex-based disparities in terms of life expectancy.

Physical Activity Impacts of a Planned Activity-Friendly Community With a multidisciplinary investigative team representing public health, architecture, engineering, computer sciences and education, this NIH-funded longitudinal, case-comparison study will examine how an activity-friendly community, which embodies the best practices in environmental design and policy, can increase residents' levels of physical activity and influence when and where they are physically active. It will also provide insights into why environmental and psychosocial factors influence physical activity, and how place impacts lifestyle behaviors related to the burden of obesity. The specific aims are to (1) examine the short-term and long-term changes in total PA levels and in spatial and temporal patterns of PA after sedentary or insufficiently active individuals move from non-AFCs to an AFC; and (2) determine what built and natural environmental factors lead to changes in PA among these populations, either directly or indirectly by affecting psychosocial factors related to PA.

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Ongoing Projects Technology Interventions

Assessment of the Utility of Dementia Patient Monitoring Technology Persons living with dementia (PWD) who wander due to disorientation and underlying agitation are at increased risk for harm due to being in an unsupervised environment, which can increase the burden of care for family caregivers. This pilot study funded by the Texas Alzheimer’s Research and Care Consortium aims to test the feasibility of a multi-component intervention that integrates a technology-based approach to increase PWD safety with evidence-informed skills training for caregivers. It examines the usability of a specially programmed watch (e.g., amount of time worn by PWD, features used by caregivers) and user satisfaction (e.g., whether it meets user expectations and needs, ease of use, what, if any changes the users would recommend) of the wearable technology that provides location information and two–way communication between caregivers and care-recipients.

GamePlan4 Care: Web-based Delivery System for REACH II With an aging population, there is a rapidly growing number of persons with dementia as well as concerns about burdens placed on family caregivers. This NIH-funded research applies technology to an existing evidence-based intervention, Resources for Enhancing Alzheimer’s Caregiver Health II (REACH II). The goal is to create a scalable and sustainable on-line family caregiver support system to be accomplished through two study aims: (1) advance the current proof-of-concept GP4C into a viable delivery system for the REACH II intervention; and (2) compare the relative impact of GP4C and GP4C-Education on a wide range of family caregiver outcomes.

GamePlan4Care is a novel

multifaceted intervention concept-tested in a previously funded Texas Cares grant. Working collaboratively with colleagues at Baylor Scott and White Health who are designing and implementing GamePlan4Care, Center investigators are responsible for evaluation.

“Technology can help older adults maintain independence and reduce burdens of care.

But it is important to test the acceptability and usability among older adults.”

29

Completed Projects

Active for Life ®

“Projects conducted over the past several years demonstrate the importance of translating research to practice, the benefits of approaching interventions from multiple levels, and building on best practices about achieving behavioral change over time in different populations and settings.

These projects were funded between 2001 and 2018.”

Funded by the Robert Wood Johnson Foundation, Active for Life® examined the effectiveness of two different evidence-based programs to increase physical activity in older adults in eleven settings across the nation. The program was designed to test the applicability of the RE-AIM framework and demonstrate that evidence-based physical activity programs can be successfully translated. Initiated in 2001 as the Center’s signature program Texas A&M served as the National Program Office providing technical assistance and direction to multiple grantees. This national program

provid-

ed the foundation for the Center’s substantial experience in identifying essential intervention elements and learning how to make programs more culturally and population relevant so that they may be scaled and sustained.

Adolescents & Young Adult Healthy Survivorship AYA Healthy Survivorship was a mobile application (app) designed for Adolescent and Young Adult (AYA) cancer survivors (ages 15-39) developed in partnership with the Texas Department of State Health Services Comprehensive Cancer Control Program. Expanding on the AYA Healthy Survivorship tool, the app assessed survivors’ overall health by providing scores for lifestyle, physical activity, diet and nutrition, and well-being. In addition, this interactive tool provided timely information to survivors about late effects, screening guidelines, care planning, and local resources such as those identified in MyHealthFinder. AYA Healthy Survivorship offered personalized tips for being more active, eating better, and living a healthier life; all delivered via email. During the active phase of this work, AYA Healthy Survivorship linked users to a secure and private Healthy Survivorship website (www.healthysurvivorship.org) where AYA users could register for a unique personalized profile and create cancer survivorship plans based on survey-driven templates. This tool was shared widely with members of the Cancer Alliance of Texas.

After Cancer Care Ends-Survivorship Starts for Adolescents and Young Adults (Access-AYA) This Cancer Prevention Research Institute of Texas (CPRIT) grant was designed to (1) develop and deliver professional education to Central Texas medical professionals including family and internal medicine doctors, nurses and nurse practitioners, social workers and physical therapists; (2) engage with AYA survivors and their families to help them use resources to develop survivorship plans and to learn more about ways to reduce risk and improve their health and well-being; and (3) create networks, information and communication systems to improve access to survivorship services and resources.

30

Aging & the Built Environment This NIH-funded innovative translational research program disseminated information on the health and quality of life benefits associated with providing outdoor space at senior communities. The “Access to Nature for Older Adults” program was based on an award-winning multimedia tool that translated current research findings to practical guidelines for industry professionals.

Other components included an interactive website, supplemental readings on

dementia, and continuing education credits. The program was developed by an interdisciplinary team from the Texas A&M College of Architecture and Texas A&M Health Science Center School of Public Health.

AgriLife Diabetes Management Programs With the high prevalence of diabetes in Texas, it is important to have programs designed for different populations and settings. Do Well, Be Well with Diabetes was the original Texas A&M AgriLife Extension diabetes program that reached out across Texas to rural communities without access to diabetes education. In response to the need for programs to reach more diverse hi-risk populations,¡Sí, Yo Puedo Controlar Mi Diabetes! (Si Yo Puedo) was developed for low literate, Spanishspeaking Hispanic/Latinos, employing novellas to deliver health messages in a culturally relevant manner. An initial pilot study at the Texas-Mexico border demonstrated that Si Yo Puedo could increase diabetes management self-confidence, improve diabetes self-care behaviors, and help participants maintain good blood glucose control. This program is now being widely disseminated as a model program for federally qualified health centers in Texas, and in other venues throughout South Texas.

Assessing the Built Environment in Colonias to Influence Policy Promoting Physical Activity in Mexican American Children & Families Funded by the Robert Wood Johnson Foundation Program in Salud America!, this study proposed to produce environmental policy recommendations promoting physical activity in economically-disadvantaged, understudied Mexican American children and families in the Rio Grande Valley. It involved conducting environmental assessments of different neighborhoods and presenting findings to key community stakeholders for action.

31

Assessing Existing Screening Guidelines for Physical Activity for Older Adults Goals for this Robert Wood Johnson funded project included: (1) reviewing existing literature regarding exercise guidelines and the extent of adverse events associated with exercise interventions and different screening approaches for older adults; (2) surveying the trans-NIH Behavior Change Consortium to provide the latest empirical data on screening criteria utilized in these premier behaviorally-based physical activity interventions; and (3) conducting focus groups and organize informal working group sessions at selected national professional meetings.

A screening roundtable of key stakeholders was

organized to discuss strategies for disseminating best practices and tracking any adverse events associated with new recommendations. A major product was the development of the EasyForYou Screening tool.

Brazos Valley Obesity Prevention Network The Brazos Valley Obesity Prevention Network (BVOPN) was a local coalition that worked to enhance community partnerships to promote awareness and expand opportunities to combat obesity in the Brazos Valley region. BVOPN partners worked together and received a grant to fund UP-BEAT, a local project designed to examine the impact of community and environmental strategies for increasing physical activity. In conjunction with the BCOPN efforts, the Brazos Valley Council of Governments was recognized by the Environmental Protection Agency, receiving a Building Healthy Communities for Active Aging Award.

Cancer Prevention and Control Research Network Funded as a Special Initiative Project of the CDC Prevention Research Centers, the Communities of Texas: Cancer-ActivityEducation-Research-Support (CTxCARES) was a member center of this CDC-funded thematic network. Our network was a catalyst for the adoption of evidence-based cancer prevention and control interventions in Central Texas. CTxCARES, as part of The Texas A&M School of Public Health Center for Community Health Development, partnered with Texas AgriLife Extension, Scott & White Healthcare, the Brazos Valley Area Agency on Aging, and other community and state-wide agencies to foster research on cancer prevention and control. Initial activities focused on promoting the health and well-being of cancer survivors, with an emphasis on the development of m-health tools for providing needed information and behavioral change strategies.

32

Changing Mobility Patterns of the Senior Generation Funded by the Institute for Mobility Research (Germany), this multi-disciplinary research project was designed to develop new knowledge about seniors’ mobility. Combining experts across disciplines including sociology, psychology, transport studies, econometric modeling, urban planning, and travel survey methods, researchers employed descriptive and multivariate statistical analyses of travel survey data from five countries (China, Germany, Japan, United Kingdom, and the US) and five decades. Objectives included: 1) an analysis of historic and current travel behavior of people 65+ years; 2) identification of factors possibly changing mobility patterns of people 65+, 3) quantitative estimation of future travel behavior of people 65+ ; and 4) implications of future travel behaviors for the transport system and BMW group.

Colon Cancer Screening, Training, Education & Prevention This Cancer Prevention Research Institute of Texas (CPRIT) grant addressed a critical unmet need for colon cancer screenings in the Brazos Valley by increasing the number of low-income underserved Texans 50 years and older who are referred to the Texas A&M Family Medicine Residency Clinic for CRC screenings. This project improved access to cancer screenings and follow-up care through culturally relevant case management from Promotoras/Community Health Workers (P/CHW), while simultaneously increasing the pool of family medicine residents and practicing family physicians trained in colonoscopy screenings in Texas. The evaluation team led by Center investigators tracked the availability, accessibility, and appropriateness of cancer screenings.

Developing Partnerships for Delivering Evidence-based SelfManagement Programs Chronic Disease Self-Management Program and Diabetes Self-Management Program workshops have been disseminated in the Brazos Valley and other regions in East Texas with support of the Texas Department of Aging and Disability Services.

A grant from WellCare Health Plans, Inc. provided the opportunity to partner with several organizations in the Houston/ Galveston area to build a private-public partnership for creating a sustainable system for delivering evidence-based self-management programs. This partnership enabled program delivery and training, technical assistance in program recruitment and selection, and evaluation of the program by documenting reach, adoption, and fidelity processes and outcomes.

33

Diabetes Prevention & Management Funded as a core research program of the Prevention Research Center, the Diabetes Prevention and Management Project aimed to improve the health of rural and underserved populations through better implementation, dissemination, and sustainability of clinical and community disease prevention and management guidelines. The research project focused on advancing dissemination research and attention to determinants and intervention research.

The project’s primary goal was to examine gaps in real-world utilization of disease prevention and control

guidelines and develop strategies for closing these gaps. Data from various assessments supported the need for diabetes and chronic disease self-management research in the Brazos Valley.

Disparities in Hospital Treatment Leading to Lower Extremity Amputation (LEA) among Residents Living Along the Texas-Mexico Border Specific aims of this pilot study were to examine differences in race/ethnicity, age, gender or insurance status among those who undergo LEA, exploring geographic and SES differences in total charges for care and particular treatments and therapeutic interventions. The high incidence of lower extremity amputations at the border was documented.

Dissemination of Fit & Strong! in the Brazos Valley Fit & Strong!, an evidence-based physical activity program for older adults, was disseminated in the Brazos Valley with support from Scott & White Healthcare’s Community Resource Center for Senior Health and St. Joseph’s Healthy Communities. The program, originally designed for older adults with osteoarthritis, is eight weeks long and combines flexibility, strength training, and aerobic walking with health education to reduce arthritis symptoms, maintain independent functioning, and increase participation in physical activity among older adults. This pilot study implemented in conjunction with the Brazos Valley Area Agency on Aging demonstrated that older adults in the Brazos Valley liked this program and could benefit from it.

Doctor-Patient Encounters: Communications about Lifestyle Recommendations and Other Geriatric Conditions This was a small grant supported by The Texas A&M Health Science Center School of Public Health and the Baylor Scott and White Health Services Research Program. The purpose was to examine how doctors communicate to their older patients regarding lifestyle recommendations and the influence of patient, physician, and setting factors. Additionally, we examined the amount of time spent on different lifestyle discussions. The study concluded that precious little time was spent on provider-patient discussions about lifestyle behaviors.

34

EPICO: Education to Promote Improved Cancer Outcomes The program was designed to increase delivery of comprehensive cancer services through the development of a replicable, sustainable tailored training program for promotores on prevention, treatment, and healthy survivorship for colorectal, breast and cervical cancers among at-risk residents in the Lower Rio Grande Valley (LRGV) on the Texas-Mexico border.

Specific aims were to: (1) equip promotores to educate residents on prevention, treatment, and survivorship issues related to colorectal, breast, and cervical cancers; (2) enable promotores to use tailoring strategies to improve their outreach efforts; and (3) increase residents’ prevention, treatment, and healthy survivorship behaviors. A critical role was advisement on translation and dissemination efforts.

Enhanced Breast & Cervical Cancer Prevention for Low Income & Under-Served Using Transdisciplinary Collaboration in a Family Medicine Setting This breast and cervical cancer program used a transdisciplinary training approach for family medicine residents, nursing students, public health students, and community health workers/promotoras (CHW/Ps), to bring screening and prevention services to women in rural and underserved communities in the nine-county Brazos Valley region of Texas. The program provided education, screening, and treatment services to medically uninsured, low-income women. The goals included to 1) facilitate access to screening and diagnostic services, across the continuum of care, for women in nine Texas counties; 2) provide interdisciplinary culturally- appropriate joint training to family medicine residents, nursing students, and CHW/Ps; 3) utilize CHW/Ps, staff, students, and volunteers to provide community outreach and education and 4) improve family medicine, nursing, and public health practice related to evidence-based, culturally- appropriate care in women’s cancer services. Center staff served as co-investigators in this activity.

Enhanced Colorectal Cancer Screening in a Family Medicine Residency Program This Cancer Prevention Research Institute of Texas (CPRIT) grant addressed a critical unmet need for colon cancer screenings in the Brazos Valley by increasing the number of low-income underserved Texans, 50 years and older, who are referred to the Texas A&M Family Medicine Residency Clinic for CRC screenings. This project improved access to cancer screenings and follow-up care through culturally relevant case management from Promotoras/Community Health Workers (P/CHW), while simultaneously increasing the pool of family medicine residents and practicing family physicians trained in colonoscopy screenings in Texas. The evaluation team tracked the availability, accessibility, and appropriateness of cancer screenings.

35

Enhancing Self-Care Activities of Patients with Diabetes Using a PDA: A Pilot Study The specific aims of this Baylor Scott and White Health Services Research Program project were to 1) assess the feasibility of PDA use in diabetes self-care by patients aged ≥18 years with type 2 diabetes; 2) identify which patients would benefit most from the use of a PDA; and 3) explore whether the use of a PDA as an adjunctive diabetes self-care device leads to better or improved patient adherence to diabetes self-care activities.

This work was foundational in our development of

self-assessment tools and related mobile health applications.”

Falls Reduction Education & Empowerment (FREE) Project The United Way of Tarrant County (UWTC), in partnership with eight Area Agencies on Aging (AAAs), the Texas Falls Prevention Coalition (TFPC) and other organizations, collectively known as “Falls Reduction Education and Empowerment (FREE) Partners,” was awarded funds by the Administration on Active Living to reduce falls and fall risk in Texas. The School of Public Health oversaw the Texas Falls Free Coalition and evaluated the effectiveness of implementing A Matter of Balance (AMOB) among participating Area Agencies on Aging. The goal of graduating at least 4,000 participants in AMOB in the Dallas/Fort Worth, Austin, San Antonio, Corpus Christi, and El Paso metropolitan areas was met. Though the TFPC, FREE provided training for fall prevention programs to master trainers, physical therapists, emergency medical professionals and community health workers. FREE’s key sustainability partners, Texas Healthy at Home and WellMed, were consulted on best strategies to generate funding for program delivery and sustainability.

Friend to Friend Successfully adapting the research-tested intervention program, Friend to Friend (National Cancer Institute, 2006) for delivery by Texas A&M AgriLife Extension agents likely had a lasting impact on reducing the burden of cancer in rural and frontier Texas counties. Increasing the number of these women who found cancer in earlier stages not only reduced mortality and suffering but the higher costs for treating later stage cancer and the frequently devastating financial repercussions for their families. Urban women with cancer may travel a few miles for cancer treatments, but rural Texas women will likely travel hundreds of miles to the nearest treatment source. Center investigators provided consultation about the RE-AIM planning and evaluation framework for Friend to Friend.

36

Health Maintenance Consortium SPH

served

as

the

Resource

Center

for

this

consortium

of

twenty-one

funded

NIH

grants

examining

factors associated with long-term behavioral maintenance. The Resource Center has created an infrastructure to 1) foster ongoing cross-site communications among the funded projects; 2) provide technical assistance to identify common questions, methods, and measures related to maintenance and sustainability and to address cross-cutting issues that add synergy to the individual projects; 3) establish a central clearinghouse for behavioral change concepts, assessment instruments, intervention protocols, methods, and data that can be beneficial for other researchers and practitioners; and 4) disseminate research findings to both researchers and practitioners. Nearly 50,000 individuals from adolescence to adulthood to old age were involved in this HMC-supported research, making this one of the largest group of studies of behavior change maintenance.

Healthy Aging & Independent Living The Community Research Center for Senior Health (CRC-Senior Health) served as the evaluation unit for the HAIL initiative with the United Way of Tarrant County.

Working collaboratively with the CRC-Senior Health,

Center

investigators were involved in designing evaluation tools, providing technical assistance on data protocol issues, and providing final reports of major impacts on relevant outcomes such as self and family health status, quality of life, and health care utilization. Furthermore, based on protocol-driven interviews with five funded agencies, Alzheimer’s Association, Easter Seals, Meals on Wheels, North Texas Area Community Health Center, and Senior Citizen Services, the evaluation team developed strategies and guidelines to promote understanding and reliable evaluation for the HAIL initiative with a focus on addressing program evaluation in general, as well as offering information specific to protocols and roles with the HAIL initiative.

ICANFIT This web-based mobile application helped disseminate community resources and promote physical activity for older survivors by determining locations and programs based on zip codes, setting up personal goals and tracking progress, developing social networks with peers, and opening access to senior-friendly resources. The study was one of the first web and mobile technology-based solutions for older cancer survivors to promote PA and increase the quality of life. The data collected was used to determine feasibility, refine ICANFIT, and provide pilot data for future funding applications. A major accomplishment was the creation of an ICANFIT website (http://www.icanfit.org/).

37

Impact, Sustainability & Scalability of Multi-Component Falls Prevention Programs Working collaboratively with the Centers for Disease Control and Prevention (CDC) and the three funded State Health Department Injury Programs, the goal was to facilitate the evaluation of the processes and impacts of state-driven fall prevention programs for older adults. The two primary aims during the initial three years of the states’ five-year multi-component fall prevention program implementation were to: (1) determine the impact of the designated multi-component fall prevention interventions on health, health care utilization, and costs using quantitative and qualitative methods; and (2) build states’ capacity for ensuring program successes by providing technical assistance on strategies for enhancing and monitoring the reach, fidelity, sustainability, and scalability of evidence-based fall prevention programming. This work resulted in a lessons learned report shared with CDC staff and grantees.

It Takes A Village— A Multi-Disciplinary, Multi-Level Evaluation of the State Driven Fall Prevention Project During the three year “Village” evaluation, essential elements of effective fall prevention programming at the state level were identified to accelerate and improve the dissemination of these effective models and associated findings to a broader, national audience. The three aims were to: (1) evaluate the impact of programs as they are scaled statewide; (2) provide technical assistance to bring programs to scale, and (3) disseminate findings to key stakeholders. The ultimate impact of this initiative was to improve the health and functioning of the growing population of older Americans at-risk for falling.

Learning Network The Learning Network was affiliated with the Active for Life® program and built community capacity for translating research to practice. The Learning Network was designed to create a mechanism for sharing resources about successful approaches to active aging.

By partnering with the National Blueprint, this project created an interactive Learning

Network for the Building Healthy Communities Recognition Program which promoted the pairing of smart growth principles with activity programming for older adults.

38

Medication Use, Dietary Intake, and Functional Outcomes Among Homebound Elders This was a small grant supported by The Texas A&M University System School of Public Health and the Baylor Scott and White Health Services Research Program. This project examined medication use, dietary intake, and functional outcomes among a large and diverse sample of frail elders in the community. The project delineated drug-use patterns that may influence

dietary intake and nutritional status, physical performance, and disability, and it identified appropriate targets

for tailored interventions.

National Study of Evidence-Based Chronic Disease Management The National Council on Aging served as the Technical Resource Center for this Administration on Aging Initiative which sought to enroll over 50,000 older adults throughout the Nation in chronic disease self-management programs. Working collaboratively with the NCOA and the Stanford Patient Education Research Center at Stanford University, Center investigators conducted a national study of 1,000 older adults to document individual outcomes of the Stanford Chronic Disease

Self-Management

Program,

behaviors, and health care utilization.

such

as

self-reported

health

status,

quality

of

life,

health

Data came from approximately 30 delivery sites across the Nation, with an

emphasis on getting a diverse population of participants from both urban and rural areas. This collaboration provided a synergy that helped bridge the research-to-practice gap and further our knowledge about the outcomes of widely disseminated evidence-based programs. This evaluation further demonstrated that chronic disease self-management programs could meet the triple health reform aims of “better health, better health care, and better value..�

Nationwide Evaluation of Evidence-Based Programs for Seniors Working collaboratively with the Administration on Aging, the following objectives were addressed in a three-year cooperative agreement: (1) assess the current state of knowledge about EBP practice and evaluation; (2) identify strength and gaps in reaching aging populations, delivering EBP services, and building training and evaluation capacity; (3) recommend a nationwide evaluation plan, specifying design, measurement, desired outcomes, and other critical elements; and (4) indicate key players/areas of expertise needed to conduct the proposed evaluation plan. This activity was coordinated with the Healthy Aging Research Network.

39

Obesity, Stress, & Neuromuscular Function in Older Adults Obesity prevalence among older adults is a growing concern as obesity has been associated with increased falls risk and declines in mobility and functional independence. At the same time, stress is considered as one of the most significant health problems in the 21st century that has a burdening impact on both physical and mental health. While obesity is an established risk factor for cerebral health and impaired cognition, there is very little information available regarding obesity-related changes in brain function during physical activities in older adults. Funded by the National Institute on Aging, the R15 AREA award aimed to identify the impact of obesity and stress on brain function associated with loss of physical functioning in older adults that can inform the development of intervention strategies to promote brain (and subsequently) physical health. An additional objective of this award was to strengthen the research environment at the School of Public Health Texas A&M Health Science Center and to expose (under)graduate students to multidisciplinary biomedical research, thereby broadening their range of career choices.

Patient Reported Outcomes in Patient Centered Medical Homes With supplemental funding from the National Cancer Institute, Texas A&M participated in a cluster-randomized pragmatic trial comprised of nine pairs of diverse primary care practices randomized to adopt and field My Own Health Report (MOHR). This study evaluated an electronic or paper-based, publicly available health behavior and mental health assessment paired with a counseling and goal setting tool, versus no systematic assessment. This pragmatic research study examined how intervention practices independently integrated MOHR into their workflow, adapted their integration over time, and affected the patient experience.

40

Pilot Evaluation of the Chronic Disease Self-Management Program This Centers for Medicare and Medicaid Services funded project was responsive to the requirements of Section 4202 subsection (b) of the Affordable Care Act (ACA) directing the Secretary of the Department of Health and Human Services to “conduct an evaluation of community-based prevention and wellness programs and develop a plan for promoting healthy lifestyles and chronic disease self-management for Medicare beneficiaries.� This study examined the impact of the Chronic Disease Self-Management Program (CDSMP) on health outcomes, utilization, and costs in an existing sample of participating beneficiaries by linking CDSMP records to Medicare administrative data. Working collaboratively with Stanford University, the Texas A&M Health Science Center Evaluation team was responsible for data linkage, analysis, and report writing. A major contribution was designing on-line modules related to quality assurance and identifying innovative quality assurance practices to be shared throughout the aging services network.

Planning for a National Evaluation & Implementation of Evidence -Based Programs for Seniors The national roll-out of evidence-based disease prevention programs funded through the Administration on Aging (AoA) required technical assistance in planning, implementation, and evaluation. Working collaboratively with Healthy Aging Network consultants as well as National Council on Aging (NCOA) colleagues, Center investigators assisted the AoA in designing a national research strategy for understanding the processes involved in delivering evidence-based programs as well as documenting program reach and benefits. Activities involved creating a common data base, assisting States in conducting research and presenting study findings around the RE-AIM Planning and Evaluation framework, and

advising

on

strategies

for

enhancing

quality

assurance

and

fidelity

processes.

A

major

contribution was designing online modules related to quality assurance and identifying innovative quality assurance practices that can be shared throughout the aging services network.

41

Policies, Programs, & Partners for Fall Prevention (PPPFP) This was a collaborative effort, funded through the CDC, with the University of North Carolina Schools of Medicine and Public Health. Working with over 40 State Fall Prevention Coalitions, PPPFP addressed the urgent need to identify more effective public health strategies for reducing falls, fall-related injuries, and fall-related rates of emergency room visits among the growing population of seniors. Additionally, through the implementation of new training structures, PPPFP built upon existing partnerships to increase the impact and sustainability of evidence-based fall prevention programs delivered to vulnerable older populations. The project developed strategies and train community health workers in Texas and North Carolina in the implementation of Otago, a community-based falls prevention program delivered primarily in the home by physical therapists.

Prevention Research Center—Research Core Project The purpose of this research core was to improve the health of rural and underserved populations through better implementation, dissemination, and sustainability of clinical and community prevention and disease management guidelines. Two primary questions were addressed: (1) why community and clinical practice guidelines, which are designed to improve health, were not better utilized? and (2) What strategies for better guideline implementation, adherence, and dissemination in especially vulnerable populations (including poor rural populations) were most effective.

Program for Rural & Minority Health Disparities Research The Disparities Program was a collaborative initiative between the Center for Community Health Development at the School of Public Health and the Center for the Study of Health Disparities at TAMU. Funded by the National Center on Minority Health and Health Disparities at NIH, this program focused on the intersection of setting and population characteristics and how they impacted health—with specific attention to nutrition, physical activity, obesity, and diabetes.

The program’s core research project, Employing Diabetes Self-Management Models to Reduce Health Disparities in

(central) Texas, addressed many aims of relevance including 1) documenting the nature and magnitude of health disparities among

patients with type 2 diabetes; 2) evaluating different diabetes self-management intervention

approaches on patient

behavioral and clinical

outcomes; 3) assessing the cost-effectiveness of these different

approaches to diabetes self-management education; and 4) exploring the reach of our intervention efforts and the broader organizational impacts of diabetes self-management education, examining how self-management

interventions

get linked back into clinical practice. Center investigators co-directed the research and translation core and participated in research to investigate behavioral and social strategies for diabetes management. This activity served as the foundation for our later diabetes prevention and management research and practice efforts.

42

Promoting Walking & Other Physical Activity among Obese & Diabetic Patients in Integrated Healthcare Plans Despite the recognition of the environment as a major determinant of activity levels, little is known about how primary care practitioners include environmental factors in their recommendations for obese patients. Funded through the Scott and White Research Foundation, this pilot study which was a collaboration between Scott and White, the College of Architecture and the School of Public Health examined both physician and environmental influences on patient activity levels by 1) assessing if, and how, healthcare providers encourage walking and engagement in other physical activity to their obese and diabetic patients; and 2) identifying specific built environmental facilitators of, and barriers to, walking and engagement in other physical activity in the neighborhood. A major product was the development of a community resource guide for use by health care providers and patients to identify accessible places for physical activity.

Reinventing Public Transportation Programs to Fight Obesity Epidemic: A Pilot Study in El Paso, Texas Little is known about the causal impact of a rapid bus transit system on nearby residents’ physical activity. There are many methodological challenges to overcome in designing a rigorous longitudinal case-control study to understand how new transportation options affect obesity risk factors among a predominantly lower-income Hispanic population. With internal Texas A&M University funding (PESCA), a multidisciplinary team with expertise in architecture, urban design, transportation sciences, and public health conducted pilot work to develop valid, reliable, and culturally sensitive recruitment strategies and data collection protocols needed to submit a competitive NIH grant proposal in 2017. The R01 submission was reviewed successfully and Fighting Obesity by Reinventing Public Transportation: A Natural Experiment was funded in 2018.

South, West, and Central Consortium—Geriatric Education Center The South, West, and Central Consortium, Geriatric Education Center of Texas (SWACGEC) was based at the University of Texas Health Science Center at San Antonio. The SWAC GEC has facilitated the improvement of patient care for the aged through interdisciplinary partnerships with faculty and practitioners in the fields of gerontology and geriatrics. The consortium has provided culturally appropriate geriatric training to more than 50,000 health

professionals

both

coordinating

on-site

and

by

distance

learning.

As

a

Consortium

partner,

SPH

was

focused

on

educational and training efforts related to chronic disease management, especially around the implementation, dissemination, and sustainability of evidence-based chronic disease management programs.

43

Testing a Low-Literacy Diabetes Self-Management Education Kiosk In response to concerns about the need for more culturally sensitive self-management tools, an educational KIOSK was developed by team members to provide basic self-management information about diabetes to low literacy populations in both English and Spanish. This research was supported by the Morris L. Lichtenstein, Jr., Medical Research Foundation and was designed to evaluate the implementation and dissemination of a computer-assisted touch screen in multiple clinics and organizations in the Central Texas and Coastal Bend regions. The over-arching goals of the KIOSK were to improve the availability of diabetes self-management education and improve the sustainability of consumer’s ability to self-manage diabetes through the ready availability of diabetes education tools and decrease or delay diabetes complications. After some local pilot testing in the Brazos Valley to assess the feasibility and use of the KIOSK, we have redesigned the basic educational module to run off a web-based system so that we can more easily place KIOSKs in different geographic settings.

Texas A&M University Coalition for Healthy Active Living Rapid advances in sensor technologies, big data analytics and processing, electronic health and medical records, and the realization of the so-called “Internet of Things” have created a world in which devices and data can be harnessed to promote health and wellbeing in ways unimaginable just a mere decade ago. The Texas A&M University Center for Healthy Active Living (TAMU-CHAL) served as a research, education, outreach, and clinical nucleus within which multi-disciplinary research teams can be empowered to develop, test, and deploy new techniques and strategies which exploit this new ecosystem of data, services, and sensors to improve public and individual health. The core

mission of

this center was to engineer technologies and techniques for data collection and analyses, facilitate new forms of health research and analyses, and enable novel lines of health interventions, monitoring, and promotion for targeted populations of at-risk individuals. In partnership with Baylor Scott & White Health (a leading healthcare services TAMU-CHAL integrated and coordinated research efforts across the TAMU Colleges of

provider), the

Engineering, Geosciences,

Education & Human Development, Medicine, and the School of Public Health, serving as a concrete example under the banner of the TAMU One Health Initiative.

44

Texas Cares: Model for Memory Capable Communities Funded by the Texas Alzheimer's Research and Care Consortium, this was a collaborative effort between Texas A&M and Baylor Scott and White Health to provide Persons with Dementia (PWD) and their family caregivers access to local services and supports that have been proven to promote the health and well�being of the PWD and their family caregivers. Objectives of this pilot research study were to concept test a comprehensive model of care to: (1) promote dementia friendly communities for Texans; (2) personalize educational and support services through candid interviews with dementia caregivers; and (3) create an online adaptation of an evidence-based intervention to provide tailored resources and coaching. This seed funding has resulted in funded projects to further develop and test behavioral, environmental, and technological approaches to dementia care.

Texas Childhood Obesity Prevention Policy Evaluation Funded by the Robert Wood Johnson Foundation, the Texas Childhood Obesity Prevention Policy Evaluation Project (T-COPPE) was created to evaluate the impact of two national policies as they are implemented in Texas. T-COPPE was a 5-year study running from 2009-2013, which evaluated the effect of the Safe Routes to School (SR2S) and the Women, Infants, and Children (WIC) Nutrition Program on the health of Texans. This was the first major

Texas

initiative

supported by a statewide coalition of more than 80 partners including academics, prevention advocates, community leaders, and government agencies collectively called Live Smart Texas (LST). Findings from this study were disseminated through a comprehensive policy outreach educational effort, including a series of high visibility policy forums and related activities coordinated through the Texas Health Institute and the Live Smart Texas coalition website to inform future policy implementation and development.

45

Texas Falls Prevention Coalition The Texas Falls Prevention Coalition was established in 2007 to “promote, implement and evaluate evidence-based programs and policies that help reduce risk factors of falls and injuries in older adults; provide education and resources to increase public awareness, mobilize communities and effect policy change for a falls free Texas.” In May 2014, coordination responsibilities were transferred to Texas A&M School of Public Health to reconstitute a Steering Committee of broad-based stakeholders to promote a multi-faceted approach to falls prevention throughout Texas. A Steering Committee was appointed with representation from the state aging (Department of Aging and Disability Services) and health (Department of Health and Human Services) agencies, the

Texas Association of Area Agencies on Aging (T4A);

health care partners and providers (e.g., Baylor Scott and White Healthcare, WellMed Charitable Foundation, Texas Hospital Association, and the Texas Physical Therapist Association); and academia (Texas A&M).

WellMed has provided seed

funding to support promotion activities.

Texas Grow! Eat! Go!: Using Family Focused Garden, Nutrition & Physical Activity Programs to Reduce Childhood Obesity The goal of this Integrated Research and Extension project was to assess the efficacy of a coordinated school health (CSH) program enhanced with family-focused, experiential garden, nutrition, and physical activity programs on the

prevalence

of child overweight and obesity in 3rd-grade students. The home food and physical activity environments were targeted through two Extension programs designed to build upon CSH.

Independent and combined effects of different

programmatic approaches were evaluated. This activity served to generate an evidence-based program now integrated into the Healthy South Texas initiative. The School of Public Health led the process evaluation examining key stakeholders’ perspectives of the implementation, dissemination, and sustainability of this program.

Texas Healthy Aging Research Network Collaborating Center Together with the Collaborating Center of the Healthy Aging Research Network (HAN), other HAN sites and the CDC, TxHAN worked to continue the advancement of the translation of prevention research to community-based practice focused on an aging population. Through partnerships with local, county, and state agencies, TxHAN sought to identify public health, aging services, and related community resources and engage them in collaboration for healthy aging. The TxHAN advanced key HAN research initiatives in the areas of physical activity and environmental assessment, while also engaging in new research priorities including depression, nutrition, and Alzheimer’s disease.

46

Texas Healthy Lifestyles With funding from the Texas Department of Aging and Disability Services, Texas Healthy Lifestyles: Communities Putting Prevention to Work disseminated the Chronic Disease Self-Management Program to over 3000 older Texans. The State selected five geographic areas–Tarrant County, Bexar County, Central Texas, Rio Grande area and the East

Texas

Coalition–as regional sites for delivery and dissemination of this program. The School of Public Health directed the state-wide evaluation effort to track program dissemination, document the adoption by local community agencies, and provided technical assistance on standardized data collection and fidelity processes among partnering communities.

Coordinating local efforts with the Brazos Valley Area Agency on Aging, seniors in our community had the opportunity to participate in a variety of evidence-based chronic disease management programs delivered through aging and public health as well as other community sectors. Our Brazos Valley AAA has recently formed a partnership with the Texas A&M University College of Nursing and is training nursing students as class leaders for our evidence-based programs. This partnership has proven to be an excellent educational opportunity as well as a means for disseminating and sustaining the delivery of evidence-based programs throughout the state.

Texercise: Evaluating its Reach & Effectiveness Texercise was a statewide health promotion program of the Texas Department of Aging and Disability Services that encouraged individuals and communities to adopt healthy lifestyle habits such as regular physical activity that can sustain or improve mobility among the more than 2.5 million older Texans. Texas A&M Health Science Center Prevention Research Centers Healthy Aging Research Network partnered with the Baylor Scott and White HealthCare

Community

Research

Center

for

Senior

Health

to

evaluate

Texercise’s

reach

and

effectiveness.

Major

objectives were to (1) help standardize the existing program for widespread dissemination as an evidence-based program and (2)

conduct a systematic evaluation of the processes and outcomes associated with Texercise.

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Texercise Select– Building the Evidence-Base Texercise Select was a statewide health promotion created collaboratively between the Texas Department of Aging and Disability Services and Texas A&M School of Public Health Program on Healthy Aging. The program combined: (1) education about the importance of physical activity and healthy eating; (2) skill-building sessions for learning how to set and achieve attainable lifestyle goals; and (3) a multi-component exercise program designed to increase strength, endurance, balance, and flexibility. Following up on an earlier study which standardized Texercise Select, major objectives of this study were to examine: (1) the impact of Texercise Select on increased physical activity and healthy eating, enhanced social interaction, improved perceived quality of life, and better physical functioning; (2) the relationship between intervention dosage and study outcomes; (3) potential differential impacts across participant characteristics; (4) programmatic costs and quality-adjusted life years attributed to program; and (5) factors affecting (i.e. barriers, facilitators) program implementation, dissemination, and long/short-term sustainability. This research enabled Texercise Select to be considered an evidence-based program and eligible for Title3D funding.

UP-BEAT Project & City-BEAT Walking Circuit UP-BEAT (Umbrella Partnerships- BE Active in our Town) was a collaborative effort to improve the health and well-being of persons living in the Brazos Valley. With funding from the Department of State Health Services, UP-BEAT facilitated new and current partner efforts to increase access to physical activity among limited resource youth and families in Brazos County. UP-BEAT worked toward environmental and policy changes to increase access to physical activity within the Brazos Valley. UP-BEAT has implemented the City-BEAT walking circuit in downtown Bryan to highlight walkable areas and to encourage visitors and residents to use the downtown areas for physical activity. Working with the City of Bryan, the City-BEAT walking circuit was coordinated with the existing audio walking tour of downtown. Additionally, UP-BEAT trained community youth to conduct environmental assessments of limited resource neighborhoods in Brazos County.

The youth shared their findings with local key stakeholders and policy-makers in efforts to make changes to increase physical activity opportunities in the Brazos Valley.

WellCare: Developing Partnerships for Delivering Evidence-Based SelfManagement Programs While Chronic Disease Self-Management Program and Diabetes Self-Management Program workshops have been disseminated in the Brazos Valley and other regions in East Texas with support of the Texas Department of Aging and Disability Services, a grant from WellCare Health Plans, Inc. offered a significant opportunity to partner with a number of organizations in the Houston/Galveston area. Such private-public partnerships are essential for building a sustainable delivery system for reaching underserved populations. Our goal was to empower at least 400 older adults Houston/Galveston

area

to

better

manage

their

chronic disease and

in

the

diabetes. This was accomplished with

the introduction of evidence-based programming in partnership with the collaboration of partners in the Houston Consortium. Center investigators assisted in program delivery and training, provided technical assistance in program recruitment and selection, and evaluated the program by documenting reach, adoption, and fidelity processes and outcomes.

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Wisdom, Power, Control Texas A&M AgriLife Extension in collaboration with Texas A&M School of Public Health (SPH) piloted Wisdom, Power, Control through a grant funded by the USDA National Institute of Food and Agriculture. Wisdom, Power, Control was developed by Texas A&M AgriLife Extension in response to the need for an evidence-based, culturally relevant type 2 diabetes self-management education (DSME) program targeting African Americans. Employing an experiential, hands-on approach in instruction, the seven-week empowerment-based program aligns with the American Diabetes Association’s standards for DSME. The study aims were to examine programmatic effects on hemoglobin A1c, diabetes knowledge, self-efficacy, and self-care skills. As part of this effort, this project sought to reach underserved African Americans who have limited access to health resources and build capacity in the targeted communities. Following the successful one-year pilot project, there are plans to further market the Wisdom, Power, Control program to African-American communities.

Working on Wellness In response to the CDC Funding Opportunity on Programs to Reduce Obesity in High Obesity Areas,

Working on

Wellness (WoW), a community-based program was established to address obesity in Hidalgo County, Texas, where more than 40% of its 800,000 residents were obese. The Texas A&M AgriLife Extension Service and Texas A&M Health Science Center School of Public Health partnered to address the obesity issue in Hidalgo County by combining the skills and expertise of both organizations to improve access to healthier foods and safe places for physical activity. Bringing a wide array of specialists to support project implementation and evaluation, both organizations had a strong presence in Hidalgo County and considerable experience in implementing and evaluating community prevention programs in border communities.

Utilizing a community-based participatory approach, community assessments were conducted and

proposed strategies for addressing high rates of obesity vetted with community stakeholders. The School of Public Health was responsible for the process and outcomes evaluation.

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Funding Sources Administration for Community Living Baylor Scott and White Health Centers for Disease Control and Prevention

Health Resources and Services Administration National Council on Aging National Institutes of Health Robert Wood Johnson Foundation

St. Joseph’s Healthy Communities Texas Alzheimer's Research and Care Consortium Texas Department of Aging and Disability Services Texas Department of State Health Services Texas Health and Human Services Commission United States Department of Agriculture United Way of Tarrant County WellCare Health Plans, Inc. WellMed Charitable Foundation 50

Contact Information Texas A&M School of Public Health 212 Adriance Lab Rd. College Station, TX 77843

Dr. Marcia Ory

979.436.9368 mory@tamhsc.edu

Dr. Matthew Smith

979.436.9518 matthew.smith@tamhsc.edu

Twitter

@TAMU_CPHA

Facebook

facebook.com/TAMUCPHA/

Email

healthyaging@sph.tamhsc.edu

Web

cpha.tamhsc.edu fallsfreetexas.org

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