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This proposed Science of Behavior Change (SOBC) study will examine coercive couple and parent-child conflict, which together constitute a ubiquitous, potent, and destructive (but modifiable) interpersonal poison to a wide range of adult and children's health outcomes. Such patterns are also linked with poor parent-child relationships and with more harsh punishment, which is associated with disturbed responses to environmental stresses (e.g., disruption in sympathetic nervous system and hypothalamic-pituitary-adrenocortical responses), a wide variety of adverse health outcomes in childhood, including dental caries, obesity, and diabetes related metabolic markers. This phase of NIH's Science of Behavior Change program emphasizes an "experimental medicine approach to behavior change" necessitating identification of central interpersonal/social targets for maximal impact on far-reaching panoply of health outcomes. This project will focus on factors associated diabetes and oral health (though the processes affect many other disease outcomes). Both are associated with pain, distress, expense, loss of productivity, and even mortality. They share overlapping medical regimens, are driven by overlapping proximal health behaviors, and affect a wide developmental span, from early childhood to late adulthood.
Coercive processes between couples will be studied in lab-based experiments with couples in which one partner is at risk for or has Type II Diabetes. For these participants, the health behavior of interest will be healthy eating behaviors. Coercive processes between parents/caregivers and their children will be studied in lab-based experiments with children at risk for early childhood caries. For these participants, adherence to tooth-brushing and healthy eating behavior, including consumption of sugar-sweetened beverages, will be the health behaviors of interest.
This project will test two interventions to engage coercive processes, both adapted for the current study from established behavioral interventions. One intervention is meant to change coercive processes by reframing or re-attributing behavior (cognitive intervention). This intervention is adapted from research in distressed couples by Gottman, Babcock, Slep, and others. The second intervention is meant to change coercive processes by having dyads or parents/caregivers enact a specific behavior (behavioral intervention) shown to reduce coercive processes both among couples and in parent-child relationships. These types of interventions have been called “proximal change interventions” or “microtrials”, developed with the specific intent of testing the effect of an intervention on a putative change mechanism, before testing the intervention on a long-term clinical outcome. Given the aims of the SOBC Research Network, interventions of these types seem particularly well-suited for this project.
This project will develop and identify measures to allow for testing whether the cognitive and behavioral proximal change interventions engaged/changed coercive processes as intended. These measures will capture coercive processes at three different levels:
1) The project will adapt an observational coding system to assess coercive processes, drawing from established coding systems that are considered the “gold standards” of observational coding.
2) The project will also develop and test a self-report measure (for couples) or parent/caregiver report measure (for parent-child dyads) of coercive processes. Although there are self-report measures of related constructs, such as relationship quality and satisfaction, there are no self-report measures that would allow for a specific test of coercive processes.
3) The project will identify physiological markers of coercive processes, based on real-time assessment of sympathetic and parasympathetic activity, and other potential biomarkers.