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1. [SOBC Measures Repository.][3] 2. [SOBC Resource and Coordinating Center Website.][1] 3. [NIH Common Fund SOBC Website.][2] ## **SOBC Overview** ## The Common Fund's Science of Behavior Change (SOBC) Program aims to improve our understanding of human behavior change across a broad range of health-related behaviors. The SOBC Program supports research that integrates basic and translational science and cuts across many disciplines including, but not limited to, cognitive and affective neuroscience, neuroeconomics, behavioral genetics, and behavioral economics. The program plans to establish groundwork for a unified science of behavior change that capitalizes on both the emerging basic science and the progress already made in the design of behavioral interventions in specific disease areas. This will be accomplished by supporting basic research to improve our understanding of human motivation and maintenance of behavior change across multiple diseases and conditions, and using this knowledge to develop more effective and economical behavioral interventions. For more information, go to ## **Project Overview** ## **How does stress affect health behaviors -- preferences, beliefs, or constraints?** *Johannes Haushofer (Princeton), Chaning Jang (Princeton), Kate Orkin (Oxford), and Crick Lund (Cape Town)* A recent Cochrane Review of RCTs aimed to increase regimen adherence paints a bleak picture of the current state of the field (Nieuwlaat et al., 2014). The authors summarize the results of 182 RCTs, which aimed to improve regimen adherence through various interventions, noting that most interventions produced little improvements in regimen adherence with small magnitudes of effect; additionally, those that worked were expensive interventions that combined many constituent elements, thereby making it difficult to understand the mechanisms through which they took their effect. The goal of the current study, therefore, is to take an experimental medicine-based approach which first identifies candidate targets related to stress and stress resilience - in particular, temporal discounting, self-efficacy, and executive control - which are likely to affect adherence and other health behaviors; develops interventions to affect these targets and assays to verify target engagement; and tests whether the engagement of these targets affects regimen adherence and other health behaviors. **Study 1: Identification and testing of target measures** The research areas of temporal discounting, executive control, and self-efficacy boast almost as many measures as researchers. The goal of Specific Aim 1 is to identify, test, and refine a set of measures for each of our three targets. To this end, we will conduct a systematic literature review and create a ranking of candidate measures (Study 1A). Subsequently, the most promising measures will be adapted to the Kenyan context and tested on participants at the Busara Center for Behavioral Economics in Nairobi, Kenya, on each of two occasions. We will use the results to rerank the measures against each other (Study 1B). The top measures for each target will be chosen for all further studies. **Study 2: Effects of Stress on discounting, self-efficacy, and executive control** The goal of this study is to ascertain whether the three targets – temporal discounting (preferences), self-efficacy (beliefs), and executive control/memory (constraints) – are indeed causally affected by stress, as our proposed mechanism suggests. We will therefore conduct a laboratory experiment in which participants will be exposed to one of four mild stressors: a social stressor (the Trier Social Stress Test), a physical stressor (the Cold Pressor Task), a financial stressor (the Centipede Game), and a physiological stressor (hydrocortisone administration). Importantly, these stressors will be either acute, i.e. one-time, or “chronic”, i.e. repeated over the course of a week. This distinction is important because acute and chronic stress have different effects both on physiology and behavior. We will then test the effect of these acute and “chronic” stressors on the measures of our three targets. Answering this question is important for two reasons: first, to establish that our targets of interest are indeed consequences of stress, and therefore the first step in our putative mechanism holds; second, to ascertain that the targets are malleable, which is important for later interventions. **Study 3: Identification and development of interventions and test of target engagement** Having identified and tested assays to measure our targets in Aim 1, and hopefully having demonstrated in Aim 2 that these targets really are consequences of stress, we next propose to identify candidate interventions, and test whether they engage our targets. This study proceeds in close analogy with Aim 1: we will first conduct a systematic literature review to assess which interventions are promising candidates for engagement of our targets (Study 3A). We will then adapt the most promising interventions to the Kenyan context, and test in a series of laboratory experiments in Nairobi whether they indeed engage our targets (Study 3B). Together, these proposed studies will contribute to establishing a more mechanistic understanding of the effects and stress, as well as the origin and failure of health behaviors, such as medical regimen adherence. [1]: [2]: [3]:
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