Daniel Cukor, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): [unreadable] The purpose of this application is for Daniel Cukor, Ph.D. to transition to an independent investigator in the field of psychosocial nephrology. Depression in hemodialysis patients has been associated with lower quality of life, poor compliance to dietary restrictions, and an overall increase in mortality. This proposal would help Dr. Cukor, a trained Clinical Health Psychologist, test a Cognitive Behavioral Therapy (CBT) Intervention that has been specifically designed for an ethnically diverse ESRD population to reduce their levels of depressive affect and improve their compliance with a hemodialysis-healthy lifestyle. This is the first attempt at treating depression in ESRD patients with a controlled psychosocial intervention. Under the mentorship of Jeremy Coplan, MD, Paul Kimmel, MD, and Rolf Peterson, Ph.D., a didactic experience has been developed to help Dr. Cukor further his skills in the disciplines of nephrology, psychological theory and intervention, as well as research methodology. The actual intervention is based on traditional CBT treatment for depression with modifications for an ESRD population based on Dr. Cukor's previous clinical experience. Overall, this study provides a model to test the efficacy of this intervention on hemodialysis patients versus wait-list controls. Eighty subjects will be randomized to either the intervention first condition or the wait list and then they will receive the 10 session intervention. Psychological, Biological, and Medical information will be gathered before and after the intervention as well as at follow-up to provide data on the subjects' mood, quality of life, behavioral compliance, psychopathology and the general effects of their illness. [unreadable] This project stands to contribute to the health of the community at large, as it could demonstrate the efficacy of an intervention that is designed to target depression and compliance in an ethnically diverse dialysis population. This could lend support to the belief that the relationship between depression and ESRD is bidirectional, meaning that an effective psychosocial intervention will not only impact depressive affect, compliance, quality of life, and illness perceptions, but also laboratory dialysis values and even possibly overall health. If it is proven to be beneficial, this targeted and brief intervention could be incorporated into standard of care for all depressed dialysis patients. [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Lack of adherence to immunosuppressive therapy following kidney transplantation is a serious public health issue, as it is a major contributor to organ loss in this increasingly prevalent medical condition. The major goals of this proposal are to test unannounced phone pill counts as a reliable and valid method of measuring immunosuppressive medication adherence and to test a behavioral intervention designed to improve medication adherence in kidney transplant patients. The study will take place at Downstate Medical Center in Brooklyn. For the assessment phase of the study, subjects will receive an unannounced phone call and be asked to count their immunosuppressive medication pills on the phone with the interviewer. Five more phone visits will take place, with a goal of having subjects receiving a phone call approximately every 2 weeks for 3 months. Subjects whose baseline levels of adherence are less than ideal (below 98%) will be recruited to participate in the second phase of the study, the behavioral intervention. The intervention will be 8 sessions over no more than 12 weeks. The intervention will have sessions devoted to psychoeducation, motivational interviewing, identifying adherence barriers, self monitoring, coping with side effects, develop medication taking strategy, developing support resources, identifying negative affect, behavioral activation, cognitive restructuring, relapse prevention, and planning for the future. Participants who successfully complete the intervention will then undergo another 3 month assessment period, similar to their pre-intervention assessment. This study utilizes a multiple baseline design and will help determine if behavioral intervention is successful at improving medication adherence and immunosupression in kidney transplant patients. PUBLIC HEALTH RELEVANCE: One third of kidney failures are due to medication non-adherence. This study will verify whether unannounced phone pill counts are a reliable and feasible method for immunosuppressive therapy medication adherence in kidney transplant patients and determine if our behavioral intervention is effective at improving medication adherence. This is the first structured trial of a behavioral intervention to improve adherence in this population.

Obstructive Sleep Apnea (OSA) Is responsible for 38,000 cardiovascular deaths yearly and costs 42 million dollars on related hospitalizations, according to estimates from the National Commission on Sleep Disorders Research. Untreated OSA leads to cardiovascular morbidity, automobile accidents, cognitive deficits, excessive daytime sleepiness and excess mortality. Fortunately, OSA treatment reduces risk for cardiovascular disease by 64%. Although OSA is a public health problem that disproportionately affects blacks, no systematic study has documented adherence to recommended OSA assessment and treatment at the community level. Preliminary evidence from a community-based study we conducted suggests that 43% of blacks screened with the ARES are at high OSA risk, but only 27% adhered to recommended OSA assessment. Evidence also suggests that blacks are less likely to adhere to OSA treatment. While few black patients adhered to physician's recommendations, evidence from our Sleep Disorders Center in Brooklyn, NY showed that 90% received a diagnosis. Effective behavioral interventions are needed to increase the number of blacks receiving OSA assessment and treatment. In a two-arm randomized controlled trial among 380 blacks at high OSA risk, we will evaluate effects of a culturally and linguistically tailored telephone delivered behavioral intervention in increasing rates of OSA assessment and adherence to CPAP treatment. We will also evaluate Intervention effects on clinical outcomes (body mass index, lipid level, blood pressure, fasting plasma glucose/HbAIC, and C-reactive protein). Volunteers will be recruited from black-owned barbershops, beauty salons, churches, and community centers in Brooklyn, NY. The long-term goal is to apply this Intervention modality in community-based settings, thereby linking community health promotion to the healthcare system. Thus, our program could serve as an alternative, non-traditional model of disseminating this intervention for cardiovascular risk reduction among blacks nationwide. The potential for dissemination Is high, as there are over 18-thousand black barbershops and 13-thousand black churches in urban centers across the United States.

The overarching goal of this program Is to foster the development of the next generation of URM researchers using a multidisciplinary, community-engaged approach to applying behavioral health models to eradicate health disparities In cardiometabolic diseases and HIV. The focus of the program will be on acquisition of behavioral research skills, formulation of relevant research questions, development of methodologically sound protocols, publication of peer-reviewed papers, and networking with mentors and peers. At the end of the training period, trainees will have acquired the necessary skillset to pursue further training In public health, thus reducing the national gap between URM and non-URM scientists competing for NIH funding.