Title: Assessing Urban-Rural Environmental Stress Inequities in ADRD through Ecological Momentary Assessment (AURESIA)
Grant #: R01NS139192
Project Period: 2024-2029
Amount: $3,959,426
Funding agency: National Institute of Neurological Disorders and Stroke (NINDS)
Primary Investigator: Jordan
Description: This study aims to identify and understand the role of environmental stressors in the development of Alzheimer's Disease-Related Dementias (ADRD) and related health inequities across urban and rural populations. We will recruit 600 participants (300 urban dwelling and 300 rural dwelling) from the U.S. State of Indiana at high risk for developing ADRD. High risk individuals will be identified by analyzing passive digital markers (PDM) in electronic health record (EHR) data using a validated algorithm developed and tested by our research team in a currently funded NIA R01. Participants will complete a cognitive assessment based on the Uniform Data Set (UDS) 3.0 from the NIA Alzheimer's Disease Center program to determine eligibility at baseline. Only individuals with mild cognitive impairment (MCI) will be enrolled in the study. Following a process utilized in our currently funded R21 data collection, each enrolled participant will then report their stressors for a two-week period using our novel Stress Reports in Variable Environments (STRIVE) mobile ecological momentary assessment (EMA) app while wearing a smartwatch to track their activity level, heart rate, and sleep. Our custom built STRIVE app passively collects GPS coordinates of participants every 60 seconds and participant initiated self-reports of stressors, including description, subjective severity, coping response, and photo of stressful environment. We will conduct qualitative thematic analysis of text- and image-based stressor data. These measurements will be used as indicators of each participant's 'usual environment' as well as experience of and exposure to environmental stressors. We will continue to monitor PDMs in participant EHR data and administer cognitive assessments 12 months, and 24 months to determine if subjects convert from MCI to ADRD. Through this research, we will address 2 aims: 1) To determine where, when, and what environmental stressors are experienced by urban and rural dwelling individuals at high risk for ADRD, and 2) to determine inequities in the relationship between environmental stressors, lived environment, and conversion to ADRD between urban and rural dwellers. Completing these aims will advance knowledge of 1) How environmental stress plays a role in ADRD health inequities; 2) New environmental stress-related therapeutic targets for treatment of ADRD; and 3) New interventional strategies based on validated stress factors to mitigate ADRD health disparity between urban and rural environments.
Projects
Title: Examining the daily stress of mid-life adults in the built and natural environment (STRIVE)
Grant #: R21AG077333
Project Period: 2022-2024
Amount: $464,190
Funding agency: National Institute on Aging (NIA)
Primary Investigator: Jordan
Description:In the United States, mid-life adults are staying in the workforce longer and are engaging in higher levels of physical activity than previous generations, potentially extending their interactions with elements of the built and natural environments that influence their experience of daily stress. The relationship between various types of stress and alterations in cognitive functioning has been well documented, and there is growing evidence showing a relationship between daily stress in mid-life and cognitive decline. Even though mid-life adults constitute one of the largest portions of the current U.S. population, there is relatively little data about the experience of daily stress and health outcomes in this age group. Perceived stress in mid-life adults has also been closely linked with physical disability later in life. Mid-life adults of different socioeconomic status and race are subject to structural inequality in their living environments. Those living in urban environments with higher levels of poverty and violence are experience higher levels of environmental stress than those living in suburban or rural environments. It is well documented that Blacks are exposed to environmental stressors more than Whites. In this Stage 0 study of the NIH Stage Model for Behavioral Intervention Development, we propose to use our novel custom-built Stress Reports in Free-living Environments (STRIVE) ecological momentary assessment (EMA) mobile phone app to measure the experience of daily stress of mid-life adults in free-living conditions. Using our novel app and capturing data in real time will allow us to determine (1) where and when daily stress happens for mid-life adults, (2) whether mid-life adults' daily stressors are linked to certain elements of the built and natural environment, and (3) whether EMA measurement of daily stress is comparable to the 'gold standard' Daily Inventory of Stressful Events (DISE) measurement tool that captures daily stress at the end of the day in mid-life adults (used in Midlife in the United State Survey (MIDUS)). These data will expand our understanding of mid-life adults' experience of stress in free living conditions and pave the way for data-driven individual and community-based intervention designs to promote health and well-being in mid-life adults. Potential interventions that could stem from our data include technology based 'just in time' interventions that account for spatiotemporal location, mindfulness-based interventions that incorporate environmental stress triggers, and community-based interventions designed to eliminate environmental stressors that are commonly experienced by mid-life adults (e.g., congested areas).
Title: A just in time mobile stress intervention for cancer survivors (MOSAIC)
Grant #: Sub-Award of UM1TR004402
Project Period: 2022-2024
Amount: $100,000
Funding agency: Indiana Clinical and Translational Sciences Institute (CTSI)
Primary Investigator: Jordan
Description: Nearly 17 million cancer survivors are living in the United States today. In this proposal, we focus on survivors of breast cancer and prostate cancer, as they are the most common cancers in women and men respectively. Approximately 32% of breast cancer survivors experience depression, and 42% experience anxiety. Approximately 17% of prostate cancer survivors experience depression, while 27% experience anxiety. For breast and prostate cancer survivors, depression and anxiety are significantly linked to higher mortality rate. Stressors and anxiety often co-occur, with stress often preceding the experience of anxiety. There is an increased risk for anxiety and mood disorders after exposure to intense stressors, like cancer. Stress is also associated with risk for depression. Depressed individuals have 2.5 times more stressors compared to non-depressed individuals. Furthermore, depression may develop or reoccur due to stress. Traditional therapeutic interventions are usually delivered in person or virtually by licensed mental health clinicians. Access is often limited by clinician shortages, insurance coverage, and time available to attend therapy sessions - leading to a gap in mental health care for many. We seek to address this gap through this proposal. The objectives of our proposed research are threefold: (1) to co-design a mobile acceptance and commitment therapy (ACT) stress intervention collaboratively with cancer survivors (called MOSAIC); (2) to conduct an NIH Stage Model for Behavioral Intervention Development Stage IA study to test and refine MOSAIC with approximately 15 cancer survivors for accuracy and use; (3) to conduct a Stage IB pilot test to examine feasibility of a larger scale randomized controlled trial. This approach is innovative compared to talk therapy-based approaches in that it is biofeedback initiated in real-time to take place in the gaps between appointments with mental health professionals as well as in moments of specific need (i.e., a "just in time" intervention). In sum, MOSAIC will tailor mental health care to the cancer survivor population, individually identify when intervention is needed based on HRV biofeedback, and reduce burden on the mental healthcare system.