Goal 1: Promote Human Health

Studying Health in Addition to Disease

Why do some people stop smoking after a stroke or myocardial infarction, whereas others do not? What motivates people who adopt a healthier diet and exercise program during their lifetime or after a significant health event? How can we promote healthier lifestyle choices at all stages of life? How do we ensure equitable health promoting activities for minorities, vulnerable populations, and lower socio-economic status ...more »

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Answering this critical question would enable us to have a more complete picture both of disease and of health.

Feasibility and challenges of addressing this CQ or CC :

It is feasible to address this critical question because we need to expand our understanding of how people remain healthy or regain health, especially given the unhappy statistics concerning obesity, physical activity, blood pressure, diabetes, etc.

Few would disagree with the importance of studying the epidemiology, mechanisms, and progression of disease: research is focused on preventing or curing diseases. In addition to this disease-focused model, there are untapped opportunities to examine health and wellness. Borrowing from the field of Positive Psychology, which is the study of the aspects or characteristics of mental health (e.g., the strengths, values, behavior that contribute to well-being), we can expand this idea to study the aspects of those who remain healthy, who have retained health after disease, or who have successfully made healthy lifestyle changes. In terms of obesity, an example of this idea is Rena Wing’s National Weight Control Registry, which studies individuals who have successfully maintained long-term weight loss.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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176 up votes
41 down votes
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Goal 1: Promote Human Health

ROLE OF HEALTH DISPARITIES IN SLEEP AND CIRCADIAN HEALTH—ENVIRONMENT

Self-report data indicate that insufficient sleep is more common in minority populations. This seems to be related to socioeconomic status. There is a need to move this beyond self-report and obtain objective measures in the relevant populations. Moreover, the basis of this difference needs to be established. What aspect of the environment leads to these differences, e.g., noise, stress related to sense of vulnerability, ...more »

Submitted by (@jnoel0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Self-report indicates that sleep duration is lower in minority populations. This seems to be related to socioeconomic groups. To address this issue requires understanding the basis of this and developing appropriate interventions.

 

The impact of this is as follows:

 

a. Implementing new technology based on mobile approaches to assess sleep duration in subjects in different socioeconomic groups.

b. Developing a comprehensive approach to understanding and evaluating environmental influences in sleep and circadian rhythm.

c. Designing and testing intervention to increase sleep duration in disadvantaged populations.

d. Improving the sleep health of minority populations.

Feasibility and challenges of addressing this CQ or CC :

There is rapidly developing new mobile technology to assess sleep duration and other phenotypes in individuals living in their normal lives. There are a number of studies currently being conducted that could be leveraged to address this question. There are also developing approaches to assess environmental influences on sleep and circadian rhythm such as noise, light exposure, etc. Thus, this question could be addressed in the near future.

Name of idea submitter and other team members who worked on this idea : Sleep Research Society

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122 net votes
173 up votes
51 down votes
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Goal 2: Reduce Human Disease

HEALTH CARE DISPARITIES IN DIAGNOSIS AND TREATMENT OF COMMON SLEEP AND CIRCADIAN DISORDERS

There is evidence of a higher prevalence of sleep and circadian disorders in different ethnic groups. This is true for both adult and pediatric subjects. There is also evidence that minority populations in lower socioeconomic groups do not seek evaluation for sleep disorders as frequently as other segments of our population. There is also evidence that they are less adherent to treatments such as nasal CPAP for obstructive ...more »

Submitted by (@jnoel0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Sleep disorders are more common in minority populations. Moreover, these populations have higher rates of the known consequences of these disorders such as stroke, myocardial infarction, hypertension, resistant hypertension. Despite this, current population studies such as the Sleep Heart Health Study have included only a very small percentage of African Americans. The impact of this would be the following:

 

a. Elucidating the basis of barriers to case identification in these group

b. Designing specific intervention to overcome these barriers.

c. Developing methods to improve adherence to therapy in this group.

d. Removing sleep and circadian disorders as a risk factor for consequences such as stroke, cardiovascular disease and resistant hypertension in minority populations

Feasibility and challenges of addressing this CQ or CC :

There is a developing interest in this area in the field of circadian and sleep research. There is a developing knowledge base about health disparities in sleep and circadian disorders. Minority institutions such as Morehouse have developing programs in this area. We also have mobile technology that facilitates study of sleep and circadian disorders in minority populations.

Name of idea submitter and other team members who worked on this idea : Sleep Research Society

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118 net votes
163 up votes
45 down votes
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Goal 2: Reduce Human Disease

Obesity and health inequities

What are the most effective weight loss/weight gain prevention strategies for high risk groups?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Effective obesity interventions for high risk groups would help reduce health disparities.

Feasibility and challenges of addressing this CQ or CC :

This CQ is feasible because there are significant data that shows that health disparities exist and should be addressed.

Currently two thirds of Americans are either overweight or obese and obesity disproportionately affects individuals from disadvantaged backgrounds. To date there have been few, well designed trials that target high risk groups and it is still unclear what are the most effective strategies to prevent obesity and promote weight loss among ethnic minorities and low-income populations. For instance, the prevalence of obesity is highest among Mexican American boys (compared to white and African American boys; Ogden 2014), yet there are few (if any) trials targeting this high risk group.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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73 net votes
113 up votes
40 down votes
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Goal 3: Advance Translational Research

Health Behavior Change in Vulnerable Individuals

What knowledge about health behavior change can be leveraged to design innovative and effective strategies for behavior change among the most vulnerable individuals?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Significant health disparities exist in part because primary and secondary prevention strategies are not optimal for particularly vulnerable populations, who often grapple with multiple co-morbidities and low resources. Improving health promotion efforts by targeting health behaviors could help to close the disparity gap.

Feasibility and challenges of addressing this CQ or CC :

Many health damaging behaviors, such as smoking, are much more prevalent in certain groups than in the population at large. Multi-level efforts to promote health behavior change have not been optimally effective in these vulnerable groups. We need to build on what we know, understand the gaps, and develop new, culturally sensitive behavior change intervention strategies that will be effective for all groups.

Multi-level strategies to change health-damaging behaviors are effective for some behaviors, but tend to be least effective for the most vulnerable populations. For example, the percentage of people who smoke has decreased dramatically in the last 60 years, but significantly less so for racial and ethnic minorities, those with mental health issues, low income groups, and other vulnerable individuals. These differences contribute to health disparities among these groups, and are in part due to the need for multiple risk reduction and for strategies that are culturally informed.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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58 net votes
80 up votes
22 down votes
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Goal 2: Reduce Human Disease

Can Psychological Science Improve Weight Loss?

Will sensitivity to the psychological aspects of obesity, including lifestyle priorities and motivations, improve the efficacy of long-term effectiveness of weight loss and obesity prevention interventions?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

A primary focus on principles of psychology may result in significantly improved control of the obesity epidemic. Effective interventions could reduce the risk of diabetes, sleep apnea, and hypertension. This research could also affect clinical practice guidelines for weight loss and obesity treatment.

Feasibility and challenges of addressing this CQ or CC :

Psychological science has been successful in developing effective treatments for a number of conditions, including sleep disorders, depressive symptoms, anxiety and phobias. Many of the behavioral principles employed in such interventions (e.g., cognitive restructuring, motivational methods) could be translated for the prevention and treatment of obesity within a reasonable time frame. Additional attention should be directed to the needs of population subgroups in which obesity is most prevalent.

In their Viewpoint article on weight loss intervention research, Pagoto and Appelhans (JAMA, 2013, see attachment) question whether a continued focus on dietary factors in research on weight loss and obesity is warranted. Their commentary raises the importance of attention to the individual psychological characteristics that influence adherence to weight loss interventions rather than dietary composition.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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51 net votes
104 up votes
53 down votes
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Goal 3: Advance Translational Research

Interventions to Eliminate Health Inequities

There is a need to identify effective interventions for heart, lung, blood, and sleep diseases that could have a transformative population level impact on health inequities if expanded at the national level.

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

• Provide new knowledge for implementing strategies that will tackle inequities

• Provides opportunity to create multidiscipline research communities focused on health inequities

• Will gain momentum from federal and national implementation institutions to promote effective interventions to address health inequities

Feasibility and challenges of addressing this CQ or CC :

• Capitalizing on new methods, metrics and tapping big data could provide a promising platform to use systems science to better understand the barriers to eliminating health inequities in a short timeframe

• Identifying barriers will allow investigators to devise innovative implementation strategies that can reduce health inequities

• NHLBI could encourage communities of researchers to use team science to both identify barriers and link with other teams to implement strategies to reduce and eliminate barriers

• Established NHLBI health inequities Think Tank and space for developing innovative strategies to address health inequities.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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32 net votes
47 up votes
15 down votes
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Goal 2: Reduce Human Disease

Mental health and wellness in sickle cell disease

A growing concern among the sickle cell community surrounds the lack of mental health and wellness services. Many in the community deal with anxiety and depression. It is well known how intricately connected mental and physical health are. So if we know that stress can trigger a psychological crisis which in turn triggers a physical pain crisis, why do we not automatically include mental health services within patient ...more »

Submitted by (@sicklecellwarrior)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Many in the SCD community feel like providers do not take a proactive approach to mental health. A comprehensive approach to developing mental health and wellness services and programs provides an opportunity to address factors contributing to morbidity, and perhaps mortality, in the SCD community, outside of the hospital walls.

Name of idea submitter and other team members who worked on this idea : Sickle Cell Warriors, Inc. community members

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25 net votes
38 up votes
13 down votes
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Goal 3: Advance Translational Research

Develop common-sense standards for obesity research

Obesity research is riddled with methodological problems that are rarely challenged, leading to the perpetuation of misinformation and interventions that do harm. Given the two-thirds of the population who are classified as higher weight and thus subject to these interventions, it is past time to clean up the basic scientific flaws in this research area. For a quick summary of a couple of these issues, see Poodle Science: ...more »

Submitted by (@dbdb00)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

This subject really is both CG and CC. The CQ aspect is to see past the weight bias and stigma we are all subject to in order to see diversity of weight as normal, even as people across the weight spectrum suffer health insults from sources that are rarely investigated within the medical model (cf social determinants of health). The CC aspect is the enormous economic and cultural pressures to maintain the valuing of some bodies over others in order to sell products and create a group of people who have fewer ways to defend themselves from oppression.

Feasibility and challenges of addressing this CQ or CC :

Several key areas could make a big difference and they are quite feasible.

1. Require researchers to have studied weight bias and stigma so they are more aware of their own potential proclivities to frame research questions or results according to the status quo.

2. Require any study that claims a weight loss finding to have, report, and publish followup data on all participants at least 2-5 years post-intervention.

3. Require any study claiming a health issue related to weight to compare not higher and lower weight people, but rather higher weight people who have pursued weight loss and higher weight people who have not, since there is no way for higher weight people to be always-been-thinner.

4. Require weight/health research to control for obvious confounders such as weight cycling, SES, exposure to weight stigma, exposure to weight discrimination, exposure to racism, exposure to stress, lack of access to unbiased medical care, etc.

5. Require that journals allowing statements in the abstract or discussion or conclusions that generalize beyond the data be accountable, and that journals provide an accurate translation of the findings for journalists complete with statements about limitations of findings and possible alternative interpretations.

6. Fund projects which are about listening, especially to people who are rarely asked about their lived experience, in order to generate better research that actually improves quality of life for higher-weight people.

Name of idea submitter and other team members who worked on this idea : Deb Burgard, PhD

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44 up votes
20 down votes
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Goal 2: Reduce Human Disease

Use of health communication principles in management of obesity

What approaches can utilize current knowledge on health literacy/health communications as a research development tool and/or strategy to enhance obesity prevention and treatment efforts?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Allow the use of non-activity and non-dietary based approaches for managing overweight and obesity

Feasibility and challenges of addressing this CQ or CC :

Health communication and health literacy are of interest in the US Healthy People 2020 goals. The methodology and principles of health communications and the relationship between health literacy and health outcomes are emerging especially for obesity. There is a sufficient pool of scientists trained to conduct this type of work.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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22 net votes
49 up votes
27 down votes
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Goal 1: Promote Human Health

Human normal variation and resilience across lifespan

What is the measureable normal human variation at the -omic, cellular, organ, and system levels within the population and across the lifespan? • What are the range of normal human cellular functions that create resilience at all levels—cells, organs, organ systems? • What inter-organ, tissue, and cellular communications maintain individual health and the health of populations? • How do we understand why individuals with ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

• Will provide a better definition of what is normal in order to better interpret and exploit the big data available through increased personalized monitoring and use of EMRs.

• Insights into the underlying mechanisms of resilient phenotypes will provide new paradigms for disease prevention and treatment.

Feasibility and challenges of addressing this CQ or CC :

Feasibility will depend on the level of investment (large) and accessibility to commons data.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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19 net votes
26 up votes
7 down votes
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Goal 2: Reduce Human Disease

Seeking the secret behind “resilience” to a variety of HLBS diseases

What is the secret behind the “resilience” some people have to heart, lung, blood, and sleep (HLBS) diseases?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Results of such research should reveal physiological mechanisms of resilience that could be used to develop interventions that would prevent or cure a variety of heart, lung, blood, and sleep diseases.

Feasibility and challenges of addressing this CQ or CC :

Advances in omics, clinical testing

, accumulation of large sets of clinical data and samples

, big data tools

, and increased interest from public (normal volunteers) and patients to participate in large scientific experiments make it feasible.

For instance, these may be healthy people carrying genetic mutations strongly associated with HLBS diseases (or causing rare/familial genetic diseases – these might easier to focus on first), but also people who are not hypertensive, hypercholesterolemic, or diabetic in spite of consistently making bad dietary choices, people who did not develop lung conditions in spite of high pollutant exposure, or are otherwise “protected” from other heart, lung, blood and sleep diseases. This reasoning is not very different from that used to identify ApoA Milano, or even PCSK9 or the “longevity genes”. Such information should reveal physiological mechanisms that could be leveraged to develop interventions to prevent or cure HLBS diseases.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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19 net votes
26 up votes
7 down votes
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