Developing a Culture of
Prevention, Recovery &
Wellness for Our Futures NOW!
Dennis D. Embry, Ph.D., President/Senior
Scie...
What good things do the people of
Texas want to pack in the suitcase
for life of their children?
What heavy things do the ...
How many of you know…
2x
3Wednesday, July 18, 12
35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Merikangas et al., 2010
Lifetime Prevale...
35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Merikangas et al., 2010
Lifetime...
35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Behavior
Merikangas et al., 2010...
35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Behavior
Mood
Merikangas et al.,...
35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Substance
Behavior
Mood
Merikang...
Nearly 3 out of 4 of United States 17- to 24-year-olds are
ineligible for military service for based on national
epidemiol...
By 21 years of age,
61.1% of participants
had met criteria for a
well-specified psychiatric
disorder.
An additional 21.4% h...
The US has
75 million
children and
teens.
40.4 million
are on
psychotropic
medications
Wall Street Journal, 12-28-2010
7We...
Depression Onset By Birth Cohort
8Wednesday, July 18, 12
Depression Onset By Birth Cohort
Born 1986-1995?
8Wednesday, July 18, 12
Depression Onset By Birth Cohort
Born 1986-1995?
Born 1996-2005?
8Wednesday, July 18, 12
Evolutionary bottleneck
1491 AD
OriginalHuman
Migrations to
North America
30,000,000
Souls in
North America
300,000
Souls≈...
Evolutionary bottleneck
1491 AD
OriginalHuman
Migrations to
North America
30,000,000
Souls in
North America
300,000
Souls≈...
Evolutionary bottleneck
Slavery
1500’s to
1863
Original Human
Populations in Africa
Capture
30% to
50% +
mortality
≈
Middl...
Evolutionary bottleneck
Slavery
1500’s to
1863
Original Human
Populations in Africa
Capture
30% to
50% +
mortality
≈
Today...
Epigenesis
Epigenetics are
heritable
changes in
gene expression
caused by
mechanisms
other than
changes in the
underlying ...
Youthanasia
12Wednesday, July 18, 12
Humans are the only species with bi-directional
wealth and wellbeing transfer across generations
Our
Children
Our
Adults &...
Humans are the only species with bi-directional
wealth and wellbeing transfer across generations
Our
Children
Our
Adults &...
Humans are the only species with bi-directional
wealth and wellbeing transfer across generations
Our
Children
Our
Adults &...
We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds
14Wednesda...
We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds
Who are li...
We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds
Who are li...
We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds
Who are le...
We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds
Who are le...
We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
15Wednesday, July 18, 12
We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds
15Wednesda...
We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
65-Year
Olds
15Wednesday, July 18, ...
We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
15Wednesday, July 18, 12
16Wednesday, July 18, 12
Our Own Future and Our Own Children’s Future
17Wednesday, July 18, 12
Our Own & Our Children’s Future Rests On Other’s Futures
18Wednesday, July 18, 12
Our Own & Our Children’s Future Rests On Other’s Futures
depression
bipolar
drugs
tobacco
alcohol
ADHD
aggression
learning...
Key facts that predict our futures in America…
and, by the way, Texas…
19Wednesday, July 18, 12
Key facts that predict our futures in America…
and, by the way, Texas…
Our children
have the highest
rates of mental,
emot...
Key facts that predict our futures in America…
and, by the way, Texas…
Our children
have the highest
rates of mental,
emot...
Key facts that predict our futures in America…
and, by the way, Texas…
Our children
have the highest
rates of mental,
emot...
20Wednesday, July 18, 12
What these trends this predict for small
businesses in America & Texas?
20Wednesday, July 18, 12
What these trends this predict for small
businesses in America & Texas?
What do these trends predict for US
global economi...
What these trends this predict for small
businesses in America & Texas?
What do these trends predict for US
global economi...
Who in Texas can act to protect our futures?
And how much could we reduce these problems?
21Wednesday, July 18, 12
Psychological flexibility is required…
22Wednesday, July 18, 12
23Wednesday, July 18, 12
Mental, Emotional and Behavior Disorders = MEBs
24Wednesday, July 18, 12
Available at:
www.slideshare.net/drdennisembry
The Critical Role of Nurturing Environments for
Promoting Human Well-Being
...
Behavioral Vaccines and
Evidence-Based Kernels:
Nonpharmaceutical
Approaches for the
Prevention of Mental,
Emotional, and
...
Available at:
www.slideshare.net/drdennisembry
Evidence-based Kernels: Fundamental Units of Behavioral
Influence
Dennis D. ...
Physiological
influences trigger
adverse biological
mechanisms
Reinforcement
more for anti-social
than prosocial
behaviors
...
Mood
Instability
Inattention
Lo Reward
Delay
Lo Executive
Function
Lo Behavioral
Competencies
Poor
Motor
Skills
Immune-
He...
Mood
Instability
Inattention
Lo Reward
Delay
Lo Executive
Function
Lo Behavioral
Competencies
Poor
Motor
Skills
Immune-
He...
Rise in
Depression
Rates
Rise in
Aggression
Rates
Rise in
Obesity
Rates
Change in
Genes
Increased
Cancer
Increased
Autism
...
Rise in
Depression
Rates
Rise in
Aggression
Rates
Rise in
Obesity
Rates
Change in
Genes
Increased
Cancer
Increased
Autism
...
Rise in
Depression
Rates
Rise in
Aggression
Rates
Rise in
Obesity
Rates
Change in
Genes
Increased
Cancer
Increased
Autism
...
Four Types of Kernels
Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
Happens BEFORE
t...
Physiological
influences trigger
protective biological
mechanisms
Reinforcement
more for prosocial
behaviors
Antecedents
cu...
Mood
Stability
Attention
Hi Reward
Delay
Hi Executive
Function
Hi Behavioral
Competencies
Good
Motor
Skills
Immune-
Healin...
Mood
Stability
Attention
Hi Reward
Delay
Hi Executive
Function
Hi Behavioral
Competencies
Good
Motor
Skills
Immune-
Healin...
Kernels are building
blocks of behavior change
Humans survive individually and collectively by
influencing the behavior or ...
Table2:Examplesofkernelsforselected,indicatedanduniversalprevention
Kernel Treatment Intervention Prevention/Protection
Pr...
Protecting our children right now
34Wednesday, July 18, 12
Muriel Saunders
PAX GBG: An Example Behavioral Vaccine
Read about multiple scientific studies on the “Good Behavior Game” a...
Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
Happens BEFORE
the behavior
Happens AF...
Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
Happens BEFORE
the behavior
Happens AF...
Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
Happens BEFORE
the behavior
Happens AF...
Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
Happens BEFORE
the behavior
Happens AF...
Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
Happens BEFORE
the behavior
Happens AF...
Timeline of Life Time Benefits…
37Wednesday, July 18, 12
Timeline of Life Time Benefits…
More time for
teaching and learning
First Month
Less stress for
Staff  Students
Better
Atte...
How much might PAX GBG
save for Texans?
To do PAX GBG will cost about $150 to protect our children for
life from mental il...
First graders
exposed to GBG
for one year had
these benefits at
age 21.
SOURCE: Kellam, S. G., Mackenzie, A. C., Brown, C. ...
Lifespan example of one kernel
for prevention, intervention and
treatment
Reinforcement
Kernel
Happens AFTER
the behavior
...
Giggle Fest Giving Cuts in
Line
Mumble, Grumble
 Gowl
Play Hangman
Jokester Making Faces
Nerf Toss or
Nerf Basket
Paper Ai...
Seine River Pilot Demonstration
April, 2011 – Principals and key
staff trained for two days for all
12 schools.
April, 201...
An ancient inukshuk points the
way
0%
6%
12%
18%
24%
30%
Psychosis
Omega-3 Placeo
27.5%
4.9%
PercentagewithPsychosisat12mo...
0
0.25
0.50
0.75
1.00
Before supplementation During supplementation
RatioofDisciplinaryIncidentsSupplementation/Baseline
A...
Why not reproduce the rapid
results in the US to get a 37%
reduction in jail violence?
It cost the Brits 19¢ per day or $6...
Omega-3 Status and US Military Suicide Deaths
Suicide Deaths of Active-Duty US Military and
Omega-3 Fatty-Acid Status: A C...
REVIEW Open Access
Clearance of fear memory from the hippocampus
through neurogenesis by omega-3 fatty acids:
a novel prev...
Omega-3 can improve school
grades and success
-2
-1
0
1
2
3
4
5
6
7
Reading Spelling
Omega 3 Placebo
These were gains in
a...
Hedelin et al. BMC Psychiatry 2010, 10:38
http://www.biomedcentral.com/1471-244X/10/38
Open AccessRESEARCH ARTICLE
© 2010 ...
Goal Maps (visual organized brief
motivational interview)
Relational
Frame
Kernel
Creates verbal
relations for the
behavio...
First children learn a vision of a wonderful school
51Wednesday, July 18, 12
Wait for the Timer for tobacco
addictions with SMI/CMI
Antecedent
Kernel
Happens
BEFORE the
behavior
52Wednesday, July 18,...
Beat the timer in school to
improve engagement
Antecedent
Kernel
Happens
BEFORE the
behavior
53Wednesday, July 18, 12
Trend-line for humorous warnings on binge drinking
by women of child-rearing age
No Warnings	 	 Humorous Warnings
Antecede...
Trend-line for humorous warnings on binge drinking
by women of child-rearing age
1995 1997 1999 2001 2002 2003 2004 2005 2...
Trend-line for humorous warnings on binge drinking
by women of child-rearing age
1995 1997 1999 2001 2002 2003 2004 2005 2...
Trend-line for humorous warnings on binge drinking
by women of child-rearing age
1995 1997 1999 2001 2002 2003 2004 2005 2...
Acceptance  Commitment
Therapy Kernels
Go to www.ContextualPsychology.org
55Wednesday, July 18, 12
Writeathoughtandafeelin
g
on the leaf and put it on the thoughts and feelings“stream”
Iamhavingthethoughtthat… I am having...
Writeathoughtandafeelin
g
on the leaf and put it on the thoughts and feelings“stream”
Iamhavingthethoughtthat… I am having...
T6--'-!$#%81!;S0+FQT0P!+0IIF2;G!HQT!0PP!
!
L.'(-!MC!?N.B1(-!L.'(-!3;!E-25-(!A/)()/$!;32!G-(-*/-9O!659)*./-9!.59!A5)4-27.(!...
Media promoting recovery
Do you market the harms and dangers?
Or, do you market recovery?
58Wednesday, July 18, 12
59Wednesday, July 18, 12
Thinking about and measuring recovery, relapse
and recidivism
0
50
100
0 10 20 30 40 50
Time in Months
0
50
100
0 10 20 30...
Thinking about and measuring recovery, relapse
and recidivism
0
50
100
0 10 20 30 40 50
Time in Months
0
50
100
0 10 20 30...
Percentage of patients in recovery during followup year.
Harrow M et al. Schizophr Bull 2005;31:723-734
Percentage of
pati...
Percent of Patients Ever in Recovery (5 Follow-ups Over 15 Years).
Harrow M et al. Schizophr Bull 2005;31:723-734
62Wednes...
Percent of Nonmedicated Schizophrenia and Schizophreniform Patients in Recovery at 15-Year Follow-ups.
Harrow M et al. Sch...
Recognition/Rewards
for Successs
Vaccine
Recipe Identify
Behaviors
Reduced
Identify
Behaviors
Increased
List local,
state ...
65Wednesday, July 18, 12
Dennis D. Embry, Ph.D.
dde@paxis.org
520-299-6770
Business cards available
for follow up and copies
of papers  presentatio...
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Creating a culture of prevention and recovery

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Texas is the land of professed public bootstraps, and very private suffering. There is not a family in Texas that has not been touched by the rising prevalence of mental, emotional, behavioral and related physical illnesses. In fact there is not a family in America that has not been so touched, based on the elegant epidemiological monitoring in the US.

So in the land of big hats, why cannot Texas take the lead in a very big idea that will save billions of dollars, improve health, increase the global economic competitiveness of the US, and improve our national security? All that sounds, well, frankly very patriotic and American. What is the really big idea?

First, virtually every mental, emotional, and behavioral disorder (including addictions) is preventable. How solid is that statement? Stamp on the ground ten times as hard as you can. Did you feel it? Well that is how solid the science is. You don’t hear it on your TV; you don’t hear that science in your newspaper or Time magazine; you don’t hear it from your health care provider; and people are not learning this at university. And absolutely nobody is lobbying the Texas Legislature or Governor about this science and possibility. I’ll wager you might not believe me, even though I am a pretty dang good scientist. So if you don’t believe me that the science exists, you can go to www.pubmed.gov and look every study or fact I site. After my talk, you will jabbering away at just about anybody who will listen.

Second, recovery from mental, emotional, and behavioral disorders—including very serious ones like schizophrenia and bipolar disorder—can go into remission. This remission and recovery is not dependent on medications. Now that is not a fact that you will hear on TV, or hear from the pharmaceutical detail people in your doctor’s office. Now I read almost everything I can on these problems, and I missed hearing about this science—until recently. That shows you how buried it is. At my plenary, you will hear about the practical science of recovery.

Third, there are ways to pay for all this using something called, “Social Impact Bonds.” So instead of Texas selling bonds for building another prison, bonds can be sold preventing or reducing the problems in the first place. Now there’s an idea. And, yes other countries are doing this.

The really big idea—a Texas big idea? Well, Texas could be the first place in America to do all this. That would change America, and all our futures.

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Creating a culture of prevention and recovery

  1. 1. Developing a Culture of Prevention, Recovery & Wellness for Our Futures NOW! Dennis D. Embry, Ph.D., President/Senior Scientist,PAXIS Institute Keynote Presentation: Texas Behavioral Health Institute, Austin, TX, July 17, 2012 1Wednesday, July 18, 12
  2. 2. What good things do the people of Texas want to pack in the suitcase for life of their children? What heavy things do the people of Texas NOT want to pack in the suitcase for life of their children? 2Wednesday, July 18, 12
  3. 3. How many of you know… 2x 3Wednesday, July 18, 12
  4. 4. 35% 30% 25% 20% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Merikangas et al., 2010 Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 4Wednesday, July 18, 12
  5. 5. 35% 30% 25% 20% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Anxiety Merikangas et al., 2010 Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 4Wednesday, July 18, 12
  6. 6. 35% 30% 25% 20% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Anxiety Behavior Merikangas et al., 2010 Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 4Wednesday, July 18, 12
  7. 7. 35% 30% 25% 20% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Anxiety Behavior Mood Merikangas et al., 2010 Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 4Wednesday, July 18, 12
  8. 8. 35% 30% 25% 20% 15% 10% 5% 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Anxiety Substance Behavior Mood Merikangas et al., 2010 Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 4Wednesday, July 18, 12
  9. 9. Nearly 3 out of 4 of United States 17- to 24-year-olds are ineligible for military service for based on national epidemiological data (not service entrance exams) Medical/physical problems, 35 percent. Illegal drug use, 18 percent. Mental Category V (the lowest 10 percent of the population), 9 percent. Too many dependents under age 18, 6 percent. Criminal record, 5 percent. Army Times, Nov 5, 2009 • www.missionreadiness.org/PAEE0609.pd 5Wednesday, July 18, 12
  10. 10. By 21 years of age, 61.1% of participants had met criteria for a well-specified psychiatric disorder. An additional 21.4% had met criteria for a not otherwise specified disorder only, increasing the total cumulative prevalence for any disorder to 82.5%. Cumulative prevalence of psychiatric disorders by young adulthood a prospective cohort analysis from the Great Smoky Mountains Study. 6Wednesday, July 18, 12
  11. 11. The US has 75 million children and teens. 40.4 million are on psychotropic medications Wall Street Journal, 12-28-2010 7Wednesday, July 18, 12
  12. 12. Depression Onset By Birth Cohort 8Wednesday, July 18, 12
  13. 13. Depression Onset By Birth Cohort Born 1986-1995? 8Wednesday, July 18, 12
  14. 14. Depression Onset By Birth Cohort Born 1986-1995? Born 1996-2005? 8Wednesday, July 18, 12
  15. 15. Evolutionary bottleneck 1491 AD OriginalHuman Migrations to North America 30,000,000 Souls in North America 300,000 Souls≈ ≈ Disease & War26,000 to 12,000 B.E. Extermination, Marginalization, & Suppression The America’s First Peoples… Residential Schools; Western Diet 9Wednesday, July 18, 12
  16. 16. Evolutionary bottleneck 1491 AD OriginalHuman Migrations to North America 30,000,000 Souls in North America 300,000 Souls≈ ≈ Today, Historic Disparities Disease & War26,000 to 12,000 B.E. Extermination, Marginalization, & Suppression The America’s First Peoples… Residential Schools; Western Diet 9Wednesday, July 18, 12
  17. 17. Evolutionary bottleneck Slavery 1500’s to 1863 Original Human Populations in Africa Capture 30% to 50% + mortality ≈ Middle Passage Continuing Trauma Institution of Slavery Separation, violence, malnutrition Jim CrowAfrican Americans… Exposure to Toxins & Racism The Great Migration North 10Wednesday, July 18, 12
  18. 18. Evolutionary bottleneck Slavery 1500’s to 1863 Original Human Populations in Africa Capture 30% to 50% + mortality ≈ Today, historic disparities Middle Passage Continuing Trauma Institution of Slavery Separation, violence, malnutrition Jim CrowAfrican Americans… Exposure to Toxins & Racism The Great Migration North 10Wednesday, July 18, 12
  19. 19. Epigenesis Epigenetics are heritable changes in gene expression caused by mechanisms other than changes in the underlying DNA sequence. These changes can pass through multiple generations. Genesis Social Biological Environmental Inputs Nurturing or Toxic Environments, Disease, or Threats Signaling M orphogensis Phosphorlyation Acetylation Methylation Histone Remodeling Chromatin Stucture Changes Development Immunity Stem Cell Changes Imprinting Three Generation Effects Parent, 1st Generation Baby, 2nd Generation Reproductive Cells, 3rd Generation These polygenes can be “added”, “subtracted”, “divided”, or “multiplied.” 11Wednesday, July 18, 12
  20. 20. Youthanasia 12Wednesday, July 18, 12
  21. 21. Humans are the only species with bi-directional wealth and wellbeing transfer across generations Our Children Our Adults & Elders 13Wednesday, July 18, 12
  22. 22. Humans are the only species with bi-directional wealth and wellbeing transfer across generations Our Children Our Adults & Elders adults and elders invest in children 13Wednesday, July 18, 12
  23. 23. Humans are the only species with bi-directional wealth and wellbeing transfer across generations Our Children Our Adults & Elders Youth return the favor as adults adults and elders invest in children 13Wednesday, July 18, 12
  24. 24. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 5-Year Olds 65-Year Olds 14Wednesday, July 18, 12
  25. 25. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 5-Year Olds 65-Year Olds Who are living longer though get progressively sicker… 14Wednesday, July 18, 12
  26. 26. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 5-Year Olds 65-Year Olds Who are living longer though get progressively sicker… Requiring more wealth transfer 14Wednesday, July 18, 12
  27. 27. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 5-Year Olds 65-Year Olds Who are less and less able… Who are living longer though get progressively sicker… Requiring more wealth transfer 14Wednesday, July 18, 12
  28. 28. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 5-Year Olds 65-Year Olds Who are less and less able… Who are living longer though get progressively sicker… Requiring more wealth transfer But elders voting to stop funds to kids 14Wednesday, July 18, 12
  29. 29. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 15Wednesday, July 18, 12
  30. 30. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 5-Year Olds 65-Year Olds 15Wednesday, July 18, 12
  31. 31. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 65-Year Olds 15Wednesday, July 18, 12
  32. 32. We are the first civilization to abandon what Mother Nature, Evolution & God gifted us… 15Wednesday, July 18, 12
  33. 33. 16Wednesday, July 18, 12
  34. 34. Our Own Future and Our Own Children’s Future 17Wednesday, July 18, 12
  35. 35. Our Own & Our Children’s Future Rests On Other’s Futures 18Wednesday, July 18, 12
  36. 36. Our Own & Our Children’s Future Rests On Other’s Futures depression bipolar drugs tobacco alcohol ADHD aggression learning disabilities stealing suicide depression crime violence dangerous acts asthma obesity cancer heart-disease diabetes hi-blood pressure 18Wednesday, July 18, 12
  37. 37. Key facts that predict our futures in America… and, by the way, Texas… 19Wednesday, July 18, 12
  38. 38. Key facts that predict our futures in America… and, by the way, Texas… Our children have the highest rates of mental, emotional, behavioral, and related physical disorders among the rich democracies. Our children predicted to have a shorter lifespan and worse morbidity than their parents or grandparents. 19Wednesday, July 18, 12
  39. 39. Key facts that predict our futures in America… and, by the way, Texas… Our children have the highest rates of mental, emotional, behavioral, and related physical disorders among the rich democracies. Our children predicted to have a shorter lifespan and worse morbidity than their parents or grandparents. Our current adults have the highest rates of mental, emotional, behavioral, and related physical disorders among the rich democracies. 19Wednesday, July 18, 12
  40. 40. Key facts that predict our futures in America… and, by the way, Texas… Our children have the highest rates of mental, emotional, behavioral, and related physical disorders among the rich democracies. Our children predicted to have a shorter lifespan and worse morbidity than their parents or grandparents. Our bulge of retiring boomers have high rates of these same problems plus medical problems of aging. Our current adults have the highest rates of mental, emotional, behavioral, and related physical disorders among the rich democracies. 19Wednesday, July 18, 12
  41. 41. 20Wednesday, July 18, 12
  42. 42. What these trends this predict for small businesses in America & Texas? 20Wednesday, July 18, 12
  43. 43. What these trends this predict for small businesses in America & Texas? What do these trends predict for US global economic competitiveness? 20Wednesday, July 18, 12
  44. 44. What these trends this predict for small businesses in America & Texas? What do these trends predict for US global economic competitiveness? What do these trends predict for US safety and security? 20Wednesday, July 18, 12
  45. 45. Who in Texas can act to protect our futures? And how much could we reduce these problems? 21Wednesday, July 18, 12
  46. 46. Psychological flexibility is required… 22Wednesday, July 18, 12
  47. 47. 23Wednesday, July 18, 12
  48. 48. Mental, Emotional and Behavior Disorders = MEBs 24Wednesday, July 18, 12
  49. 49. Available at: www.slideshare.net/drdennisembry The Critical Role of Nurturing Environments for Promoting Human Well-Being Anthony Biglan Oregon Research Institute Brian R. Flay Oregon State University Dennis D. Embry PAXIS Institute Irwin N. Sandler Arizona State University The recent Institute of Medicine report on prevention (Na- tional Research Council & Institute of Medicine, 2009) noted the substantial interrelationship among mental, emo- tional, and behavioral disorders and pointed out that, to a great extent, these problems stem from a set of common conditions. However, despite the evidence, current re- search and practice continue to deal with the prevention of mental, emotional, and behavioral disorders as if they are unrelated and each stems from different conditions. This article proposes a framework that could accelerate prog- ress in preventing these problems. Environments that foster successful development and prevent the development of psychological and behavioral problems are usefully char- acterized as nurturing environments. First, these environ- ments minimize biologically and psychologically toxic events. Second, they teach, promote, and richly reinforce prosocial behavior, including self-regulatory behaviors and all of the skills needed to become productive adult members of society. Third, they monitor and limit oppor- tunities for problem behavior. Fourth, they foster psycho- logical flexibility—the ability to be mindful of one’s thoughts and feelings and to act in the service of one’s values even when one’s thoughts and feelings discourage taking valued action. We review evidence to support this synthesis and describe the kind of public health movement that could increase the prevalence of nurturing environ- ments and thereby contribute to the prevention of most mental, emotional, and behavioral disorders. This article is one of three in a special section (see also Mun˜oz Beardslee, & Leykin, 2012; Yoshikawa, Aber, & Beardslee, 2012) representing an elaboration on a theme for prevention science developed by the 2009 report of the National Re- The next big challenge is to translate this knowledge into significant reductions in the incidence and prevalence of multiple disorders. Doing so requires us to accept two other conclusions of the report: Psychological and behavioral disorders and related problems co-occur (e.g., Biglan, Brennan, Foster, & Holder, 2004; Donovan, Jessor, & Costa, 1993; Flay, 2002), and these problems stem largely from the same conditions (Biglan et al., 2004; Flay, Snyder, & Petraitis, Editor’s note. This article is one of three in a special section presented in this issue of the American Psychologist (May–June 2012) representing an elaboration on an important theme for prevention science developed by the landmark report of the National Research Council and Institute of Medicine (NRC & IOM, 2009). That report summarized the impressive progress in prevention research that has occurred over the past two decades with children and youth. The report also presented recommenda- tions for the next generation of research and policy initiatives to translate this progress into true improvements in the mental health of America’s children and youth. One theme in the report concerns the power of positive aspects of the social environment to promote positive develop- ment and to prevent the development of disorder. The current article develops a coherent, empirically based, theoretical framework for con- ceptualizing the positive aspects of the social environment, which the authors have labeled “nurturing environments.” The other articles in this special section elaborate on two other themes in the NRC & IOM report, one of which concerns the salient role of poverty as a pervasive risk factor (Yoshikawa, Aber, & Beardslee, 2012) and the other of which concerns the potential for preventing the incidence of depression, a major mental disorder (Mun˜oz, Beardslee, & Leykin, 2012). Authors’ note. Anthony Biglan, Promise Neighborhoods Research Consortium, Oregon Research Institute, Eugene, Oregon; Brian R. Flay, College of Public Health and Human Sciences, Oregon State University; Dennis D. Embry, PAXIS Institute, Tucson, Arizona; Irwin N. Sandler, 25Wednesday, July 18, 12
  50. 50. Behavioral Vaccines and Evidence-Based Kernels: Nonpharmaceutical Approaches for the Prevention of Mental, Emotional, and Behavioral Disorders Dennis D. Embry, PhD KEYWORDS Evidence-based kernels Behavioral vaccines Prevention Public health Available at: www.slideshare.net/drdennisembry 26Wednesday, July 18, 12
  51. 51. Available at: www.slideshare.net/drdennisembry Evidence-based Kernels: Fundamental Units of Behavioral Influence Dennis D. Embry Æ Anthony Biglan Ó The Author(s) 2008. This article is published with open access at Springerlink.com Abstract This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior–influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physi- ological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior. This paper presents an analysis of fundamental units of behavioral influence that underlie effective prevention and treatment. We call these units kernels. They have two defining features. First, in experimental analysis, researchers have found them to have a reliable effect on one or more specific behaviors. Second, they are funda- mental units of behavior influence in the sense that deleting any component of a kernel would render it inert. Under- standing kernels could contribute to an empirically based theory of behavioral influence, facilitate dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to developing interventions that are more efficient and effective. Subsequent sections of this paper expand on the two essential features of evidence-based kernels, as well as the origins of the idea and terminology. The ultimate goals of treatment and prevention research are a reduction of the prevalence of the most common and costly problems of behavior and an increase in the preva- lence of wellbeing. Current thinking about how to accomplish this assumes that we will identify empirically supported programs and, to a lesser extent, policies, and will disseminate them widely and effectively. Although substantial progress is occurring through this strategy, there Clin Child Fam Psychol Rev DOI 10.1007/s10567-008-0036-x 27Wednesday, July 18, 12
  52. 52. Physiological influences trigger adverse biological mechanisms Reinforcement more for anti-social than prosocial behaviors Antecedents cue anti-social acts and threats Verbal Relations occasion perceived threats and related reactions Major Connected Ecologic Causes of the Adverse Trends Predicting MEBs Related Illnesses Multi-Inflammatory Brain Body Response 28Wednesday, July 18, 12
  53. 53. Mood Instability Inattention Lo Reward Delay Lo Executive Function Lo Behavioral Competencies Poor Motor Skills Immune- Healing Dysfunction Physiological influences trigger adverse biological mechanisms Reinforcement more for anti-social than prosocial behaviors Antecedents cue anti-social acts and threats Verbal Relations occasion perceived threats and related reactions Major Connected Ecologic Causes of the Adverse Trends Predicting MEBs Related Illnesses Multi-Inflammatory Brain Body Response 28Wednesday, July 18, 12
  54. 54. Mood Instability Inattention Lo Reward Delay Lo Executive Function Lo Behavioral Competencies Poor Motor Skills Immune- Healing Dysfunction Physiological influences trigger adverse biological mechanisms Reinforcement more for anti-social than prosocial behaviors Antecedents cue anti-social acts and threats Verbal Relations occasion perceived threats and related reactions Major Connected Ecologic Causes of the Adverse Trends Predicting MEBs Related Illnesses Mental Illness Substance Abuse Violence Work Problems Obesity, etc CancerEarly Sex School Failure STD’s Special EdMulti-Inflammatory Brain Body Response 28Wednesday, July 18, 12
  55. 55. Rise in Depression Rates Rise in Aggression Rates Rise in Obesity Rates Change in Genes Increased Cancer Increased Autism Increased Schizo. ATOD Addictions New cultural trends predict new challenges and risks 29Wednesday, July 18, 12
  56. 56. Rise in Depression Rates Rise in Aggression Rates Rise in Obesity Rates Change in Genes Increased Cancer Increased Autism Increased Schizo. ATOD AddictionsOmega 3 Fatty Acid Deficiency Vitamin D Deficiency Reduced Outdoor Activities Fear of Violence Crime Increased Electronic Media Use New cultural trends predict new challenges and risks 29Wednesday, July 18, 12
  57. 57. Rise in Depression Rates Rise in Aggression Rates Rise in Obesity Rates Change in Genes Increased Cancer Increased Autism Increased Schizo. ATOD AddictionsOmega 3 Fatty Acid Deficiency Vitamin D Deficiency Reduced Outdoor Activities Fear of Violence Crime Increased Electronic Media Use Lower Rates of Positive Reinforcement New cultural trends predict new challenges and risks 29Wednesday, July 18, 12
  58. 58. Four Types of Kernels Antecedent Kernel Reinforcement Kernel Relational Frame Kernel Physiological Kernel Happens BEFORE the behavior Happens AFTER the behavior Creates verbal relations for the behavior Changes biochemistry of behavior Embry, D. D., Biglan, A. (2008). Evidence-Based Kernels: Fundamental Units of Behavioral Influence. Clinical Child Family Psychology Review, 39. 30Wednesday, July 18, 12
  59. 59. Physiological influences trigger protective biological mechanisms Reinforcement more for prosocial behaviors Antecedents cue prosocial behaviors Verbal Relations occasion perceived safety and affiliation Major Connected Ecologic Causes of the Positive Trends to Children, Youth and Adults Multi Anti-Inflammatory Brain Body Response 31Wednesday, July 18, 12
  60. 60. Mood Stability Attention Hi Reward Delay Hi Executive Function Hi Behavioral Competencies Good Motor Skills Immune- Healing Efficiency Physiological influences trigger protective biological mechanisms Reinforcement more for prosocial behaviors Antecedents cue prosocial behaviors Verbal Relations occasion perceived safety and affiliation Major Connected Ecologic Causes of the Positive Trends to Children, Youth and Adults Multi Anti-Inflammatory Brain Body Response 31Wednesday, July 18, 12
  61. 61. Mood Stability Attention Hi Reward Delay Hi Executive Function Hi Behavioral Competencies Good Motor Skills Immune- Healing Efficiency Physiological influences trigger protective biological mechanisms Reinforcement more for prosocial behaviors Antecedents cue prosocial behaviors Verbal Relations occasion perceived safety and affiliation Major Connected Ecologic Causes of the Positive Trends to Children, Youth and Adults Mental health Low Addictions Prosociality Work Success Heart Health etc Low Cancer Delayed Sex Hi Sch. Grad Low Injuries Higher Ed Multi Anti-Inflammatory Brain Body Response 31Wednesday, July 18, 12
  62. 62. Kernels are building blocks of behavior change Humans survive individually and collectively by influencing the behavior or other humans The 2008 paper by Embry and Biglan identifies 52 evidence based kernels that can be used to design or or improve programs. 32Wednesday, July 18, 12
  63. 63. Table2:Examplesofkernelsforselected,indicatedanduniversalprevention Kernel Treatment Intervention Prevention/Protection Prize Bowl/Mystery Motivator (reinforcement) Reduce/alcohol,/tobacco,/or/ drug/use/to/Improve/ engagement/in/treatment/ goals./ Reduce/problem/behavior/ in/high;risk/children/or/ youth./ Improve/engaged/learning/ and/reduce/disruptions/of/ whole/class./ Goal/Node Mapping (relational/frame) Reduce/relapse/or/ recidivism/rates/or/to/ improve/recovery/ Prevent/ATOD/use/rates/of/ improve/attainment/of/ therapeutic/goals// Increase/academic/success/ or/cognitive/processes// OmegaG3fatty acid supplementation (physiological) Treat/depression,/ borderline,/and/or/bipolar/ disorder./Reduce/autism/ symptoms./ Prevent/emergence/of/ psychotic/episodes/in/ prodromal/adolescents./ Improve/children’s/ cognitive/performance/and/ prevent/behavioral/ disorders./ Publicposting (antecedent)/ Reduce/community/illegal/ behaviors./ Improve/problematic/ behavior/in/therapeutic/ settings// Reduce/impulsive/or/risky/ behaviors/in/general/ population// Promoting/participation/or/ community/goods// Kernels can be used across the lifespan… 33Wednesday, July 18, 12
  64. 64. Protecting our children right now 34Wednesday, July 18, 12
  65. 65. Muriel Saunders PAX GBG: An Example Behavioral Vaccine Read about multiple scientific studies on the “Good Behavior Game” at www.pubmed.gov 35Wednesday, July 18, 12
  66. 66. Antecedent Kernel Reinforcement Kernel Relational Frame Kernel Physiological Kernel Happens BEFORE the behavior Happens AFTER the behavior Creates verbal relations for the behavior Changes biochemistry genes of behavior 36Wednesday, July 18, 12
  67. 67. Antecedent Kernel Reinforcement Kernel Relational Frame Kernel Physiological Kernel Happens BEFORE the behavior Happens AFTER the behavior Creates verbal relations for the behavior Changes biochemistry genes of behavior Multiple non-verbal transition cues 36Wednesday, July 18, 12
  68. 68. Antecedent Kernel Reinforcement Kernel Relational Frame Kernel Physiological Kernel Happens BEFORE the behavior Happens AFTER the behavior Creates verbal relations for the behavior Changes biochemistry genes of behavior Multiple non-verbal transition cues Mystery Motivator Premack Principle; Group Rewards 36Wednesday, July 18, 12
  69. 69. Antecedent Kernel Reinforcement Kernel Relational Frame Kernel Physiological Kernel Happens BEFORE the behavior Happens AFTER the behavior Creates verbal relations for the behavior Changes biochemistry genes of behavior Multiple non-verbal transition cues Mystery Motivator Premack Principle; Group Rewards Motivational Interview Group Identity 36Wednesday, July 18, 12
  70. 70. Antecedent Kernel Reinforcement Kernel Relational Frame Kernel Physiological Kernel Happens BEFORE the behavior Happens AFTER the behavior Creates verbal relations for the behavior Changes biochemistry genes of behavior Multiple non-verbal transition cues Mystery Motivator Premack Principle; Group Rewards Motivational Interview Group Identity 36Wednesday, July 18, 12
  71. 71. Timeline of Life Time Benefits… 37Wednesday, July 18, 12
  72. 72. Timeline of Life Time Benefits… More time for teaching and learning First Month Less stress for Staff Students Better Attendance Better Academics Less Illness Fewer Service Needs Fewer Referrals First Year Happier Families Less Vandalism 2nd 3rd Years ADHD Averted Oppositional Defiance Averted Special Education Averted 5-15 Years No Tobacco Less Alcohol Less Conduct Disorders Delayed vaginal sex Less Crime, Violence, Suicide High School Grad University 37Wednesday, July 18, 12
  73. 73. How much might PAX GBG save for Texans? To do PAX GBG will cost about $150 to protect our children for life from mental illnesses, behavioral problems, drug addictions, becoming a criminal, trying suicide, dying from tobacco or alcohol related illnesses. And, it increases their academic success—including university entry. PAX GBG pays back $4,636 to individuals, taxpayers, and others per student exposed in First Grade over 15 years. Assuming 40,000 First Graders each year, that saves $186 million every First Grade cohort. Cost Savings Source: Aos, S., Lee, S., Drake, E., Pennucci, A., Klima, T., Miller, M., et al. (2011). Return on Investment: Evidence-Based Options to Improve Statewide Outcomes. (July), 8. Retrieved from http://www.wsipp.wa.gov/rptfiles/11-07-1201.pdf 38Wednesday, July 18, 12
  74. 74. First graders exposed to GBG for one year had these benefits at age 21. SOURCE: Kellam, S. G., Mackenzie, A. C., Brown, C. H., Poduska, J. M., Wang, W., Petras, H., Wilcox, H. C. (2011). The good behavior game and the future of prevention and treatment. Addict Sci Clin Pract, 6(1), 73-84. Read this and other studies about the Good Behavior Game at www.pubmed.gov OUTCOMES STUDENT GROUPS GBG CLASSROOM STANDARD CLASSROOM Drug abuse and All males 19 percent 38 percent dependence disorders Highly aggressive males 29 percent 83 percent Regular smoking All males 6 percent 19 percent Highly aggressive males 0 percent 40 percent Alcohol abuse and All males and females 13 percent 20 percent dependence disorders Antisocial personality Highly aggressive males 40 percent 100 percent disorder (ASPD) Violent and criminal Highly agressive males 34 percent 50 percent behavior (and ASPD) Service use for All males 25 percent 42 percent problems with behavior, emotions, drugs, or alcohol Suicidal thoughts All females 9 percent 19 percent All males 11 percent 24 percent 39Wednesday, July 18, 12
  75. 75. Lifespan example of one kernel for prevention, intervention and treatment Reinforcement Kernel Happens AFTER the behavior Available from Amazon.com for $45 40Wednesday, July 18, 12
  76. 76. Giggle Fest Giving Cuts in Line Mumble, Grumble Gowl Play Hangman Jokester Making Faces Nerf Toss or Nerf Basket Paper Airplane Toss Pencil Tapping Penny or Poker Chip Flipping possible in the time set. You can’t help but giggle. Suggested Time: 10 to 20 seconds Winning teams can give cuts to a friend for one set time as determined by the teacher Suggested Time: One lunch, or day only. Suggested Time: 10 to 20 seconds Winning teams get to mumble, grumble and growl as much as possible during the set time. Winning teams are allowed to play a game of hang- man for a time set by the teacher. Suggested Time: 1-2 minutes; more at day’s end Suggested Time: 1-3 minutes, depending on joke book A joke is read for each winning team. Teacher may read them or team captains can read the jokes. (Teach- er needs to have several joke books ready.) Winning teams may make faces at each other or the teacher. Suggested Time: 10-30 seconds. Suggested Time: About 1-2 mins, based on nerf balls Winning teams get to line up and toss a nerf ball into a box, bin or mini basketball hoop. - ing them. (Nice at the end of the day prize) Suggested Time: A few minutes to make, then toss Suggested Time: 10 seconds or so. cups or jars. You can make some containers smalller for more “points”. Suggested Time: A minute or so PAX TIP: Please cut out and select prizes appropriate for you. Start and stop the prizes with PAX Quiet. Using prize bowl or mystery motivator in prevention 41Wednesday, July 18, 12
  77. 77. Seine River Pilot Demonstration April, 2011 – Principals and key staff trained for two days for all 12 schools. April, 2011 – First grade classrooms then trained that week April through May – Each successive month other grades trained, including 8th grade 0 2 4 6 8 10 12 Before (Baseline) After PAX GBG Disruptions by All Seine River First Graders RatePerHourPerChild 40.8% Reduction 45% 42Wednesday, July 18, 12
  78. 78. An ancient inukshuk points the way 0% 6% 12% 18% 24% 30% Psychosis Omega-3 Placeo 27.5% 4.9% PercentagewithPsychosisat12months Physiological Kernel Changes biochemistry of behavior Brief Report Omega-3 Fatty Acid Treatment of Women With Borderline Personality Disorder: A Double-Blind, Placebo-Controlled Pilot Study Mary C. Zanarini, Ed.D. Frances R. Frankenburg, M.D. Objective: The purpose of this study was to compare the effi- cacy of ethyl-eicosapentaenoic acid (E-EPA) and placebo in the treatment of female subjects with borderline personality disorder. Method: The authors conducted an 8-week, placebo-con- trolled, double-blind study of E-EPA in 30 female subjects meet- ing Revised Diagnostic Interview for Borderlines and DSM-IV cri- teria for borderline personality disorder. Results: Twenty subjects were randomly assigned to 1 g of E- EPA; 10 subjects were given placebo. Ninety percent of those in both groups completed all 8 weeks of the trial. Analyses that used random-effects regression modeling and controlled for baseline severity showed E-EPA to be superior to placebo in diminishing aggression as well as the severity of depressive symptoms. Conclusions: The results of this study suggest that E-EPA may be a safe and effective form of monotherapy for women with moderately severe borderline personality disorder. (Am J Psychiatry 2003; 160:167–169) Borderline personality disorder is marked by notable reactivity of mood and impulsive aggression. Because re- sponse to antidepressants and mood stabilizers has typi- cally been clinically modest in this patient group (1), the identification of novel treatments is needed. Candidates include omega-3 fatty acids, such as eicosapentaenoic acid and docosahexaenoic acid, which are commonly found in seafood and have beneficial effects and none of the adverse side effects commonly associated with phar- macotherapy. In cross-national studies, greater seafood consumption was associated with lower rates of bipolar disorder (30-fold range) and major depression (50-fold range) (2). In placebo-controlled trials, a mixture of these fatty acids was found to be an effective adjunctive agent for patients suffering from bipolar disorder (3), and ethyl- eicosapentaenoic acid (E-EPA) was found to have a bene- ficial adjunctive effect for patients suffering from recur- rent depression (4). Because of the shared symptoms of borderline personality disorder and these mood disorders, a double-blind, placebo-controlled trial of E-EPA seemed warranted. Method Recruitment of women between the ages of 18 and 40 was ac- complished through advertisements in Boston newspapers. week, were actively abusing alcohol or drugs, or were acutely sui- cidal. Subjects were next invited to participate in face-to-face inter- views. At that time, the study procedures were fully explained, and written informed consent was obtained. Two semistructured diagnostic interviews were then administered to each subject: the Structured Clinical Interview for DSM-IV Axis I Disorders (6) and the Revised Diagnostic Interview for Borderlines (DIB-R) (7). Two observer-rated scales were also administered: the Modified Overt Aggression Scale (8) and the Montgomery-Åsberg Depression Rating Scale (9). Subjects were included if they met both DIB-R and DSM-IV cri- teria for borderline personality disorder. They were excluded if they met current or lifetime criteria for schizophrenia, schizoaf- fective disorder, or bipolar I or bipolar II disorder or were cur- rently in the midst of a major depressive episode. Study duration was 8 weeks. Subjects were seen every week for the first month and then biweekly for the next month. Both psy- chiatric rating scales were readministered at each subsequent visit. Side effects were also assessed at these visits with a struc- tured questionnaire. Subjects received two capsules per day (beginning the day after their baseline assessment); each capsule contained either 500 mg of 97% E-EPA or a placebo (mineral oil). One gram was chosen as the dose most likely to be effective on the basis of unpublished studies in depression (David Horrobin, personal communication, Feb. 1, 2001). Capsules were supplied by Laxdale Pharmaceuticals (Stirling, U.K.). Between-group baseline demographic variables and clinical history variables were analyzed by using chi-square analyses for categorical variables and Student’s t test for continuous variables. Source: Archives of General PsychiatrySource: Am. Journal of Psychiatry 43Wednesday, July 18, 12
  79. 79. 0 0.25 0.50 0.75 1.00 Before supplementation During supplementation RatioofDisciplinaryIncidentsSupplementation/Baseline Active Placebo Reduced  Felony  Violent  Offenses  Among  Prisoners   with  recommended  daily  amounts  of  vitamins,  minerals  and  essen=al  fay  acids UK  maximum  security  prison  -­‐  338  offences  among  172  prisoners  over  9  months  treatment  in  a  compared  to  9   months  baseline.   Gesch  et  al.    Br  J  Psychiatry  2002,  181:22-­‐28 Ac=ve  -­‐37.0%  p  ‹  0.005 Placebo  -­‐10.1%  p  =  ns Physiological Kernel 44Wednesday, July 18, 12
  80. 80. Why not reproduce the rapid results in the US to get a 37% reduction in jail violence? It cost the Brits 19¢ per day or $69.35 per year. 45Wednesday, July 18, 12
  81. 81. Omega-3 Status and US Military Suicide Deaths Suicide Deaths of Active-Duty US Military and Omega-3 Fatty-Acid Status: A Case-Control Comparison Michael D. Lewis, MD; Joseph R. Hibbeln, MD; Jeremiah E. Johnson, RD; Yu Hong Lin, PhD; Duk Y. Hyun, BS; and James D. Loewke, BS ABSTRACT Background: The recent escalation of US military suicide deaths to record numbers has been a sentinel for impaired force efficacy and has accelerated the search for reversible risk factors. Objective: To determine whether deficiencies of neuroactive, highly unsaturated omega-3 essential fatty acids (n-3 HUFAs), in particular docosahexaenoic acid (DHA), are associated with increased risk of suicide death among a large random sample of active-duty US military. Method: In this retrospective case-control study, serum fatty acids were quantified as a percentage of total fatty acids among US military suicide deaths (n=800) and controls (n=800) matched for age, date of collection of sera, sex, rank, and year of incident. Participants were active-duty US military personnel (2002–2008). For cases, age at death ranged from 17–59 years (mean=27.3 years, SD=7.3 years). Outcome measures included death by suicide, postdeployment health assessment questionnaire (Department of Defense Form 2796), and ICD-9 mental health diagnosis data. Results: Risk of suicide death was 14% higher per SD of lower DHA percentage (OR=1.14; 95% CI, 1.02–1.27; P.03) in adjusted logistic regressions. Among men, risk of suicide death was 62% greater with low serum DHA status (adjusted OR=1.62; 95% CI, 1.12–2.34; P.01, comparing DHA below 1.75% [n=1,389] to DHA of 1.75% and above [n=141]). Risk of suicide death was 52% greater in those who reported having seen wounded, dead, or killed coalition personnel (OR=1.52; 95% CI, 1.11–2.09; P.01). Suicide rates among active-duty US military have increased to re- cord numbers, doubling since the inception of Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom and rivaling the battlefield in toll on the US military.1 Army Vice–Chief of Staff General Peter W. Chiarelli described the record suicide rate as “horrible” and voiced frustration that “the Army has not yet been able to identify any causal links among the suicide cases.”2(pA2) Deficiencies of nutrients critical for brain function may be a signifi- cant contributing risk factor for psychiatric pathology, especially suicide and stress-related psychiatric symptoms.3 Highly unsaturated omega-3 essential fatty acids (n-3 HUFAs), in particular docosahexaenoic acid (DHA), are selectively concentrated in neural tissues and are required for optimal neural function.4 These fatty acids cannot be made de novo but are available only from dietary sources, with seafood being the richest source. Nutritional deficiencies in n-3 HUFAs may increase vulnerabil- ity to combat deployment stress, manifesting as psychiatric symptoms including adjustment disorders, major depression, impulsive violence, and suicide.5 In civilian populations, observational studies indicate that low fish consumption is associated with increased risk of completed sui- cides6,7 and greater suicidal ideation.8 Low DHA status was associated with increased risk of past suicide attempts9 and future suicide attempts.10 In comparison to placebo, 2 grams per day of n-3 HUFA reduced suicidal thinking and depressive symptoms and reduced the perception of stress among subjects (n=49) with deliberate self-harm.11 These findings suggest that low DHA levels may be a contributing factor for adverse psychiatric symptoms. In this study, we posited that low DHA status would be associated with increased risk of suicide death among military personnel. Prospectively collected serum and supporting data were available from the Armed Forces Health Surveillance Center (AFHSC) for a large number of active-duty suicide deaths (n=800) and matched controls (n=800). To our knowledge, this is the largest study of 46Wednesday, July 18, 12
  82. 82. REVIEW Open Access Clearance of fear memory from the hippocampus through neurogenesis by omega-3 fatty acids: a novel preventive strategy for posttraumatic stress disorder? Yutaka Matsuoka1,2 Abstract Not only has accidental injury been shown to account for a significant health burden on all populations, regardless of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric condition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentially important goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunity to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence and associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory and proposes a new, rationally hypothesized translational preventive intervention for PTSD through promoting hippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial of injured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediately after accidental injury can reduce subsequent PTSD symptoms. Matsuoka BioPsychoSocial Medicine 2011, 5:3 http://www.bpsmedicine.com/content/5/1/3 Clearance of fear memory from the hippocampus through neurogenesis by omega-3 fatty acids: a novel preventive strategy for posttraumatic stress disorder? Matsuoka Matsuoka BioPsychoSocial Medicine 2011, 5:3 http://www.bpsmedicine.com/content/5/1/3 (8 February 2011) Omega-3 for PTSD symptoms could be used routinely for the patients exposed to trauma REVIEW Open Access Clearance of fear memory from the hippocampus through neurogenesis by omega-3 fatty acids: a novel preventive strategy for posttraumatic stress disorder? Yutaka Matsuoka1,2 Abstract Not only has accidental injury been shown to account for a significant health burden on all populations, regardless of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric condition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentially important goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunity to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence and associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory and proposes a new, rationally hypothesized translational preventive intervention for PTSD through promoting hippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial of injured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediately after accidental injury can reduce subsequent PTSD symptoms. Matsuoka BioPsychoSocial Medicine 2011, 5:3 http://www.bpsmedicine.com/content/5/1/3 Clearance of fear memory from the hippocampus through neurogenesis by omega-3 fatty acids: a novel preventive strategy for posttraumatic stress disorder? Matsuoka Matsuoka BioPsychoSocial Medicine 2011, 5:3 http://www.bpsmedicine.com/content/5/1/3 (8 February 2011) 47Wednesday, July 18, 12
  83. 83. Omega-3 can improve school grades and success -2 -1 0 1 2 3 4 5 6 7 Reading Spelling Omega 3 Placebo These were gains in academics after 3 months of exposure to fish oil. Before Omega 3 After Omega 3 See www.durhamtrial.org/ 48Wednesday, July 18, 12
  84. 84. Hedelin et al. BMC Psychiatry 2010, 10:38 http://www.biomedcentral.com/1471-244X/10/38 Open AccessRESEARCH ARTICLE © 2010 Hedelin et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Research article Dietary intake of fish, omega-3, omega-6 polyunsaturated fatty acids and vitamin D and the prevalence of psychotic-like symptoms in a cohort of 33 000 women from the general population Maria Hedelin*1,2, Marie Löf3, Marita Olsson3,4, Tommy Lewander1, Björn Nilsson1, Christina M Hultman1,3 and Elisabete Weiderpass2,3,5 Abstract Background: Low intake of fish, polyunsaturated fatty acids (PUFA) and vitamin D deficiency has been suggested to play a role in the development of schizophrenia. Our aim was to evaluate the association between the intake of different fish species, PUFA and vitamin D and the prevalence of psychotic-like symptoms in a population-based study among Swedish women. Methods: Dietary intake was estimated using a food frequency questionnaire among 33 623 women aged 30-49 years at enrolment (1991/92). Information on psychotic-like symptoms was derived from a follow-up questionnaire in the years 2002/03. Participants were classified into three predefined levels: low, middle and high frequency of symptoms. The association between diet and psychotic-like symptoms was summarized in terms of relative risks (RR) and corresponding 95% confidence intervals and was evaluated by energy-adjusted multinomial logistic regression. Results: 18 411 women were classified as having a low level of psychotic-like symptoms, 14 395 as middle and 817 as having a high level. The risk of high level symptoms was 53% (95% CI, 30-69%) lower among women who ate fish 3-4 times per week compared to women who never ate fish. The risk was also lower for women with a high intake of omega-3 and omega-6 PUFA compared to women with a lower intake of these fatty acids. The effect was most pronounced for omega-6 PUFAs. The RR comparing the highest to the lowest quartile of omega-6 PUFAs intake was 0.78 (95% CI, 0.64-0.97). The associations were J-shaped with the strongest reduced risk for an intermediate intake of fish or PUFA. For fatty fish (herring/mackerel, salmon-type fish), the strongest inverse association was found for an intermediate intake (RR: 0.81, 95% CI, 0.66-0.98), whereas a high intake of fatty fish was associated with an increased risk of psychotic-like symptoms (RR: 1.90, 95% CI, 1.34-2.70). Women in the highest compared with the lowest quartile of vitamin D consumption experienced a 37% (95% CI, 22-50%) lower risk of psychotic-like symptoms. Conclusion: Our findings raise a possibility that adult women with a high intake of fish, omega-3 or omega-6 PUFA and vitamin D have a lower rate of psychotic-like symptoms. Background Even though psychoses are relatively rare, between 5-15% of the general population has been estimated to report single schizophrenia-like symptoms like delusions, magi- cal thinking, and hearing internal voices at some point in their lifetime [1-3]. The biological mechanisms underly- ing the etiology of schizophrenia and psychotic symp- toms are largely unknown. Genetic constitution is important [4], but environmental factors like an unhealthy lifestyle with a poor diet may be involved [5,6]. Schizophrenia in adulthood is often preceded by milder symptoms and delusions during adolescence. The typical age of onset for schizophrenia is early adulthood (20-25 years of age). Expression of psychotic symptoms in popu- * Correspondence: maria.hedelin@ki.se 1 Department of Neuroscience, Psychiatry, Ulleråker, Uppsala University, Uppsala, Sweden Full list of author information is available at the end of the article ENVIRONMENT AND SCHIZOPHRENIA Developmental Vitamin D Deficiency and Risk of Schizophrenia: A 10-Year Update John J. McGrath*,1,2,3 , Thomas H. Burne1,2 , Francxois Fe´ron4 , Allan Mackay-Sim5 , and Darryl W. Eyles1,2 1 Queensland Center for Mental Health Research, The Park Center for Mental Health, Wacol, Queensland 4076, Australia; 2 Queensland Brain Institute, University of Queensland, St Lucia, Queensland 4076 Australia; 3 Department of Psychiatry, University of Queensland, St Lucia,Queensland4076Australia;4 NeurobiologiedesInteractionsCellulairesetNeurophysiopathologie(CNRSUMR6184),Universite´ de la Me´diterrane´e (Aix-Marseille II), Faculte´ de Me´decine Nord, Institut Fe´de´ratif de Recherche Jean Roche (IFR11), Marseille, France; 5 NationalCenterforAdultStemCellResearch,EskitisInstituteforCellandMolecularTherapies,GriffithUniversity,Brisbane,Queensland 4111, Australia *To whom correspondence should be addressed; tel: þ61-7-3346-6372, fax: þ61-7-3271-8698, e-mail: john_mcgrath@qcmhr.uq.edu.au There is an urgent need to generate and test candidate risk factors that may explain gradients in the incidence of schizophrenia. Based on clues from epidemiology, we pro- posed that developmental vitamin D deficiency may con- tribute to the risk of developing schizophrenia. This hypothesis may explain diverse epidemiological findings in- cluding season of birth, the latitude gradients in incidence and prevalence, the increased risk in dark-skinned migrants to certain countries, and the urban-rural gradient. Animal experiments demonstrate that transient prenatal hypovita- minosis D is associated with persisting changes in brain structure and function, including convergent evidence of al- tered dopaminergic function. A recent case-control study based on neonatal blood samples identified a significant as- sociation between neonatal vitamin D status and risk of schizophrenia. This article provides a concise summary of the epidemiological and animal experimental research that has explored this hypothesis. Key words: vitamin D/schizophrenia/epidemiology/ animal models/neurodevelopment/prevention Introduction There is robust evidence demonstrating that the risk of schizophrenia varies according to season of birth, place of birth, and migrant status.1 We propose that develop- mental vitamin D (DVD) deficiency underlies these gradients.2 Over the last decade, we have undertaken a coordinated program of animal experiments, assay development, and analytic epidemiology in order to ex- plore this hypothesis. This article summarizes the current research related to this hypothesis and makes recommen- dations for future research. Key features of the evidence are summarized in table 1. Vitamin D—The Basics Ultra Violet B (UVB) radiation on the epidermis converts a cholesterol metabolite to vitamin D3 (cholecalciferol; a preprohormone). This is subsequently hydroxylated to 25-hydroxyvitamin D3 (25OHD), a prehormone com- monly used to measure vitamin D status. A second hy- droxylation of this molecule converts 25OHD to the active secosteroid hormone 1,25-dihydroxyvitamin D3 (1,25OHD). This hormone binds the vitamin D receptor (VDR), a member of the nuclear receptor superfamily. In concert with a range of binding partners and coactiva- tors (including the retinoid X receptor), this phylo- genetically ancient system influences the expression of many genes in mammals. Vitamin D is a potent prodifferentiating and antiproliferative agent. Vitamin D deficiency (25 nmol/l) and insufficiency (25–50 nmo/l) are common in many nations.6–8 Hypovi- taminosis D is more prevalent in winter, in high latitudes, and in dark-skinned individuals. Migrants to European countries are at higher risk of hypovitaminosis D com- pared with native-born.9 Compared with nonimmigrants, those from Africa have the highest adjusted ORs for vi- tamin D deficiency (about 7-fold), followed by migrants from Arab-Islamic countries (about 6-fold) and Turkey (about 4-fold).10 Apart from darker skin color, variables related to dress (eg, wearing a veil), behavior (eg, less out- door activities), and diet also contribute to an increased risk of deficiency in certain ethnic groups.11,12 Urban res- idence is associated with an increased risk of hypovitami- nosis, due to factors such as reduced outdoor activity and access to UVB radiation.13,14 Schizophrenia Bulletin doi:10.1093/schbul/sbq101 Ó The Author 2010. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org. 1 Schizophrenia Bulletin Advance Access published September 10, 2010 atUQLibraryonSeptember19,2010schizophreniabulletin.oxfordjournals.orgDownloadedfrom Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant Mortality, and Skin Color: A Role for Prenatal Vitamin D Deficiency and Infections? Dennis K. Kinney1–3 , Pamela Teixeira2 , Diane Hsu2 , Siena C. Napoleon2,4 , David J. Crowley2 , Andrea Miller2 , William Hyman2 , and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3 De- partment of Psychiatry, Harvard Medical School, Boston, MA; 4 Wellesley College, Wellesley, MA Previous surveys found a large (10-fold) variation in schizophrenia prevalence at different geographic sites and a tendency for prevalence to increase with latitude. We conducted meta-analyses of prevalence studies to inves- tigate whether these findings pointed to underlying etiologic factors in schizophrenia or were the result of methodolog- ical artifacts or the confounding of sites’ latitude with level of healthcare at those sites. We found that these patterns were still present after controlling for an index of health- care—infant mortality—and focusing on 49 studies that used similar diagnostic and ascertainment methods. The tendencies for schizophrenia prevalence to increase with both latitude and colder climate were still large and signif- icant and present on several continents. The increase in prevalence with latitude was greater for groups with low fish consumption, darker skin, and higher infant mortali- ty—consistent with a role of prenatal vitamin D deficiency in schizophrenia. Previous research indicates that poor pre- natal healthcare and nutrition increase risk for schizophre- nia within the same region. These adverse conditions are more prevalent in developing countries concentrated near the equator, but schizophrenia prevalence is lowest at sites near the equator. This suggests that schizophrenia- producing environmental factors associated with higher lat- itude may be so powerful they overwhelm protective effects of better healthcare in industrialized countries. The ob- served patterns of correlations of risk factors with preva- lence are consistent with an etiologic role for prenatal vitamin D deficiency and exposure to certain infectious dis- eases. Research to elucidate environmental factors that un- derlie variations in schizophrenia prevalence deserves high priority. Key words: epidemiology/etiology/immune function/ prenatal/geography/risk factor Introduction Schizophrenia is an unusually burdensome disorder be- cause of the great economic costs of extensive care and loss of economic productivity, as well as the personal suf- fering and stigma, which often affect a patient and his or her family for most of the patient’s life. Moreover, for most patients there is still no cure or even an effective way of treating many of the most disabling, ‘‘negative’’ symptoms of the disorder. Therefore, a key goal of schizo- phrenia research is elucidation of etiologic factors, partic- ularly environmental ones that could be readily avoided and used in effective, inexpensive, and ethically sound pri- mary prevention programs. In a comprehensive survey of schizophrenia prevalence studies around the world that were published in English over a period of 4 decades, Torrey1 noted 2 important patterns. First, prevalence rates varied widely at different geographic sites, with the highest rate being more than 10 times greater than the lowest. Second, there was a strong tendency for schizophrenia prevalence to increase with increasing latitude; ie, prevalence rates tended to be very low near the equator and to increase as one moved toward the poles. Both of Torrey’s conclusions were also reached in a survey and meta-analysis by Saha et al,2 which included more recent studies as well as ones pub- lished in languages other than English. Several other sur- veys have also concluded that schizophrenia rates vary at least 10-fold around the world, including studies using measures of point prevalence, lifetime prevalence, and incidence.1,3–10 Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 byguestonFebruary10,2012http://schizophreniabulletin.oxfordjournals.org/Downloadedfrom 49Wednesday, July 18, 12
  85. 85. Goal Maps (visual organized brief motivational interview) Relational Frame Kernel Creates verbal relations for the behavior Cigarettes Consumed Alcohol Consumed Marijuana Consumed 50Wednesday, July 18, 12
  86. 86. First children learn a vision of a wonderful school 51Wednesday, July 18, 12
  87. 87. Wait for the Timer for tobacco addictions with SMI/CMI Antecedent Kernel Happens BEFORE the behavior 52Wednesday, July 18, 12
  88. 88. Beat the timer in school to improve engagement Antecedent Kernel Happens BEFORE the behavior 53Wednesday, July 18, 12
  89. 89. Trend-line for humorous warnings on binge drinking by women of child-rearing age No Warnings Humorous Warnings Antecedent Kernel 54Wednesday, July 18, 12
  90. 90. Trend-line for humorous warnings on binge drinking by women of child-rearing age 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007 0 4 8 12 16 20 Percentage No Warnings Humorous Warnings Antecedent Kernel 54Wednesday, July 18, 12
  91. 91. Trend-line for humorous warnings on binge drinking by women of child-rearing age 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007 0 4 8 12 16 20 Percentage No Warnings Humorous Warnings Antecedent Kernel 54Wednesday, July 18, 12
  92. 92. Trend-line for humorous warnings on binge drinking by women of child-rearing age 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007 0 4 8 12 16 20 Percentage No Warnings Humorous Warnings Antecedent Kernel 54Wednesday, July 18, 12
  93. 93. Acceptance Commitment Therapy Kernels Go to www.ContextualPsychology.org 55Wednesday, July 18, 12
  94. 94. Writeathoughtandafeelin g on the leaf and put it on the thoughts and feelings“stream” Iamhavingthethoughtthat… I am having a feeling of … Copyright © 2007-2012,PAXIS Institute. All rights reserved. May be reproduced but not sold.www.paxtalk.com I am having a sensation of … 56Wednesday, July 18, 12
  95. 95. Writeathoughtandafeelin g on the leaf and put it on the thoughts and feelings“stream” Iamhavingthethoughtthat… I am having a feeling of … Copyright © 2007-2012,PAXIS Institute. All rights reserved. May be reproduced but not sold.www.paxtalk.com I am having a sensation of … 56Wednesday, July 18, 12
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c.! ,(-'7'#! J#)/()5%-,#!%-8! J)##-7!C#$%'()%*! 8'.()8#).VO:!DV3DN! %'()*!137/)5K! U%-7#,#8#-7!Y#)-#*W! T#86,#!,(556-'7A! '**#%*!C#$%'().@KK:! @K@:!@DK! F5J)(#!J)(C*#5%7',! C#$%'()!'-! 7$#)%J#67',! .#77'-.DO:!DLK! T#86,#!'5J6*.'#!()! )'.YA!C#$%'().!'-! #-#)%*! J(J6*%7'(-DL@3DL! F5J)(#8! %,%8#5',.DLL3DLV! 4)(5(7'-! J%)7','J%7'(-!()! ,(556-'7A!((8.DL_:! DLN! ! UniversalTargeted Kernels lower cost of training, support change… Kernels provide robustness, cost-efficiency and community sustainability across multi-problem behaviors. Intervention 57Wednesday, July 18, 12
  97. 97. Media promoting recovery Do you market the harms and dangers? Or, do you market recovery? 58Wednesday, July 18, 12
  98. 98. 59Wednesday, July 18, 12
  99. 99. Thinking about and measuring recovery, relapse and recidivism 0 50 100 0 10 20 30 40 50 Time in Months 0 50 100 0 10 20 30 40 50 Time in Months Treatment Strategy #1 Treatment Strategy #2 Only 17% of the discharged clients of program #1 have not relapsed,been re-arrested,or re-hospitalized by 48 months. About 80% of the discharged clients of program #2 “survived”with no relapse, re-arrested,or re-hospitalization by 48 months. Do these two evidence- based strategies look significantly different at 20 days? 60Wednesday, July 18, 12
  100. 100. Thinking about and measuring recovery, relapse and recidivism 0 50 100 0 10 20 30 40 50 Time in Months 0 50 100 0 10 20 30 40 50 Time in Months Treatment Strategy #1 Treatment Strategy #2 Only 17% of the discharged clients of program #1 have not relapsed,been re-arrested,or re-hospitalized by 48 months. About 80% of the discharged clients of program #2 “survived”with no relapse, re-arrested,or re-hospitalization by 48 months. 60Wednesday, July 18, 12
  101. 101. Percentage of patients in recovery during followup year. Harrow M et al. Schizophr Bull 2005;31:723-734 Percentage of patients in recovery during followup year. Note: SZ = schizophrenia, SZNIF = schizophreniform, OP = other psychotic, NP = nonpsychotic. Non-psychotic Other psychotic Schizophreniform Schizophrenia 61Wednesday, July 18, 12
  102. 102. Percent of Patients Ever in Recovery (5 Follow-ups Over 15 Years). Harrow M et al. Schizophr Bull 2005;31:723-734 62Wednesday, July 18, 12
  103. 103. Percent of Nonmedicated Schizophrenia and Schizophreniform Patients in Recovery at 15-Year Follow-ups. Harrow M et al. Schizophr Bull 2005;31:723-734 63Wednesday, July 18, 12
  104. 104. Recognition/Rewards for Successs Vaccine Recipe Identify Behaviors Reduced Identify Behaviors Increased List local, state and national policies positively impacted or lled by recipe Psychinfo www.pubmed.gov ERIC NTIS User T Local State National Cite relevant studies Cite relevant endorsements or standards Create policy funding supports (organizational, local and/or state Cultivate some current or prospective early adopters for testimonials Lo Hi - A catchy positive name (meme) - What the ts are - Where/ how to get recipe - Relational framing Support Training Daily, Weekly or Monthly Feedback res TH cacy, Adoption, Implementation, Maintenance - What the costs of use are Developmental stages Multiple Settings Fam ilies Schools Communities Organiations Birth Childhood Adolescence Adulthood Intensity/reachlevels High Intensity Low reach Low Intensity A B C Hi reach Impacting Values Evaluation Outcome Monitoring Population Targeting The path from research findings to public health policy and impact 64Wednesday, July 18, 12
  105. 105. 65Wednesday, July 18, 12
  106. 106. Dennis D. Embry, Ph.D. dde@paxis.org 520-299-6770 Business cards available for follow up and copies of papers presentations 66Wednesday, July 18, 12
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