Creating an Evidence-Based Approach to Lifespan Suicide Prevention
 

Creating an Evidence-Based Approach to Lifespan Suicide Prevention

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Keynote: Address: ...

Keynote: Address:

Humans appear to be the only species on the planet that kill themselves, which is the apparent result of the unique properties of language and the fact that other humans are the principal predator and the principal source of safety in our lives. Last year, three times as many America’s died from suicide as died at the height of the polio epidemic in the 1950s: 36,000 deaths from suicide, versus 3,000 from polio.

A public-health approach across the lifespan is required to reduce this terrible suffering and injury. A public-health campaign is less about the warning signs of suicide than specific actions that disable the “pump handle” to the wells of despair that result in suicidality.

This talk lays out four key principles from a lead article in a special issue of the American Psychologist on prevention, by the presenter and colleagues [1]. These principles arise from the consilience of evolutionary, medical, and behavioral sciences. The principles are not limited to the prevention of suicide; indeed, they principles address prevention of multiple mental, emotional, behavioral, and related physical disorders as outlined by the Institute of Medicine [2].

This talk integrates these principles with low-cost evidence-based kernels [3] and behavioral vaccines [4, 5] that can operate as an integrated public-health model to prevent multiple mental, emotional, behavioral, and related disorders [6]. This talk specifically shows how several apparently simple strategies can be promoted to prevent suicide across the lifespan, illustrated by data and practical mechanisms with rapid results and cost savings for multiple-silos of government and the private sector. The net result is happier, healthier, and productive citizens of all ages.

Breakout #1: Preventing Future Suicide from Pregnancy through Childhood Evidence-based Kernels and Behavioral Vaccines

This breakout expands on the keynote with specific evidence-based kernels and behavioral vaccines, organization and implementation details for low-cost strategies that can avert suicidality 10 to 20 years later cost effectively. One specific strategy that will be covered in greater detail is the Good Behavior Game (which is being widely promoted by in the US and Canada), as the only early elementary school strategy with lifetime scientific data on reducing sucidality [7]. Presently, the Substance Abuse and Mental Health Services Administration (SAMSHA) is funding 30 sties to do the Good Behavior Game, with 28 of those being supervised by Dr. Embry and his colleagues.

Breakout #2: Preventing Suicide from Adulthood through Senior Years

This breakout explores what science we have that shows pathways for preventing suicide among adults of all ages, beyond signs of suicide. This breakout links the principles from the keynote with evidence-based kernels and behavioral vaccines that can be used in multiple contexts and initiatives. Policies and practices can be scale

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Creating an Evidence-Based Approach to Lifespan Suicide Prevention Creating an Evidence-Based Approach to Lifespan Suicide Prevention Presentation Transcript

  • Dennis D. Embry, Ph.D. Crea%ng  an  Evidence-­‐Based  Approach   President/Senior Scientist to  Lifespan  Suicide  Preven%on PAXIS InstituteMonday, April 15, 13 1
  • 38,000Monday, April 15, 13 2
  • The Polio EpidemicMonday, April 15, 13 3
  • The Polio EpidemicMonday, April 15, 13 3
  • The Polio Epidemic 3,000Monday, April 15, 13 3
  • A recent webinar experience on the topicMonday, April 15, 13 4
  • Monday, April 15, 13 5
  • Is this early prevention?Monday, April 15, 13 5
  • Monday, April 15, 13 6
  • Is this early prevention?Monday, April 15, 13 6
  • Monday, April 15, 13 7
  • Is this early prevention?Monday, April 15, 13 7
  • Monday, April 15, 13 8
  • Is this early prevention?Monday, April 15, 13 8
  • Thinking way upstream What might be the early malleable predictors? What if we started here with early suicide prevention?Monday, April 15, 13 9
  • Thinking way upstream What might be the early malleable predictors? Could we actually change those predictors easily and reliably? And what else might change as a consequence of the prevention or protection strategies.Monday, April 15, 13 10
  • risk factors during development from early childhood to adolescence Psychiatric problems in childhood and/or adolescence, including depression Child and/or adolescent externalizing disorders Childhood adversity (especially with the above) Low self-efficacy Aggressive or delinquent behavior Poor peer relations Prax Kinderpsychol Kinderpsychiatr. 2012;61(1):32-49.Monday, April 15, 13 11
  • risk factors during development from early childhood to adolescence Psychiatric problems in childhood and/or adolescence, including depression Child and/or adolescent externalizing disorders Childhood adversity (especially with the above) Low self-efficacy Aggressive or delinquent behavior Poor peer relations And prenatal and post-natal Prax Kinderpsychol Kinderpsychiatr. 2012;61(1):32-49.Monday, April 15, 13 11
  • Thinking way upstream What might be the early malleable predictors? Could we actually change those predictors easily and reliably? And what else might change as a consequence of the prevention or protection strategies.Monday, April 15, 13 12
  • Surveying the Past Foretells Our FuturesMonday, April 15, 13 13
  • Consider the cohort trends…#1 mental health disorderMonday, April 15, 13 14
  • Consider the cohort trends…#1 mental health disorderMonday, April 15, 13 14
  • Consider the cohort trends…#1 mental health disorder Born NOW?Monday, April 15, 13 14
  • Consider the cohort trends…#1 mental health disorder Born NOW?Monday, April 15, 13 14
  • Consider the cohort trends…#1 mental health disorder Born NOW? These trends are not the result of over- diagnosesMonday, April 15, 13 14
  • Cumulative prevalence of psychiatric Cumulative Prevalence disorders by young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. 9 10 11 12 13 14 15 16 19 21 AGE Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 15
  • Cumulative prevalence of psychiatric Cumulative Prevalence disorders by Oldest Cohort young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. 9 10 11 12 13 14 15 16 19 21 AGE Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 15
  • Cumulative prevalence of psychiatric Middle Cohort Cumulative Prevalence disorders by Oldest Cohort young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. 9 10 11 12 13 14 15 16 19 21 AGE Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 15
  • Cumulative Youngest Cohort prevalence of psychiatric Middle Cohort Cumulative Prevalence disorders by Oldest Cohort young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. 9 10 11 12 13 14 15 16 19 21 AGE Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 15
  • Cumulative Youngest Cohort prevalence of psychiatric Middle Cohort Cumulative Prevalence disorders by Oldest Cohort young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. EARLIER START; Higher Prevalence 9 10 11 12 13 14 15 16 19 21 AGE Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 15
  • Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40% 35% 30% 25% 20% 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 16
  • Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40% 35% Anxiety 30% 25% 20% 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 16
  • Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40% 35% Anxiety 30% 25% Behavior 20% 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 16
  • Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40% 35% Anxiety 30% 25% Behavior 20% Mood 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 16
  • Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40% 35% Anxiety 30% 25% Substance Behavior 20% Mood 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 16
  • Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40% 1-out-2 USA 35% young adults will be afflicted with Anxiety 30% one or more of these disorders 25% Substance Behavior by age 18 20% Mood 15% 10% NOTE 5% EARLY START Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 16
  • The US had 75 million children and teens 2009 Wall Street Journal, 12-28-2010Monday, April 15, 13 17
  • The US had 75 million children and teens 2009 40.4 million kids had one psychotropic med in 2009 Wall Street Journal, 12-28-2010Monday, April 15, 13 17
  • How many of you know a blue-collar, middle-class, or upper-class family who is reasonably intact… Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 18
  • How many of you know a blue-collar, middle-class, or upper-class family who is reasonably intact… with a child, teen, or adult child with a mental, emotional, or behavioral disorder? Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 18
  • How do we handle this problem of mental illnesses?Monday, April 15, 13 19
  • Prevalence rates are increasing rapidly in North America How do we handle this problem of mental illnesses?Monday, April 15, 13 19
  • Common set of conditions producing these negative trends… Poor Health RNA IL6 DNA Epigenetic Changes Inspirational Credit: Clyde Hertzman Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 20
  • Common set of conditions producing these negative trends… HIgh Exposure to Toxic Influences/ACEs Exposure to Low Psychological Flexibility HIgh Exposure to Problematic Behaviors High Reinforcement of Anti-Social Behavior Poor Health • Mental Disorders RNA • Emotional Disorders IL6 DNA • Behavioral Disorders • Related Physical Disorders Epigenetic Changes Evolutionary Adaptations to a Predatory, Stressful World; Inspirational Credit: Clyde Hertzman worse social determinants Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 20
  • Multi-Inflammatory Brain & Body Response Major Connected Causes of the Adverse Trends Predicting MEBs & Related Illnesses Reinforcement Antecedents Physiological Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Mismatches Predict Multiple MACH DisordersMonday, April 15, 13 21
  • Mood Lo Reward Lo Executive Lo Behavioral Inattention Function Instability Delay Competencies Poor Immune- Motor Healing Skills Multi-Inflammatory Brain & Body Response Dysfunction Major Connected Causes of the Adverse Trends Predicting MEBs & Related Illnesses Reinforcement Antecedents Physiological Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Mismatches Predict Multiple MACH DisordersMonday, April 15, 13 21
  • Substance Work Obesity, Early Mental Illness Violence Cancer School Abuse Problems etc Sex Failure Mood Lo Reward Lo Executive Lo Behavioral Inattention Function Instability Delay Competencies Poor Immune- STD’s Motor Healing Special Skills Multi-Inflammatory Brain & Body Response Dysfunction Ed Major Connected Causes of the Adverse Trends Predicting MEBs & Related Illnesses Reinforcement Antecedents Physiological Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Mismatches Predict Multiple MACH DisordersMonday, April 15, 13 21
  • The America’s First Peoples… 26,000 to 12,000 B.E. 1491 AD Disease & War Extermination, OriginalHuman Marginalization, Migrations to & Suppression North America 30,000,000 300,000 ≈ Souls in ≈ Souls North America Residential Schools; Western Diet Evolutionary bottleneckMonday, April 15, 13 22
  • The America’s First Peoples… 26,000 to 12,000 B.E. 1491 AD Disease & War Extermination, OriginalHuman Marginalization, Migrations to & Suppression North America 30,000,000 300,000 ≈ Souls in ≈ Souls Today North America Residential Schools; Western Diet Evolutionary bottleneckMonday, April 15, 13 22
  • Slavery The Great African Americans 1863 Middle … 1500’s to Passage Institution of Slavery Jim Crow Migration North Original Human Populations in Africa Continuing ≈ Capture Trauma 30% to Separation, Exposure 50% + violence, to Toxins mortality malnutrition Evolutionary bottleneckMonday, April 15, 13 23
  • Slavery The Great African Americans 1863 Middle … 1500’s to Passage Institution of Slavery Jim Crow Migration North Original Human Populations in Africa Continuing ≈ Capture Trauma today 30% to Separation, Exposure 50% + violence, to Toxins mortality malnutrition Evolutionary bottleneckMonday, April 15, 13 23
  • Example Lasting Effects of Evolutionary Bottlenecks US Blacks Barbados St. Lucia Jamaica Political pundits say: Cameroon (urban) Cameroon (Rural) Nigeria (Rural) 40% “Slavery is over. Jim Slavery Exposure No Slavery Exposure Crow is over. Everybody 30% should be over all this.” 20% Evolution is bigger than 10% pundits, and epigensis is a solution to a past 0% evolutionary problem Hi Blood Pressure Percentage that might come back. Source: Scientific American, February, 1999 Evolution is conservative.Monday, April 15, 13 24
  • Epigenetic  Mechanisms Health  &  Behavior Yes, the social and •  Nurturing  environments •  Obesity,  asthma,  diabetes physical environment •  Toxic  environments •  Early  sex,  pregnancy of humans changes gene expression. •  Development/aging •  Violence,  DSM-­IV •  Cancer,  auto-­immune Epigenetic   Factor Add slide here about the epigenetic mechanisms; this shows how what children see, hear, do and feel in the brain, then cascades through neuro-hormones to change the genes. This will show that micro-environments matterMonday, April 15, 13 25
  • Ignore the What shall we do? Make problem? everybody Pretend mentally and everything is physically fine? healthier?Monday, April 15, 13 26
  • First, Devise Early Wins NOW Across Age Groups Trajectory of Mental, Behavioral, and Emotional Disorders (illustrative graph only) Past Predicted Possible Future Future with Prevention Science Pre-Conception Prevalence Rate ers i sord Pre-Natal al D ehavior B Infancy and o nal, oti Early Childhood l, Em fM enta ath o Elementary ent P Curr Adolescence Young Adults Adulthood YearsMonday, April 15, 13 27
  • First, Devise Early Wins NOW Across Age Groups Trajectory of Mental, Behavioral, and Emotional Disorders (illustrative graph only) Past Predicted Possible Future Future with Prevention Science Pre-Conception Prevalence Rate ers i sord Pre-Natal al D ehavior B Infancy and o nal, oti Early Childhood l, Em fM enta ath o Elementary ent P Curr Adolescence Young Adults Adulthood YearsMonday, April 15, 13 28
  • Conditions producing positive trends… Health RNA IL6 DNA Epigentic Changes Inspirational Credit: Clyde Hertsman Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 29
  • Conditions producing positive trends… Low Exposure to Toxic Influences Exposure to High Psychological Flexibility Low Exposure to Problematic Behaviors High Reinforcement of Prosocial-Social Behavior Health • Mental Health RNA • Emotional Health/Balance IL6 DNA • Behavioral Competence • Related Physical Health Epigentic Changes Evolutionary Adaptations to a Safe, Supportive World Inspirational Credit: Clyde Hertsman Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 29
  • Devise Early Wins NOW with multiple footprints Universal multiple outcome Acccess to focus Prevention & Promotion Science multiple age-stage focusMonday, April 15, 13 30
  • Devise Early Wins NOW with multiple footprints Mental Health Emotional Health Universal multiple outcome Behavioral Health Acccess to focus Physical Health Prevention & Can imp Cognitive Ability Promotion rove multiple health outcomes for all ages Science Pre-conception multiple Infancy, Childhood age-stage focus Adolescence Young Adults & Adults SeniorsMonday, April 15, 13 31
  • Devise Early Wins NOW with multiple footprints Mental Health Biglan, Flay, Embry, & Irwin, 2012 Emotional Health Prosocialty Rich Reinforced Nurturing Low Problem Behaviors Universal multiple outcome Behavioral Health Environments Logic Model for Acccess to focus Physical Health population-level benefits Prevention & Can Low Toxic Psychological Better imp Cognitive Ability Influences Flexibility Promotion rove multiple Futures health outcomes for all ages Science for All Pre-conception Health multiple Infancy, Childhood IL6 RNA DNA age-stage focus Adolescence Epigensis Young Adults & Adults Seniors Inspirational Credit: Clyde HertsmanMonday, April 15, 13 32
  • Suicide Rates Not Evenly DistributedMonday, April 15, 13 33
  • Mothers and children in North America do not get sufficient Vitamin D via sunlight Mothers and children in North America do not eat foods sufficient in Vitamin D This evolutionary mismatch harms mental healthMonday, April 15, 13 34
  • D. K. Kinney et al. Mismatch, Latitude & Schizophrenia Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 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 derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/ partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor 4 Wellesley College, Wellesley, MA Fig. 1. Schizophrenia Prevalence and Latitude by Continent and Infant Mortality. Note: South Asia sites were from India and Indonesia; those sites had higher infant mortality rates than all but one of the East Asian sites. For theMonday, April 15, 13 regressionlinesinNorth America, those withinfantmortalityrates above 30 per 1000 weregroupedas having a higherrate, those below30 as having Introduction 35 Previous surveys found a large (>10-fold) variation in
  • D. K. Kinney et al. Mismatch, Latitude & Schizophrenia Semmelweis Reflex Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 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 derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/ partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor 4 Wellesley College, Wellesley, MA Fig. 1. Schizophrenia Prevalence and Latitude by Continent and Infant Mortality. Note: South Asia sites were from India and Indonesia; those sites had higher infant mortality rates than all but one of the East Asian sites. For theMonday, April 15, 13 regressionlinesinNorth America, those withinfantmortalityrates above 30 per 1000 weregroupedas having a higherrate, those below30 as having Introduction 35 Previous surveys found a large (>10-fold) variation in
  • D. K. Kinney et al. Mismatch, Fish Intake & Schizophrenia Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 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 derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/ partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor 4 Wellesley College, Wellesley, MA Fig. 2. Schizophrenia Prevalence and Latitude by Fish Intake. Note: Error bars represent 95% confidence limits. The slopes of linear regression lines were 0.03 for sites with high fish intake, 0.21 for sites withMonday, April 15, 13 moderate fish intake, and 0.17 for sitesIntroduction with low fish intake. For the subset of Scandinavian sites, the slope of linear regression for was 0.03 for 36 Previous surveys found a large (>10-fold) variation in
  • D. K. Kinney et al. Mismatch, Fish Intake & Schizophrenia Semmelweis Reflex Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 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 derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/ partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor 4 Wellesley College, Wellesley, MA Fig. 2. Schizophrenia Prevalence and Latitude by Fish Intake. Note: Error bars represent 95% confidence limits. The slopes of linear regression lines were 0.03 for sites with high fish intake, 0.21 for sites withMonday, April 15, 13 moderate fish intake, and 0.17 for sitesIntroduction with low fish intake. For the subset of Scandinavian sites, the slope of linear regression for was 0.03 for 36 Previous surveys found a large (>10-fold) variation in
  • e increased markedly economic status and healthcare, as indexed in our anal- ysis by the infant mortality rate, appears to be a muchrenia prevalence with weaker predictor of risk for schizophrenia than are lati- d is not due simply to Mismatch, Skin Color & Schizophrenia tude and winter temperature. A high infant mortality ratetic and ascertainmentalysis of data collected particularly informa-t controlled for possi- ences in prevalence at investigative person- were used to obtain ent sites within the Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009studied schizophrenia doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 ites in the same timeiagnostic criteria and Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant data showedSkin very A Role for Prenatal Vitamin D Deficiency and Infections? Mortality, and a Color: with both latitude w temperature (r = Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2cially wide variation in 2 Key words: epidemiology/etiology/immune function/ 3 Genetics Laboratory, McLean Hospital, Belmont, MA; De-he equator, prevalenceSchool, Boston, MA; prenatal/geography/risk factor partment of Psychiatry, Harvard Medical 4 Wellesley College, Wellesley, MA Fig. 3. Schizophrenia Prevalence and Latitude by Skin Color.at is, for all groups and Note: Error bars represent 95% confidence limits. The slopes of the Monday, April 15, 13 Introduction 37 Previous surveys found a large (>10-fold) variation in
  • e increased markedly economic status and healthcare, as indexed in our anal- ysis by the infant mortality rate, appears to be a muchrenia prevalence with weaker predictor of risk for schizophrenia than are lati- d is not due simply to Mismatch, Skin Color & Schizophrenia tude and winter temperature. A high infant mortality ratetic and ascertainmentalysis of data collected Semmelweis particularly informa- Reflext controlled for possi- ences in prevalence at investigative person- were used to obtain ent sites within the Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009studied schizophrenia doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 ites in the same timeiagnostic criteria and Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant data showedSkin very A Role for Prenatal Vitamin D Deficiency and Infections? Mortality, and a Color: with both latitude w temperature (r = Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2cially wide variation in 2 Key words: epidemiology/etiology/immune function/ 3 Genetics Laboratory, McLean Hospital, Belmont, MA; De-he equator, prevalenceSchool, Boston, MA; prenatal/geography/risk factor partment of Psychiatry, Harvard Medical 4 Wellesley College, Wellesley, MA Fig. 3. Schizophrenia Prevalence and Latitude by Skin Color.at is, for all groups and Note: Error bars represent 95% confidence limits. The slopes of the Monday, April 15, 13 Introduction 37 Previous surveys found a large (>10-fold) variation in
  • Latitude and Infantile Autism Grant, W. B. and C. M. Soles (2009). "Epidemiologic evidence supporting the role of maternal vitamin D deficiency as a risk factor for the development of infantile autism." Dermatoendocrinol 1(4): 223-228.Monday, April 15, 13 38
  • Latitude and Infantile Autism Semmelweis Grant, W. B. and C. M. Soles (2009). Reflex "Epidemiologic evidence supporting the role of maternal vitamin D deficiency as a risk factor for the development of infantile autism." Dermatoendocrinol 1(4): 223-228.Monday, April 15, 13 38
  • Estimated deaths per year would fall by 37,000 people, or about 16%-22% of annual mortality in Canada. And, $14 billionMonday, April 15, 13 39
  • Estimated deaths Semmelweis per year would fall by 37,000 people, Reflex or about 16%-22% of annual mortality in Canada. And, $14 billionMonday, April 15, 13 39
  • Among pregnant women, lower Vitamin D is associated with: • Adverse fertility • Primary cesarean section parameters (n = 2), (n = 1), • Preeclampsia (n = 5), • Few days (n = 2) shorter gestation, • Gestational diabetes or higher blood glucose • And, postpartum (n = 6), depression (n = 1) • Bacterial vaginosis (n = 4), Acta Obstet Gynecol Scand. 2012 Dec;91(12):1357-67. doi: 10.1111/ aogs.12000. Epub 2012 Oct 17. The impact of vitamin D on pregnancy: a systematic review. Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS.Monday, April 15, 13 40
  • Among pregnant women, lower Vitamin D is associated with: Semmelweis • Adverse fertility • Primary cesarean section Reflex parameters (n = 2), (n = 1), • Preeclampsia (n = 5), • Few days (n = 2) shorter gestation, • Gestational diabetes or higher blood glucose • And, postpartum (n = 6), depression (n = 1) • Bacterial vaginosis (n = 4), Acta Obstet Gynecol Scand. 2012 Dec;91(12):1357-67. doi: 10.1111/ aogs.12000. Epub 2012 Oct 17. The impact of vitamin D on pregnancy: a systematic review. Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS.Monday, April 15, 13 40
  • Suicidal ideation during pregnancy Pregnant moms with Suicidal ideation and omega-3 intake from seafood during pregnancy ALSPAC-Bristol suicidality or Prevalence of any suicidal thoughts (32wk) 11 postpartum 10 depression 9 confer higher 8 lifetime risk 7 for their child. 6 The same 5 study shows 4 n3 intake protects mom and infant through 8th year of life.Monday, April 15, 13 41
  • And Omega-3 protects their children Child&early&developmental&risks&with&low&n3&during&pregnancy& Strength"and"Difficul2es" Ques2onnaire"Results"at"Age"7" 20.00%& 15.00%& At&age& 10.00%& 7" 5.00%& 0.00%& s& y& s& s& m em em vit Prenatal le cB bl bl b ro ro ro ra pe &P &P t& p er al Hy uc on Pe nd oB Co Em No&n3&servings&per&Wk& 1F2&servings&per&Wk& >2&Servings&per&Wk&Monday, April 15, 13 42
  • How might we reduce alcohol, tobacco, and other drugs among women of child bearing ageMonday, April 15, 13 43
  • Which warning labels might work?Monday, April 15, 13 44
  • Trend line for humorous warnings on binge drinking by women of child-rearing No Warnings Humorous WarningsMonday, April 15, 13 45
  • Trend line for humorous warnings on binge drinking by women of child-rearing No Warnings Humorous Warnings 20 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007Monday, April 15, 13 45
  • Trend line for humorous warnings on binge drinking by women of child-rearing No Warnings Humorous Warnings 20 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007Monday, April 15, 13 45
  • Trend line for humorous warnings on binge drinking by women of child-rearing No Warnings Humorous Warnings 20 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007Monday, April 15, 13 45
  • Rewarding Clerks & Stores for Not Selling to Minors Youth Who Smoked During the Last 30 Days Baseline Reward and Reminder Youth Who Smoked Every Day the Last 30 Days Baseline Reward and Reminder 45.0% 18.0% Wyoming Wyoming Source: Youth Risk 40.0% Youth Who Smoked During the Last 30 Days 16.0% Youth Who Smoked Every Day the Last 30 Days Behavior Survey 35.0% 45.0% Baseline Reward and Reminder 14.0% 18.0% Baseline Reward and Reminder A meta-analysis 30.0% 12.0% (YRBS), Centers for 25.0% 40.0% Wyoming 16.0% 10.0% Wyoming robustly Disease Control 20.0% 35.0% 8.0% 14.0% demonstrates that 15.0% 30.0% 10.0% 6.0% 12.0% cigarette smoking 4.0% 5.0% 25.0% 2.0% 10.0% is associated with 0.0% 20.0% 8.0% 18.0% an increased risk 40.0% 15.0% Wisconsin 16.0% 6.0% Wisconsin of completed 35.0% 10.0% 14.0% 4.0% suicide, consistent with a dose– 30.0% 12.0% 5.0% 25.0% 2.0% 10.0% 20.0% 0.0% 8.0% response 15.0% 6.0% 18.0% relationship. This 10.0% Wisconsin Wisconsin 40.0% 5.0% 4.0% 16.0% 2.0% conclusion has an 35.0% 0.0% 14.0% important public 18.0% 30.0% 40.0% United States 12.0% 16.0% United States health message. 25.0% 35.0% 10.0% 14.0% 30.0% 20.0% 12.0% 8.0% Journal of 25.0% 10.0% 15.0% 20.0% 6.0% 8.0% Psychiatric 10.0% 15.0% 4.0% 6.0% Research, Vol 10.0% 5.0% 4.0% 2.0% 46(10), Oct 2012, 5.0% 2.0% 0.0% 0.0% Source: YRBS, US Centers for Disease Control 0.0% Source: YRBS, US Centers for Disease Control 1257-1266. 1995 1997 1999 2001 2003 2005 2007 18.0% 1995 1997 1999 2001 2003 2005 2007 United States United States 40.0% = Trend = Wyoming 16.0% = Wisconsin =United States 35.0% 14.0%Monday, April 15, 13 30.0% 12.0% 46
  • Rewarding Clerks & Stores for Not Selling to Minors Youth Who Smoked During the Last 30 Days Baseline Reward and Reminder Youth Who Smoked Every Day the Last 30 Days Baseline Reward and Reminder 45.0% 18.0% Wyoming Wyoming Source: Youth Risk 40.0% Youth Who Smoked During the Last 30 Days 16.0% Youth Who Smoked Every Day the Last 30 Days Behavior Survey 35.0% 45.0% Baseline Reward and Reminder 14.0% 18.0% Baseline Reward and Reminder A meta-analysis 30.0% 12.0% (YRBS), Centers for 25.0% 40.0% Wyoming 16.0% 10.0% Wyoming robustly Disease Control 20.0% 35.0% 8.0% 14.0% demonstrates that 15.0% 30.0% 10.0% 6.0% 12.0% cigarette smoking 4.0% 5.0% 25.0% 2.0% 10.0% is associated with 0.0% 20.0% 8.0% 18.0% an increased risk 40.0% 15.0% Wisconsin 16.0% 6.0% Wisconsin of completed 35.0% 10.0% 14.0% 4.0% suicide, consistent with a dose– 30.0% 12.0% 5.0% 25.0% 2.0% 10.0% 20.0% 0.0% 8.0% response 15.0% 6.0% 18.0% relationship. This 10.0% Wisconsin Wisconsin 40.0% 5.0% 4.0% 16.0% 2.0% conclusion has an 35.0% 0.0% 14.0% important public 18.0% 30.0% 40.0% United States 12.0% 16.0% United States health message. 25.0% 35.0% 10.0% 14.0% 30.0% 20.0% 12.0% 8.0% Journal of 25.0% 10.0% 15.0% 20.0% 6.0% 8.0% Psychiatric 10.0% 15.0% 4.0% 6.0% Research, Vol 10.0% 5.0% 4.0% 2.0% 46(10), Oct 2012, 5.0% 2.0% 0.0% 0.0% Source: YRBS, US Centers for Disease Control 0.0% Source: YRBS, US Centers for Disease Control 1257-1266. 1995 1997 1999 2001 2003 2005 2007 18.0% 1995 1997 1999 2001 2003 2005 2007 United States United States 40.0% = Trend = Wyoming 16.0% = Wisconsin =United States 35.0% 14.0%Monday, April 15, 13 30.0% 12.0% 46
  • Wait for the Timer for tobacco addictions with SMI/CMI Antecedent Kernel Happens BEFORE the behaviorMonday, April 15, 13 47
  • Teaching Psychological flexibility by cognitive defusion the thought d put it on s and a f an fee ling le the s “s tre on am g ” lin ee af nd a ht ug tho a Write I am h avin g a se nsa tio no f… I am ha ving at… a fe elin th g of ht … ug tho the in g hav I am Copyright © 2007-2012, PAXIS Institute. All rights reserved. May be reproduced but not sold. www.paxtalk.comMonday, April 15, 13 48
  • Teaching Psychological flexibility by cognitive defusion the thought d put it on s and a f an fee ling le the s “s tre on am g ” lin ee af nd a ht ug tho a Write I am h avin g a se nsa tio no f… I am ha ving at… a fe elin th g of ht … ug tho the in g hav I am Copyright © 2007-2012, PAXIS Institute. All rights reserved. May be reproduced but not sold. www.paxtalk.comMonday, April 15, 13 48
  • Teaching Psychological flexibility by cognitive defusion Remember: the thought d put it on s and 55% of young a f an fee ling le people who the s “s tre on am completed g ” lin suicide where ee af in therapy. nd a Maybe current ht ug therapy doesn’t tho work? a Write I am h avin g a se nsa tio no f… I am ha ving at… a fe elin th g of ht … ug tho the in g hav I am Copyright © 2007-2012, PAXIS Institute. All rights reserved. May be reproduced but not sold. www.paxtalk.comMonday, April 15, 13 48
  • Rehospitalization Proportion Not Hospitalized 1.0 .9 .8 .7 .6 40 80 120 Days After Initial ReleaseMonday, April 15, 13 49
  • Rehospitalization Proportion Not Hospitalized 1.0 .9 .8 .7 .6 Treatment as Usual 40 80 120 Days After Initial ReleaseMonday, April 15, 13 49
  • Rehospitalization Proportion Not Hospitalized 1.0 ACT .9 .8 .7 .6 Treatment as Usual 40 80 120 Days After Initial ReleaseMonday, April 15, 13 49
  • Lifespan example of one kernel for prevention, intervention and treatment Reinforcement KernelHappens AFTER the behavior Available from Amazon.com for $45Monday, April 15, 13 50
  • Muriel Saunders invented the Game in 1967 as a first-year, 4th grade teacher. Published as a study in 1969. Harriet Barrish Montrose Wolf Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 51
  • Math Period 100% Blurting 75% Percent of Intervals Scored for Behavior 50% Out-of-Seat 25% JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1969, 2, 119-124 NUMBER 2 (SUMMER 1969) GOOD BEHAVIOR GAME: EFFECTS OF INDIVIDUAL CONTINGENCIES FOR GROUP CONSEQUENCES ON 0% DISRUPTIVE BEHAVIOR IN A CLASSROOM HARRIET H. BARRISH, MURIEL SAUNDERS, AND MONTROSE M. WOLF UNIVERSITY OF KANSAS 1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58 Out-of-seat and talking-out behaviors were studied in a regular fourth-grade class that in- cluded several "problem children". After baseline rates of the inappropriate behaviors were obtained, the class was divided into two teams "to play a game". Each out-of-seat and talking- Baseline Game 1 Rev. Game 2 out response by an individual child resulted in a mark being placed on the chalkboard, which meant a possible loss of privileges by all members of the students team. In this manner a contingency was arranged for the inappropriate behavior of each child while the consequence Reading Period (possible loss of privileges) of the childs behavior was shared by all members of this team as a group. The privileges were events which are available in almost every classroom, such as extra recess, first to line up for lunch, time for special projects, stars and name tags, as well as winning the game. The individual contingencies for the group consequences were successfully applied first during math period and then during reading period. The experi- mental analysis involved elements of both reversal and multiple baseline designs. 100% Blurting Researchers have recently begun to assess Hall and Broden, 1967; Becker, Madsen, the effectiveness of a variety of behavioral Arnold, and Thomas, 1967; Hall, Lund, and procedures for management of disruptive class- Jackson, 1968; Thomas, Becker, and Arm- room behavior. Some investigators have ar- strong, 1968; Madsen, Becker, and Thomas, ranged token reinforcement contingencies for 1968). Even so, at least one group of investi- appropriate classroom behavior (Birnbrauer, gators (Hall et al., 1968) encountered a teacher Wolf, Kidder, and Tague, 1965; OLeary and who apparently did not have sufficient social Becker, 1967; Wolf, Giles, and Hall, 1968). reinforcers in her repertoire to apply social However, these token reinforcers often have reinforcement procedures successfully. The been dependent upon back-up reinforcers that were unnatural in the regular classroom, such present study investigated the effects of a class- room behavior management technique based 75% as candy and money. On the other hand, on reinforcers natural to the classroom, other several investigators have utilized a reinforcer than teacher attention. The technique was intrinsic to every classroom, i.e., teacher at- designed to reduce disruptive classroom be- tention (Zimmerman and Zimmerman, 1962; havior through a game involving competition for privileges available in almost every class- This study is based upon a thesis submitted by the room. The students were divided into two senior author to the Department of Human Develop- teams and disruptive behavior by any member ment in partial fulfillment of the requirements for the of a team resulted in possible loss of privileges Master of Arts degree. The research was supported by for every member of his team. 50% a Public Health Service Fellowship IFI MH-36, 964-01 from the National Institute of Mental Health and by a grant (HD 03144) from the National Institute of Child Health and Human Development to the Bureau of Child Research and the Department of Human Subjects and Setting METHOD Out-of-Seat Development, University of Kansas. The authors wish The study was conducted in a fourth-grade to thank Drs. Donald M. Baer and Don Bushell, Jr., for helpful suggestions in preparation of the manu- classroom of 24 students. Seven of the students script; Mr. Rex Shanks, Mr. Frank A. Branagan, and had been referred several times by the teacher Mrs. Betty Roberts for their invaluable help in con- to the school principal for such problems as ducting the study; and Mrs. Susan Zook, Mrs. Sue out-of-seat behavior, indiscriminate noise and Chen, and Mr. Jay Barrish for their contributions of talking, uncooperativeness, and general class- time for reliability checks. Reprints may be obtained from the authors, Department of Human Development, room disruption. Further, the school principal reported that a general behavior management 25% University of Kansas, Lawrence, Kansas 66044. 119 Source: Barrish, Saunders, & Wolf, 1969 0% www.pubmed.gov 1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58 Baseline Game Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 52
  • Math Period 100% Blurting 75% Percent of Intervals Scored for Behavior 50% Out-of-Seat 25% JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1969, 2, 119-124 NUMBER 2 (SUMMER 1969) GOOD BEHAVIOR GAME: EFFECTS OF INDIVIDUAL CONTINGENCIES FOR GROUP CONSEQUENCES ON 0% DISRUPTIVE BEHAVIOR IN A CLASSROOM HARRIET H. BARRISH, MURIEL SAUNDERS, AND MONTROSE M. WOLF UNIVERSITY OF KANSAS 1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58 Out-of-seat and talking-out behaviors were studied in a regular fourth-grade class that in- cluded several "problem children". After baseline rates of the inappropriate behaviors were obtained, the class was divided into two teams "to play a game". Each out-of-seat and talking- Baseline Game 1 Rev. Game 2 out response by an individual child resulted in a mark being placed on the chalkboard, which meant a possible loss of privileges by all members of the students team. In this manner a contingency was arranged for the inappropriate behavior of each child while the consequence Reading Period (possible loss of privileges) of the childs behavior was shared by all members of this team as a group. The privileges were events which are available in almost every classroom, such as extra recess, first to line up for lunch, time for special projects, stars and name tags, as well as winning the game. The individual contingencies for the group consequences were successfully applied first during math period and then during reading period. The experi- mental analysis involved elements of both reversal and multiple baseline designs. 100% Blurting Researchers have recently begun to assess Hall and Broden, 1967; Becker, Madsen, the effectiveness of a variety of behavioral Arnold, and Thomas, 1967; Hall, Lund, and procedures for management of disruptive class- Jackson, 1968; Thomas, Becker, and Arm- room behavior. Some investigators have ar- strong, 1968; Madsen, Becker, and Thomas, ranged token reinforcement contingencies for 1968). Even so, at least one group of investi- appropriate classroom behavior (Birnbrauer, gators (Hall et al., 1968) encountered a teacher Wolf, Kidder, and Tague, 1965; OLeary and who apparently did not have sufficient social Becker, 1967; Wolf, Giles, and Hall, 1968). reinforcers in her repertoire to apply social However, these token reinforcers often have reinforcement procedures successfully. The been dependent upon back-up reinforcers that were unnatural in the regular classroom, such present study investigated the effects of a class- room behavior management technique based 75% as candy and money. On the other hand, on reinforcers natural to the classroom, other several investigators have utilized a reinforcer than teacher attention. The technique was intrinsic to every classroom, i.e., teacher at- designed to reduce disruptive classroom be- tention (Zimmerman and Zimmerman, 1962; havior through a game involving competition for privileges available in almost every class- This study is based upon a thesis submitted by the room. The students were divided into two senior author to the Department of Human Develop- teams and disruptive behavior by any member ment in partial fulfillment of the requirements for the of a team resulted in possible loss of privileges Master of Arts degree. The research was supported by for every member of his team. 50% a Public Health Service Fellowship IFI MH-36, 964-01 from the National Institute of Mental Health and by a grant (HD 03144) from the National Institute of Child Health and Human Development to the Bureau of Child Research and the Department of Human Subjects and Setting METHOD Out-of-Seat Development, University of Kansas. The authors wish The study was conducted in a fourth-grade to thank Drs. Donald M. Baer and Don Bushell, Jr., for helpful suggestions in preparation of the manu- classroom of 24 students. Seven of the students script; Mr. Rex Shanks, Mr. Frank A. Branagan, and had been referred several times by the teacher Mrs. Betty Roberts for their invaluable help in con- to the school principal for such problems as ducting the study; and Mrs. Susan Zook, Mrs. Sue out-of-seat behavior, indiscriminate noise and Chen, and Mr. Jay Barrish for their contributions of talking, uncooperativeness, and general class- time for reliability checks. Reprints may be obtained from the authors, Department of Human Development, room disruption. Further, the school principal reported that a general behavior management 25% University of Kansas, Lawrence, Kansas 66044. 119 Source: Barrish, Saunders, & Wolf, 1969 0% www.pubmed.gov 1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58 Baseline Game Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 52
  • Math Period 100% Blurting 75% Percent of Intervals Scored for Behavior 50% Out-of-Seat 25% JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1969, 2, 119-124 NUMBER 2 (SUMMER 1969) GOOD BEHAVIOR GAME: EFFECTS OF INDIVIDUAL CONTINGENCIES FOR GROUP CONSEQUENCES ON 0% DISRUPTIVE BEHAVIOR IN A CLASSROOM HARRIET H. BARRISH, MURIEL SAUNDERS, AND MONTROSE M. WOLF UNIVERSITY OF KANSAS 1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58 Out-of-seat and talking-out behaviors were studied in a regular fourth-grade class that in- cluded several "problem children". After baseline rates of the inappropriate behaviors were obtained, the class was divided into two teams "to play a game". Each out-of-seat and talking- Baseline Game 1 Rev. Game 2 out response by an individual child resulted in a mark being placed on the chalkboard, which meant a possible loss of privileges by all members of the students team. In this manner a contingency was arranged for the inappropriate behavior of each child while the consequence Reading Period (possible loss of privileges) of the childs behavior was shared by all members of this team as a group. The privileges were events which are available in almost every classroom, such as extra recess, first to line up for lunch, time for special projects, stars and name tags, as well as winning the game. The individual contingencies for the group consequences were successfully applied first during math period and then during reading period. The experi- mental analysis involved elements of both reversal and multiple baseline designs. 100% Blurting Researchers have recently begun to assess Hall and Broden, 1967; Becker, Madsen, the effectiveness of a variety of behavioral Arnold, and Thomas, 1967; Hall, Lund, and procedures for management of disruptive class- Jackson, 1968; Thomas, Becker, and Arm- room behavior. Some investigators have ar- strong, 1968; Madsen, Becker, and Thomas, ranged token reinforcement contingencies for 1968). Even so, at least one group of investi- appropriate classroom behavior (Birnbrauer, gators (Hall et al., 1968) encountered a teacher Wolf, Kidder, and Tague, 1965; OLeary and who apparently did not have sufficient social Becker, 1967; Wolf, Giles, and Hall, 1968). reinforcers in her repertoire to apply social However, these token reinforcers often have reinforcement procedures successfully. The been dependent upon back-up reinforcers that were unnatural in the regular classroom, such present study investigated the effects of a class- room behavior management technique based 75% as candy and money. On the other hand, on reinforcers natural to the classroom, other several investigators have utilized a reinforcer than teacher attention. The technique was intrinsic to every classroom, i.e., teacher at- designed to reduce disruptive classroom be- tention (Zimmerman and Zimmerman, 1962; havior through a game involving competition for privileges available in almost every class- This study is based upon a thesis submitted by the room. The students were divided into two senior author to the Department of Human Develop- teams and disruptive behavior by any member ment in partial fulfillment of the requirements for the of a team resulted in possible loss of privileges Master of Arts degree. The research was supported by for every member of his team. 50% a Public Health Service Fellowship IFI MH-36, 964-01 from the National Institute of Mental Health and by a grant (HD 03144) from the National Institute of Child Health and Human Development to the Bureau of Child Research and the Department of Human Subjects and Setting METHOD Out-of-Seat Development, University of Kansas. The authors wish The study was conducted in a fourth-grade to thank Drs. Donald M. Baer and Don Bushell, Jr., for helpful suggestions in preparation of the manu- classroom of 24 students. Seven of the students script; Mr. Rex Shanks, Mr. Frank A. Branagan, and had been referred several times by the teacher Mrs. Betty Roberts for their invaluable help in con- to the school principal for such problems as ducting the study; and Mrs. Susan Zook, Mrs. Sue out-of-seat behavior, indiscriminate noise and Chen, and Mr. Jay Barrish for their contributions of talking, uncooperativeness, and general class- time for reliability checks. Reprints may be obtained from the authors, Department of Human Development, room disruption. Further, the school principal reported that a general behavior management 25% University of Kansas, Lawrence, Kansas 66044. 119 Source: Barrish, Saunders, & Wolf, 1969 0% www.pubmed.gov 1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58 Baseline Game Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 52
  • Math Period 100% Blurting 75% Percent of Intervals Scored for Behavior 50% Out-of-Seat 25% JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1969, 2, 119-124 NUMBER 2 (SUMMER 1969) GOOD BEHAVIOR GAME: EFFECTS OF INDIVIDUAL CONTINGENCIES FOR GROUP CONSEQUENCES ON 0% DISRUPTIVE BEHAVIOR IN A CLASSROOM HARRIET H. BARRISH, MURIEL SAUNDERS, AND MONTROSE M. WOLF UNIVERSITY OF KANSAS 1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58 Out-of-seat and talking-out behaviors were studied in a regular fourth-grade class that in- cluded several "problem children". After baseline rates of the inappropriate behaviors were obtained, the class was divided into two teams "to play a game". Each out-of-seat and talking- Baseline Game 1 Rev. Game 2 out response by an individual child resulted in a mark being placed on the chalkboard, which meant a possible loss of privileges by all members of the students team. In this manner a contingency was arranged for the inappropriate behavior of each child while the consequence Reading Period (possible loss of privileges) of the childs behavior was shared by all members of this team as a group. The privileges were events which are available in almost every classroom, such as extra recess, first to line up for lunch, time for special projects, stars and name tags, as well as winning the game. The individual contingencies for the group consequences were successfully applied first during math period and then during reading period. The experi- mental analysis involved elements of both reversal and multiple baseline designs. 100% Blurting Researchers have recently begun to assess Hall and Broden, 1967; Becker, Madsen, the effectiveness of a variety of behavioral Arnold, and Thomas, 1967; Hall, Lund, and procedures for management of disruptive class- Jackson, 1968; Thomas, Becker, and Arm- room behavior. Some investigators have ar- strong, 1968; Madsen, Becker, and Thomas, ranged token reinforcement contingencies for 1968). Even so, at least one group of investi- appropriate classroom behavior (Birnbrauer, gators (Hall et al., 1968) encountered a teacher Wolf, Kidder, and Tague, 1965; OLeary and who apparently did not have sufficient social Becker, 1967; Wolf, Giles, and Hall, 1968). reinforcers in her repertoire to apply social However, these token reinforcers often have reinforcement procedures successfully. The been dependent upon back-up reinforcers that were unnatural in the regular classroom, such present study investigated the effects of a class- room behavior management technique based 75% as candy and money. On the other hand, on reinforcers natural to the classroom, other several investigators have utilized a reinforcer than teacher attention. The technique was intrinsic to every classroom, i.e., teacher at- designed to reduce disruptive classroom be- tention (Zimmerman and Zimmerman, 1962; havior through a game involving competition for privileges available in almost every class- This study is based upon a thesis submitted by the room. The students were divided into two senior author to the Department of Human Develop- teams and disruptive behavior by any member ment in partial fulfillment of the requirements for the of a team resulted in possible loss of privileges Master of Arts degree. The research was supported by for every member of his team. 50% a Public Health Service Fellowship IFI MH-36, 964-01 from the National Institute of Mental Health and by a grant (HD 03144) from the National Institute of Child Health and Human Development to the Bureau of Child Research and the Department of Human Subjects and Setting METHOD Out-of-Seat Development, University of Kansas. The authors wish The study was conducted in a fourth-grade to thank Drs. Donald M. Baer and Don Bushell, Jr., for helpful suggestions in preparation of the manu- classroom of 24 students. Seven of the students script; Mr. Rex Shanks, Mr. Frank A. Branagan, and had been referred several times by the teacher Mrs. Betty Roberts for their invaluable help in con- to the school principal for such problems as ducting the study; and Mrs. Susan Zook, Mrs. Sue out-of-seat behavior, indiscriminate noise and Chen, and Mr. Jay Barrish for their contributions of talking, uncooperativeness, and general class- time for reliability checks. Reprints may be obtained from the authors, Department of Human Development, room disruption. Further, the school principal reported that a general behavior management 25% University of Kansas, Lawrence, Kansas 66044. 119 Source: Barrish, Saunders, & Wolf, 1969 0% www.pubmed.gov 1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58 Baseline Game Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 52
  • Math Period 100% Blurting 75% Percent of Intervals Scored for Behavior 50% Out-of-Seat 25% JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1969, 2, 119-124 NUMBER 2 (SUMMER 1969) GOOD BEHAVIOR GAME: EFFECTS OF INDIVIDUAL CONTINGENCIES FOR GROUP CONSEQUENCES ON 0% DISRUPTIVE BEHAVIOR IN A CLASSROOM HARRIET H. BARRISH, MURIEL SAUNDERS, AND MONTROSE M. WOLF UNIVERSITY OF KANSAS 1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58 Out-of-seat and talking-out behaviors were studied in a regular fourth-grade class that in- cluded several "problem children". After baseline rates of the inappropriate behaviors were obtained, the class was divided into two teams "to play a game". Each out-of-seat and talking- Baseline Game 1 Rev. Game 2 out response by an individual child resulted in a mark being placed on the chalkboard, which meant a possible loss of privileges by all members of the students team. In this manner a contingency was arranged for the inappropriate behavior of each child while the consequence Reading Period (possible loss of privileges) of the childs behavior was shared by all members of this team as a group. The privileges were events which are available in almost every classroom, such as extra recess, first to line up for lunch, time for special projects, stars and name tags, as well as winning the game. The individual contingencies for the group consequences were successfully applied first during math period and then during reading period. The experi- mental analysis involved elements of both reversal and multiple baseline designs. 100% Blurting Researchers have recently begun to assess Hall and Broden, 1967; Becker, Madsen, the effectiveness of a variety of behavioral Arnold, and Thomas, 1967; Hall, Lund, and procedures for management of disruptive class- Jackson, 1968; Thomas, Becker, and Arm- room behavior. Some investigators have ar- strong, 1968; Madsen, Becker, and Thomas, ranged token reinforcement contingencies for 1968). Even so, at least one group of investi- appropriate classroom behavior (Birnbrauer, gators (Hall et al., 1968) encountered a teacher Wolf, Kidder, and Tague, 1965; OLeary and who apparently did not have sufficient social Becker, 1967; Wolf, Giles, and Hall, 1968). reinforcers in her repertoire to apply social However, these token reinforcers often have reinforcement procedures successfully. The been dependent upon back-up reinforcers that were unnatural in the regular classroom, such present study investigated the effects of a class- room behavior management technique based 75% as candy and money. On the other hand, on reinforcers natural to the classroom, other several investigators have utilized a reinforcer than teacher attention. The technique was intrinsic to every classroom, i.e., teacher at- designed to reduce disruptive classroom be- tention (Zimmerman and Zimmerman, 1962; havior through a game involving competition for privileges available in almost every class- This study is based upon a thesis submitted by the room. The students were divided into two senior author to the Department of Human Develop- teams and disruptive behavior by any member ment in partial fulfillment of the requirements for the of a team resulted in possible loss of privileges Master of Arts degree. The research was supported by for every member of his team. 50% a Public Health Service Fellowship IFI MH-36, 964-01 from the National Institute of Mental Health and by a grant (HD 03144) from the National Institute of Child Health and Human Development to the Bureau of Child Research and the Department of Human Subjects and Setting METHOD Out-of-Seat Development, University of Kansas. The authors wish The study was conducted in a fourth-grade to thank Drs. Donald M. Baer and Don Bushell, Jr., for helpful suggestions in preparation of the manu- classroom of 24 students. Seven of the students script; Mr. Rex Shanks, Mr. Frank A. Branagan, and had been referred several times by the teacher Mrs. Betty Roberts for their invaluable help in con- to the school principal for such problems as ducting the study; and Mrs. Susan Zook, Mrs. Sue out-of-seat behavior, indiscriminate noise and Chen, and Mr. Jay Barrish for their contributions of talking, uncooperativeness, and general class- time for reliability checks. Reprints may be obtained from the authors, Department of Human Development, room disruption. Further, the school principal reported that a general behavior management 25% University of Kansas, Lawrence, Kansas 66044. 119 Source: Barrish, Saunders, & Wolf, 1969 0% www.pubmed.gov 1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58 Baseline Game Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 52
  • Longitudinal Johns Hopkins Studies of GBG Kindergarden First Grade Grades 2 thru 12 Young Adulthood Follow Up Follow Up Age Age Age GBG No More GBG Every child 19-21 30 26 rated by teachers Age Age Age NO GBG No GBG 19-21 30 26 Purpose: To find out if GBG Tested in 41 first- and affected their adolescent Purpose: To find out if second-grade classrooms lives. GBG affected their adult within 19 elementary lives. schools with two consecutive groups of first graders. Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 53
  • Longitudinal Johns Hopkins Studies of GBG Kindergarden First Grade Grades 2 thru 12 Young Adulthood Follow Up Follow Up Age Age Age GBG No More GBG Every child 19-21 30 26 rated by teachers Age Age Age NO GBG No GBG 19-21 30 26 Purpose: To find out if GBG Tested in 41 first- and affected their adolescent Purpose: To find out if second-grade classrooms lives. GBG affected their adult within 19 elementary lives. schools with two consecutive groups of first graders. Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 53
  • ,JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 14, 317-345 (1993) The Short-Term Impact of Two Classroom-Based Preventive Interventions on Aggressive and Shy Behaviors and Poor Achievement By the early LAWRENCE J. D O L A N , SHEPPARD C . HENDRICKS BROWN , G. K E L L A M , 1990s, multiple studies including LISA WERTHAMER-LARSSON, GEORGE W . REBOK, LAWRENCE S. M A Y E R , JOLENE LAUDOLFF, JAYLAN S. TURKKAN this randomized The Johns Hopkins School of Hygiene and Public Health CARLA FORD one proved that LEONARD W H E E L E R Baltimore City Public Schools Two classroom-based preventive interventions were carried out on an epidem- iologically defined, varied population of children in a metropolitan area in the GBG reduced the early predictive United States. This is a report of the short-term impact and specificity of the two interventions from fall through spring of first grade. The first intervention, the Good Behavior Game, was aimed at reducing aggressive behavior and shy behavior. Aggressive behavior has been shown to be an important developmental antecedent behaviors. in first grade of later delinquency and heavy drug use, particularly when coupled We acknowledge the contributions of the city of Baltimore, its families and children, and the administration, faculty, and staff of the Baltimore City Public Schools. In particular, we would like to thank Walter Amprey, Superintendent of Baltimore City Public Schools; Lillian Gonzales and Patsy Blacksheare, Deputy Superintendents; Juanita Lewis, Director; Denise Borders, Chief of Account- ability; Robert Solomon, Director, Special Education; Carla Ford, Specialist, Early Childhood Edu- cation; Louise Fink, Coordinator, Social Work Services; Dale Parker-Brown, Director, Compensatory Education; Matthew Riley, Director of the Eastern District; and Willie Foster, Director of Middle Schools. We also thank Alice Brogden for manuscript control and production; Fionnuala Regan for editorial preparation; and Pamela Spencer and Maria Corrada-Bravo for their contributions to data analyses. We thank Alan Harris for contributing to the development of the GBG intervention, and Lisa Crockett for her help in developing the Peer Assessment Inventory. The studies on which this article is based have been supported by the following grants, with supplements from the National Institute on Drug Abuse: National Institute of Mental Health (NIMH) Grant No. P50 MH38725, Epidemiologic Prevention Center for Early Risk Behavior; NIMH Grant No. IR01 MH42968, Periodic Outcome of Two Preventive Trials; NIMH Grant No. 1R01 MH40859, Statistical Methods for Mental Health Preventive Trials. Correspondence and requests for reprints should be sent to Lawrence Dolan, Department of Mental Hygiene, School of Hygiene and Public Health, 624 North Broadway, Baltimore, MD 21205. 317 Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 54
  • Wow! In 1998, Drs. Kellam and Anthony showed that GBG reduced tobacco initiation—one of the middle predictors. Tobacco Initiation (Age of First Use) Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 55
  • So now, let’s see if GBG affects suicide indicators among youth and young adults. Wilcox, H. C., Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., & Anthony, J. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug & Alcohol Dependence, 95(Suppl 1), 60-73. Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 56
  • So now, let’s see if GBG affects suicide indicators among youth and young adults. Wilcox, H. C., Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., & Anthony, J. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug & Alcohol Dependence, 95(Suppl 1), 60-73. Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 56
  • So now, let’s see if GBG affects suicide indicators among youth and young adults. Wilcox, H. C., Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., & Anthony, J. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug & Alcohol Dependence, 95(Suppl 1), 60-73. Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 57
  • So now, let’s see if GBG affects suicide indicators among youth and young adults. Wilcox, H. C., Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., & Anthony, J. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug & Alcohol Dependence, 95(Suppl 1), 60-73. Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 57
  • Timeline of Benefits… Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 58
  • Timeline of Benefits… First Month More time for teaching Less stress for and learning Staff & Students First Year Better Fewer Fewer Service Less Happier Less Better Attendance Referrals Needs Illness Families Vandalism Academics 2nd & 3rd Years ADHD Oppositional Special Education Averted Defiance Averted Averted 5-15 Years No Less Less Conduct Less Less Crime, High School Grad & Tobacco Alcohol Disorders Depression Violence, Suicide University Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 58
  • 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 Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 59
  • Bra in Bra ke Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 60
  • How is this accomplished? Bra in Bra ke Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.Monday, April 15, 13 60
  • Loss by not protecting each Grade 1 cohort with example behavioral vaccine: $18 Billion in the US $182 Million in Oklahoma $3.1 Million in Tuttle city, OK Estimates based on Washington State Institute for Policy Research: Aos, S., S. Lee, et al. (2011) Return on Investment: Evidence-Based Options to Improve Statewide Outcomes. 8 Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 61
  • What if we provided parenting supports for every family?Monday, April 15, 13 62
  • Nurturing OUR Children Richly Reinforce Pro-social Behaviors Limit Problematic Behaviors Reduce Toxic Influences Increase Psychological Flexibility Biglan et al., American Psychologist, (4), 2012 Credit: ITV Case Study #1: Universal Access to a Behavioral Vaccine for Families Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 63
  • Nurturing OUR Children ✔Richly Reinforce Pro-social Behaviors ✔Limit Problematic Behaviors ✔Reduce Toxic Influences ✔Increase Psychological Flexibility Biglan et al., American Psychologist, (4), 2012 Credit: ITV Case Study #1: Universal Access to a Behavioral Vaccine for Families Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 63
  • Universal Access to Parenting Supports reduces child maltreatment in two years by… Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 64
  • 25% Universal Access to Parenting Supports reduces child maltreatment in two years by… Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 64
  • Nurturing OUR Children Richly Reinforce Pro-social Behaviors Limit Problematic Behaviors Reduce Toxic Influences Increase Psychological Flexibility Biglan et al., American Psychologist, (4), 2012 Case Study from Ancient Wisdom: Universal Access to a Behavioral Vaccine for All Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 65
  • Nurturing OUR Children Richly Reinforce Pro-social Behaviors ✔Limit Problematic Behaviors ✔Reduce Toxic Influences ✔Increase Psychological Flexibility Biglan et al., American Psychologist, (4), 2012 Case Study from Ancient Wisdom: Universal Access to a Behavioral Vaccine for All Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 65
  • Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 66
  • 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 S uicide 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 suicide deaths to record numbers has been battlefield in toll on the US military.1 Army Vice–Chief of Staff General a sentinel for impaired force efficacy and has Peter W. Chiarelli described the record suicide rate as “horrible” and accelerated the search for reversible risk factors. voiced frustration that “the Army has not yet been able to identify any Objective: To determine whether deficiencies causal links among the suicide cases.”2(pA2) of neuroactive, highly unsaturated omega-3 Deficiencies of nutrients critical for brain function may be a signifi- essential fatty acids (n-3 HUFAs), in particular docosahexaenoic acid (DHA), are associated with cant contributing risk factor for psychiatric pathology, especially suicide increased risk of suicide death among a large and stress-related psychiatric symptoms.3 Highly unsaturated omega-3 random sample of active-duty US military. essential fatty acids (n-3 HUFAs), in particular docosahexaenoic acid Method: In this retrospective case-control (DHA), are selectively concentrated in neural tissues and are required study, serum fatty acids were quantified as for optimal neural function.4 These fatty acids cannot be made de novo a percentage of total fatty acids among US but are available only from dietary sources, with seafood being the richest military suicide deaths (n = 800) and controls source. Nutritional deficiencies in n-3 HUFAs may increase vulnerabil- (n = 800) matched for age, date of collection of sera, sex, rank, and year of incident. Participants ity to combat deployment stress, manifesting as psychiatric symptoms were active-duty US military personnel including adjustment disorders, major depression, impulsive violence, (2002–2008). For cases, age at death ranged and suicide.5 In civilian populations, observational studies indicate that from 17–59 years (mean = 27.3 years, SD = 7.3 low fish consumption is associated with increased risk of completed sui- years). Outcome measures included death by cides6,7 and greater suicidal ideation.8 Low DHA status was associated suicide, postdeployment health assessment questionnaire (Department of Defense Form with increased risk of past suicide attempts9 and future suicide attempts.10 2796), and ICD-9 mental health diagnosis data. In comparison to placebo, 2 grams per day of n-3 HUFA reduced suicidal Results: Risk of suicide death was 14% higher per thinking and depressive symptoms and reduced the perception of stress SD of lower DHA percentage (OR = 1.14; 95% CI, among subjects (n = 49) with deliberate self-harm.11 1.02–1.27; P < .03) in adjusted logistic regressions. These findings suggest that low DHA levels may be a contributing Among men, risk of suicide death was 62% factor for adverse psychiatric symptoms. In this study, we posited that greater with low serum DHA status (adjusted low DHA status would be associated with increased risk of suicide death OR = 1.62; 95% CI, 1.12–2.34; P < .01, comparing DHA below 1.75% [n = 1,389] to DHA of 1.75% among military personnel. Prospectively collected serum and supporting and above [n = 141]). Risk of suicide death was data were available from the Armed Forces Health Surveillance Center 52% greater in those who reported having seen (AFHSC) for a large number of active-duty suicide deaths (n = 800) and wounded, dead, or killed coalition personnel matched controls (n = 800). To our knowledge, this is the largest study ofMonday, April 15, 13 (OR = 1.52; 95% CI, 1.11–2.09; P < .01). 67
  • Matsuoka BioPsychoSocial Medicine 2011, 5:35:3 Matsuoka BioPsychoSocial Medicine 2011, http://www.bpsmedicine.com/content/5/1/3 http://www.bpsmedicine.com/content/5/1/3 R E V V I WW RE IE E Open Access Open Access Clearance of fear memory from the hippocampus Clearance of fear memory from the hippocampus through neurogenesis by omega-3 fatty acids: through neurogenesis by omega-3 fatty acids: aanovel preventive strategy for posttraumatic novel preventive strategy for posttraumatic stress disorder? stress disorder? Yutaka Matsuoka1,2 1,2 Yutaka Matsuoka Abstract Abstract Not only has accidental injury been shown to to account for significant health burden onon all populations, regardless Not only has accidental injury been shown account for a a significant health burden all populations, regardless of of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric condition of of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents potentially condition posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a a potentially Clearance ofof fear memory from the hippocampus Clearance fear memory from the hippocampus important goal. Physicians in in the field of psychosomatic medicine and critical care medicine have the opportunity important goal. Physicians the field of psychosomatic medicine and critical care medicine have the opportunity through neurogenesis byby omega-3 fatty acids: novel through neurogenesis omega-3 fatty acids: a a novel to to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence preventive strategy for posttraumatic stress disorder? preventive strategy for posttraumatic stress disorder? and associated factors of of accident-related PTSD, then focuses on conceptual model of of fear memory and and associated factors accident-related PTSD, then focuses on a a conceptual model fear memory and Matsuoka Matsuoka proposes a new, rationally hypothesized translational preventive intervention forfor PTSD through promoting proposes a new, rationally hypothesized translational preventive intervention PTSD through promoting hippocampal neurogenesis byby omega-3 fatty acid supplementation. The results of an open-label pilot trial of hippocampal neurogenesis omega-3 fatty acid supplementation. The results of an open-label pilot trial of Matsuoka BioPsychoSocial Medicine 2011,2011, 5:3 Matsuoka BioPsychoSocial Medicine 5:3 http://www.bpsmedicine.com/content/5/1/3 (8 February 2011)2011) http://www.bpsmedicine.com/content/5/1/3 (8 February injured patients admitted to to the intensive care unit suggest that omega-3 fatty acid supplementation immediately injured patients admitted the intensive care unit suggest that omega-3 fatty acid supplementation immediately after accidental injury can reduce subsequent PTSD symptoms. after accidental injury can reduce subsequent PTSD symptoms. Omega-3 for PTSD symptoms could be used routinely for the patients exposed to traumaMonday, April 15, 13 68
  • 2 hoursMonday, April 15, 13 69
  • Estimate the costs of NOT acting… Estimate the benefits of acting to the public and private purse sort, medium and long term… Predict Benefits (including economic)Monday, April 15, 13 70
  • Make the numbers real and human Quantify by epidemiology how much suffering will happen by NOT actingMonday, April 15, 13 71
  • Make the numbers real and human Quantify by epidemiology how much suffering will happen by NOT acting Four fully loaded Boeing 747 with adults and children will land every day in Washington, DC to claim lifetime disabiity for mental, emotional and behavioral disorders…Monday, April 15, 13 71
  • Make the numbers real and human Quantify by epidemiology how much Quantify by epidemiology the positive suffering will happen by NOT acting outcomes will happen from action Four fully loaded Boeing 747 with adults and Everyday in America, 2,000+ more adults children will land every day in Washington, and children will wake up to happier, DC to claim lifetime disabiity for mental, healthier, and more productive lives… emotional and behavioral disorders…Monday, April 15, 13 71
  • Create policy, advocacy, and organizational supports to foster cooperation for common goodMonday, April 15, 13 72
  • Policy Example: Children’s Futures as Common Pool Resource Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 73
  • You Win Develop community prevention scoreboards to monitor progress Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 74
  • Develop community prevention scoreboards to monitor progress Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 74
  • C ounties with 20% or lower illegal sa les are within the federal goal. T he lower the numbers, the more clerks and retailers that are doing the right thing. C ounties with rates lower than 10% of illegal tobacco sa les are more likely to have an impact on reduce d tobacco use and addiction by Wisco nsin youth. R esu lts are in real-time. B rowse this site and learn what you ca n do to help Wisco nsin Win. C o u n ty : S a le s : AD AMS 8.57% AS HLAND 3.45% B AR R ON 8.46% B AYFI E LD 5.71% B R OW N 1.58% Develop community prevention scoreboards to monitor progress Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 74
  • Social M Mental H arketing ealth Pre of vention a nd Promo tion It’s NOT about t h e ProblemMonday, April 15, 13 75
  • See: Multi-problem analyses Predict Create Plan Population- Identify Benefits: Level Change: Nurturing Environments Logic Model for population-level benefits Cultivate Create Community Prevention Identify Score/Dashboard Update Research Safe Playing Databases for Proven Prevention Solutions Programme Case Study New Zealand Document Launch Social Marketing: Advocacy & Media Population-Level Targeting Products Performance B Developmen Birth Childhood ta l stages Low Report Adolescence Adulthood Intensity Hi Multiple reach Fa Sc Place Price ls m ho ilie e Settings ol lev Or s ga s A Co ni at ach m mu io ns nit /re ies C Promotion sity en Recognize & Reward Int successes in/by High Intensity Low reach Note: Workforce development efficiency achieved by broad use of similar/same evidence-based Create Monitor & Coach strategies or evidence-based kernels. & Developed by PAXIS Institute © 2010-2012, all rights reserved. May be freely reporduced in total with attribution and noticeMonday, April 15, 13 76
  • Now is this the time…Monday, April 15, 13 77
  • Thank you Dennis D. Embry dde@paxis.org Please see this and other presentations or papers at: www.SlideShare.net/drdennisembryMonday, April 15, 13 78