Persons with serious mental disorders (SMI) face high levels of illness burden and premature mortality due to general medical conditions. Findings from the public health literature have increasingly highlighted the importance of social determinants of health -individual and community-level factors that lie outside of the formal medical system --as causes of preventable mortality in the general population. While poor communities generally cannot fundamentally restructure their social environments, it may be possible to help individuals with SMI to better navigate within those environments, thereby mitigating the impact of social disadvantage. Mobile technologies hold the potential to accomplish this goal, given their portability, low cost, and relative ease of use, their ability to provide real time, geolocated information about community resources, and the availability of smartphone applications to promote engagement in health behaviors. This application for a continuation of a K24 midcareer investigator award proposes to support training, new research, and mentoring activities in the use of mobile applications to improve health behaviors in persons with serious mental illness and social disadvantage. The current K24 award has allowed the candidate to successfully engage and provide mentorship to numerous students, postdoctoral fellows, and junior faculty during the five-year award period. For the continuation phase, the mentoring plan draws on the rich resources of Emory University, the Morehouse School of Medicine, the Georgia Institute of Technology, and national research and faculty career development activities to provide opportunities to provide guidance in patient- oriented research to existing and new mentees. Formal training and consultation with experts will provide the candidate and mentees with exposure to theoretical models of the social determinants of health;training and support in mobile app design, and statistical approaches to analyzing geospatial and nested data. The new research funded by this award will develop and pilot test a novel smartphone-based intervention to promote healthy eating in a sample of 30 persons with SMI. The intervention will combine three mobile applications (""""""""apps"""""""") each addressing a key dimension hypothesized to be necessary for optimizing eating behaviors in the context of social disadvantage. The first app will use the smartphone's geolocation abilities to help participants find grocery stores and healthy eating options;the second app will use a casual game to enhance dietary motivation;and the third app will use a barcode scanner program to help support behavioral change by helping participants select healthier eating alternatives. A series of six one-month cohorts will each be followed by data collection on feasibility, acceptability, an qualitative interviews, allowing iterative refinement of the app. Effects of the program on dietary information, motivation, and behaviors will be assessed for the overall sample, and stratified by study cohort and key socioeconomic factors.

Public Health Relevance

This midcareer investigator award will provide support to an investigator seeking to provide outstanding mentorship to clinical investigators, while supporting an area of research of high innovation and public health significance. The study will not only provide data for a larger trial of the app, but will support a novel program of research in a highl promising field --the use of mobile technologies to improve health in persons with SMI and social disadvantage.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Special Emphasis Panel (SERV)
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Juliano-Bult, Denise M
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Emory University
Public Health & Prev Medicine
Schools of Public Health
United States
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Ward, Martha C; Lally, Cathy; Druss, Benjamin G (2017) Medicaid Expenditures for Fee-for-Service Enrollees with Behavioral Diagnoses: Findings from a 50 State Claims Analysis. Community Ment Health J 53:1-7
Walker, Elizabeth Reisinger; Pratt, Laura A; Schoenborn, Charlotte A et al. (2017) Excess mortality among people who report lifetime use of illegal drugs in the United States: A 20-year follow-up of a nationally representative survey. Drug Alcohol Depend 171:31-38
Druss, Benjamin G (2017) Improving access to exercise training programs for patients with serious mental illness. Transl Behav Med 7:62-63
Walker, Elizabeth Reisinger; Druss, Benjamin G (2017) Cumulative burden of comorbid mental disorders, substance use disorders, chronic medical conditions, and poverty on health among adults in the U.S.A. Psychol Health Med 22:727-735
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Walker, Elizabeth Reisinger; McGee, Robin E; Druss, Benjamin G (2015) Analysis of Mortality in Mental Disorders-Reply. JAMA Psychiatry 72:1150-1
Walker, Elizabeth Reisinger; Druss, Benjamin G (2015) Rate and Predictors of Persistent Major Depressive Disorder in a Nationally Representative Sample. Community Ment Health J 51:701-7
Cummings, Janet R; Wen, Hefei; Ritvo, Alexis et al. (2014) Health insurance coverage and the receipt of specialty treatment for substance use disorders among U.S. adults. Psychiatr Serv 65:1070-3

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