Michelle Marie Hospital

Research topics

Matched from this investigator's NIH project titles and abstracts.

• Emotion and Affective Neuroscience

Active NIH awards

• Efficacy of mHealth + e-Navigator stepped care intervention for ART adherence among Latino men with HIV

  5R01MD017205-04

  NIMHD · FY 2025 · $502K

  Approximately 70% of Latino men with HIV do not achieve viral suppression—an estimate that has likely worsened due to COVID-19 Pandemic stressors such as unemployment, loss of health insurance, homelessness, and exacerbated mental health and substance use disorders caused by the COVID-19 pandemic. Antiretroviral therapy (ART) adherence is associated with decreased viral load, increased CD4 counts, fewer hospital days, slower disease progression, and longer survival. Adherence also helps prevent drug resistance and reduces HIV transmission risk. The primary objective of this study is to evaluate the efficacy of stepped care strategies to improve ART adherence among adult Latino men with HIV using a sequential, multiple assignment, randomized trial (SMART). The trial will compare a stepped care strategy of delivering TXTXT first and stepping up to remote patient navigation for non-responders vs. a stepped care strategy of delivering TXTXT + e-Navigation first and stepping up to EMA-supported e-Navigation for non-responders. Both, TXTXT (“Treatment Text”) and the foundations of the e-Navigation interventions are CDC evidence-based interventions (EBI). We propose to use a SMART design which explicitly allows building, testing, and optimizing stepped care strategies without compromising rigor or randomization. We propose three specific aims: Aim 1. Compare the immediate (6-month) and sustained (9- and 12-month) efficacy of two static (non-stepped) treatment regimens (TXTXT alone vs. TXTXT + e-Navigation) on ART adherence and viral suppression among Latino men with HIV. Aim 2. Compare the immediate (6-month) and sustained (9- and 12-month) efficacy of two stepped care strategies (TXTXT with added e-Navigation for non-responders vs. TXTXT + e-Navigation with added EMA support for non-responders) on ART adherence and viral suppression among Latino men with HIV. Aim 3. Identify baseline and time-varying moderators on the association between stepped care strategy and ART adherence and viral suppression among Latino men with HIV. The proposed study is innovative by adapting and combining two EBIs, using a stepped care approach, remote patient navigators, adaptive EMA components, and a SMART design. The proposed study is significant because it provides data on the efficacy of two scalable EBIs in one efficient design and provides data on enhanced treatment options for non-responders. The study is also significant because it addresses multiple domains and levels of influence on health and health disparities. It also targets people living in an Ending the HIV Epidemic geographic focus area with the highest HIV diagnosis rate in the nation (South Florida), thereby supporting the objectives of reducing HIV disparities in populations at high risk and living in the Southern US.

• A Reinforced Mindfulness-Based Intervention to Reduce Problematic Drinking among Hispanic Emerging Adults: Feasibility and Acceptability

  5R01AA030976-03

  NIAAA · FY 2025 · $446K

  Among all age cohorts in the United States, emerging adults have the highest prevalence of alcohol use and about one-third (32%) engage in binge drinking (4 to 5 drinks in two hours females/males). While Hispanic emerging adults report lower rates of heavy alcohol use compared to their non-Hispanic White counterparts, Hispanic emerging adults who do drink are at greater risk for transitioning to substance use disorders and experience more severe negative consequences. Relative to other racial/ethnic groups, Hispanic emerging adults who engage in problematic drinking are (a) less likely to seek treatment, and (b) have less access to innovative and accessible health promoting resources. Increasing evidence supports the utility of mindfulness-based interventions (MBIs) for reducing problematic alcohol use and promoting a sustainable healthy lifestyle. However, research on MBIs to address alcohol use problems is limited by (1) minimal racial/ethnic minority representation and (2) low rates of program adherence and retention. The long-term goal of this research is to decrease alcohol misuse among Hispanic emerging adult drinkers through a culturally and developmentally adapted mindfulness-based intervention program targeting self-regulatory processes. The primary aims of the study are twofold. Primary Aim 1 - Use Community-Engaged Research methods guided by the five stages of cultural adaptations of behavioral health interventions to ensure a culturally and developmentally appropriate adaptation of mindfulness-based stress reduction (MBSR) for Hispanic emerging adults (18-25 years-old) who report 2 or more binge drinking episodes in the prior 30 days. These formative stages of the research will include an expert advisory panel review, key informant interviews (n=15), focus groups (n=30), and a pilot trial (n=10; 8-weeks with weekly hour-long adapted MBSR sessions). Formative data will be analyzed to obtain information on structure, duration, acceptability, and cultural appropriateness and further refinement of intervention protocols. Primary Aim 2 – Conduct a Cultural Adaptation Trial to evaluate the acceptability and feasibility of the adapted MBSR intervention among a community sample (n=120) of Hispanic emerging adults who report 2 or more binge drinking episodes in the prior 30 days. Participants will be randomly assigned to an MBSR condition (8 weekly 1-hour adapted MBSR sessions) or an assessment-only control condition. Secondary Aim 2.1 - Examine initial evidence of the efficacy of the MBSR intervention. We hypothesize that, relative to the participants in the control condition, participants in the MBSR condition will report: (a) greater reductions in frequency of binge drinking episodes and number of drinks per drinking occasion, and (b) greater impacts on putative mechanisms of change (e.g., reduced stress, greater self-regulation, and enhanced well-being). The proposed study has significant public health implications by contributing to translational efforts to reduce alcohol misuse among Hispanic emerging adults who would otherwise not seek treatment.

• A Reinforced Mindfulness-Based Intervention to Reduce Problematic Drinking among Latinx Emerging Adults: Feasibility and Acceptability

  5R01AA030976-02

  NIAAA · FY 2024 · $426K

  Abstract Among all age cohorts in the United States, emerging adults have the highest prevalence of alcohol use and about one-third (32%) engage in binge drinking (4 to 5 drinks in two hours females/males). While Latinx emerging adults report lower rates of heavy alcohol use compared to their non-Latinx White counterparts, Latinx who do drink are at greater risk for transitioning to substance use disorders and experience more severe negative consequences. Relative to other racial/ethnic groups, Latinx emerging adults who engage in problematic drinking are (a) less likely to seek treatment, and (b) have less access to innovative and accessible health promoting resources, exacerbating health inequities. Increasing evidence supports the utility of mindfulness-based interventions (MBIs) for reducing problematic alcohol use and promoting a sustainable healthy lifestyle. However, research on MBIs to address alcohol use problems is limited by (1) minimal racial/ethnic minority representation and (2) low rates of program adherence and retention. The long-term goal of this research is to decrease alcohol misuse among Latinx emerging adult drinkers through a culturally and developmentally adapted mindfulness-based intervention program targeting self-regulatory processes. The primary aims of the study are twofold. Primary Aim 1 - Use Community-Based Participatory Research (CBPR) methods guided by the five stages of cultural adaptations of behavioral health interventions to ensure a culturally and developmentally appropriate adaptation of mindfulness-based stress reduction (MBSR-L) for Latinx emerging adults (18-25 years-old) who report 2 or more binge drinking episodes in the prior 30 days. These formative stages of the research will include an expert advisory panel review, key informant interviews (n=15), focus groups (n=30) and a pilot trial (n=10; 8-weeks with weekly hour-long adapted MBSR sessions). Formative data will be analyzed to obtain information on structure, duration, acceptability, and cultural appropriateness and further refinement of intervention protocols. Primary Aim 2 – Conduct a Cultural Adaptation Trial to evaluate the acceptability and feasibility of the adapted MBSR-L intervention among a community sample (n=120) of Latinx underage emerging adults who report 2 or more binge drinking episodes in the prior 30 days. Participants will be randomly assigned to an MBSR-L condition (8 weekly 1-hour adapted MBSR-L sessions) or an assessment-only control condition. Secondary Aim 2.1 - Examine initial evidence of the efficacy of the MBSR-L intervention. We hypothesize that, relative to the participants in the control condition, participants in the MBSR-L condition will report: (a) greater reductions in frequency of binge drinking episodes and number of drinks per drinking occasion, and (b) greater impacts on putative mechanisms of change (e.g., reduced stress, greater self-regulation, and enhanced well-being). The proposed study has significant public health implications by contributing to translational efforts to reduce alcohol misuse and disparities among Latinx emerging adults who would otherwise not seek treatment.

• A Reinforced Mindfulness-Based Intervention to Reduce Problematic Drinking among Latinx Emerging Adults: Feasibility and Acceptability

  1R01AA030976-01

  NIAAA · FY 2023 · $372K

  Abstract Among all age cohorts in the United States, emerging adults have the highest prevalence of alcohol use and about one-third (32%) engage in binge drinking (4 to 5 drinks in two hours females/males). While Latinx emerging adults report lower rates of heavy alcohol use compared to their non-Latinx White counterparts, Latinx who do drink are at greater risk for transitioning to substance use disorders and experience more severe negative consequences. Relative to other racial/ethnic groups, Latinx emerging adults who engage in problematic drinking are (a) less likely to seek treatment, and (b) have less access to innovative and accessible health promoting resources, exacerbating health inequities. Increasing evidence supports the utility of mindfulness-based interventions (MBIs) for reducing problematic alcohol use and promoting a sustainable healthy lifestyle. However, research on MBIs to address alcohol use problems is limited by (1) minimal racial/ethnic minority representation and (2) low rates of program adherence and retention. The long-term goal of this research is to decrease alcohol misuse among Latinx emerging adult drinkers through a culturally and developmentally adapted mindfulness-based intervention program targeting self-regulatory processes. The primary aims of the study are twofold. Primary Aim 1 - Use Community-Based Participatory Research (CBPR) methods guided by the five stages of cultural adaptations of behavioral health interventions to ensure a culturally and developmentally appropriate adaptation of mindfulness-based stress reduction (MBSR-L) for Latinx emerging adults (18-25 years-old) who report 2 or more binge drinking episodes in the prior 30 days. These formative stages of the research will include an expert advisory panel review, key informant interviews (n=15), focus groups (n=30) and a pilot trial (n=10; 8-weeks with weekly hour-long adapted MBSR sessions). Formative data will be analyzed to obtain information on structure, duration, acceptability, and cultural appropriateness and further refinement of intervention protocols. Primary Aim 2 – Conduct a Cultural Adaptation Trial to evaluate the acceptability and feasibility of the adapted MBSR-L intervention among a community sample (n=120) of Latinx underage emerging adults who report 2 or more binge drinking episodes in the prior 30 days. Participants will be randomly assigned to an MBSR-L condition (8 weekly 1-hour adapted MBSR-L sessions) or an assessment-only control condition. Secondary Aim 2.1 - Examine initial evidence of the efficacy of the MBSR-L intervention. We hypothesize that, relative to the participants in the control condition, participants in the MBSR-L condition will report: (a) greater reductions in frequency of binge drinking episodes and number of drinks per drinking occasion, and (b) greater impacts on putative mechanisms of change (e.g., reduced stress, greater self-regulation, and enhanced well-being). The proposed study has significant public health implications by contributing to translational efforts to reduce alcohol misuse and disparities among Latinx emerging adults who would otherwise not seek treatment.