In this issue:
Launching 2017 in High Gear
CHAD MORRIS, Ph.D., Director
BHWP is starting 2017 off in high gear. We are excited about our upcoming work with national partners from coast to coast, from Vermont and Maine all the way to Monterey County, California.
We are kicking off the year by hosting the Bureau of Tobacco Free Florida and the Florida State University, Area Health Education Center (AHEC) for a learning tour this week. Together, we will be meeting with the Colorado Department of Public Health and Environment and innovative healthcare agencies, as well as leadership from the U.S. Department of Health and Human Services, Region VIII to discuss strategies for better reaching tobacco users with mental illnesses and addictions.
This week, we are also making final decisions regarding the second cohort of our Build a Clinic Program designed to facilitate sustainable and scalable integration of tobacco dependence treatment into primary care settings. The chosen primary care agencies will begin a seven-month web-based learning collaborative in late January. The webinar series related to the learning collaborative will be available to anyone visiting our website in the coming months.
We also hope you will take advantage of a number of new resources and trainings, including:
DIMENSIONS: Tobacco Free Toolkit for Healthcare Providers, Supplement for Justice Involved Populations. This supplement complements the DIMENSIONS: Tobacco Free Toolkit by offering guidance for healthcare providers, correctional administrators, community-based programs, staff, and advocates who wish to address the unique tobacco treatment needs of this priority population.
The University of Colorado, School of Public Health developed short video clips for Treating Tobacco Dependence and Facilitating Health Systems Change. The purpose of these clips is to provide public health professionals and other interdisciplinary providers with “key messages” or talking points that resonate with clinic administrators and leadership. The video clips target five compelling reasons for including tobacco cessation services within health systems or clinical settings.
- The first short message makes the case for reducing the impact of tobacco-related disease on patient populations.
- This video models how you might discuss meeting Federal Health Priorities, such as Health Resources and Services Administration (HRSA) reporting requirements.
- This clip models how you might discuss aligning with Health Care Reform and National Performance measures.
- Watch this video for suggestions on how you might discuss achieving meaningful use through Electronic Health Records.
- This video provides ideas how you might initiate a discussion regarding return on investment.
In addition to these new resources, we have several upcoming trainings.
BHWP will be hosting a Motivational Interviewing Training training February 27-28, 2017 on the University of Colorado Anschutz Medical Campus. This two-day intensive training will teach participants the fundamentals of Motivational Interviewing (MI), a collaborative conversational style that strengthens a person’s own motivation and commitment to change. Participants will be guided through a sequence of learning activities to support the development of proficiency in the application of MI. Register here.
Our next Rocky Mountain Tobacco Treatment Specialist Certification Program will be held in Denver on May 15-18, 2017. Register here.
We have just completely revamped our DIMENSIONS: Well Body Program. If you are interested in evidence-based guidance, motivational strategies, and a six-session manualized group curricula for healthy eating, physical exercise, sleep, and stress reduction, this is the training for you. This one and a half day training will be offered for up to 50 participants at a time. For more information, please contact Shawn Smith.
We will all be contending with an uncertain legislative future in regards to healthcare, wellness programming, and funding. I have set my intention to keep forward momentum by working to maintain my personal balance while focusing on what is within my control to make a positive impact. It is our team’s hope that the above resources and trainings will have a ripple effect regarding healthy behavior change. Personally, it is heartening to be one part of a much larger and more powerful movement toward well-being. Thank you for all the work you do!
A Study in Wellness
The Technology of Sleep
SUSAN YOUNG, Ph.D., Research Director
With the New Year, we are bombarded with news bites and ads promoting the latest technology that promises to transform our health. As fitness trackers have already flooded the market, some of the newer gizmos are aimed at a wider spectrum of health challenges, including the elusive good night’s sleep. Sleeping the recommended number of hours per night has been a chronically unachieved target for many of us. In recent years, we’ve seen an increased focus on addressing the quality of sleep as well. Sleep deprivation and poor sleep quality can contribute to a plethora of serious health risks ranging from impaired cognitive function (e.g., memory, attention, reaction time) and metabolism (e.g., blood sugar regulation, hormonal disruption)1 to increases in mental health conditions.2
Persistent sleep problems can be indicative of sleep disorders, which often go undiagnosed. For example, chronic snoring is too often viewed as a nuisance rather than a sign of a more serious sleep condition known as obstructive sleep apnea. Sleep apnea is defined by brief (≥ 10 sec) and repeated pauses in breathing during sleep. Obstructive Sleep Apnea (OSA; the most common form) occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe. Apnea increases the risk for high blood pressure, stroke, cardiovascular disease, obesity, attention problems, and cognitive impairment.3-5 Clinical diagnosis of sleep apnea typically requires an overnight stay in a sleep laboratory during which a technician monitors a variety of functions including sleep state, eye movement, muscle activity, heart rate, respiratory effort, airflow, and blood oxygen levels.6 Unfortunately, many patients are deterred by the effort required for a thorough assessment.
Computer scientists at the University of Washington have developed a smartphone app that can detect sleep apnea ‘events’ by measuring small movements in the chest and abdomen caused by breathing.7 From a smartphone, the app uses a sonar system that emits frequency-modulated sound signals and listens to their reflections. Another ‘contact free’ sleep monitoring device, which evaluates signs of apnea using a sensor placed beneath the mattress (synced with a smartphone) also shows early promise in detecting sleep apnea in the privacy of your home.8 So just when you thought your devices were banned from a healthy sleep environment, there are emerging ways to use these technologies to differentiate between sleep issues that may be life-threatening and those that are just disturbing the peace (and, perhaps, the quality of sleep of our partners).
1 Leproult, R. & Van Cauter, E. (2010). Role of sleep and sleep loss in hormonal release and metabolism. Endocrine Development, 17, 11-21.
2 Barnes, C. M. & Drake, C. L. (2015). Prioritizing sleep health: Public health policy recommendations. Perspectives on Psychological Science, 10(6), 733-737.
3 Cheng, S., Stark, C. D., & Stark, R. J. (2016). Sleep apnoea and the neurologist. Practical Neurology, Epub head of print.
4 Moon, C., Phelan, C. H., Lauver, D. R., & Bratzke, L. C. (2016). A narrative review of how sleep-related breathing disorders and cardiovascular diseases are linked: An update for advanced practice registered nurses. Clinical Nurse Specialist, 30(6), 347-362.
5 Patel, N., Donahue, C., Shenoy, A., Patel, A., & El-Sherif, N. (2017). Obstructive sleep apnea and arrhythmia: A systemic review. International Journal of Cardiology, 228, 967-970.
7 Nandakumar, R., Gollakota, S., & Watson, N. (2015, May). Contactless sleep apnea detection on smartphones. In: Proceedings of the 13th Annual International Conference on Mobile Systems, Applications, and Services, pp. 45-57. New York, NY: ACM.
8 Tal, A., Shinar, Z., Shaki, D., Codish, S., & Goldbart, A. (2016). Validation of contact-free sleep monitoring device with comparison to polysomnography. Journal of Clinical Sleep Medicine, Epub head of print.
Wellness in Practice
CINDY MORRIS, Psy.D., Clinical Director
“Cindy, you’re so hard on yourself.” This statement came from a friend in response to the apologies I offered my guests as I set out a plate of lemon bars made from a new recipe that didn’t come out quite as described by its given name, The Perfect Lemon Bar.
Yes, I can be hard on myself because I know I can do better. And yet, it doesn’t stop me from serving new or imperfect kitchen creations. I admit that in the past, I would have thrown out the batch because, while delicious, it doesn’t look just as I want. Then I would make a batch of my tried and true chocolate chip cookies, perfect every time.
But what is the fun in that? As I refine my technique, I learn something new – nuances of food chemistry, different cooking methods, and delicious recipes. If I stopped when things didn’t work out the first time, then my cooking career would have had a premature ending after the orange chicken debacle (which did end up in the garbage) my freshman year in college.
After years of experimentation in the kitchen, I’ve learned that to become an expert at anything, you need to take a risk, be willing to fail, and try again. It can be humbling at times but well worth it.
Resolutions in Harmony
MARY MANCUSO, M.A., Clinical Associate
Do you remember when you were in elementary school and learned certain areas or themes of study? They were called units. My brother’s favorite unit was Egypt. My favorite was mythology. Another favorite of mine was Haley’s Comet (yes, this was a long time ago…). During the summer months, when we were devoid of units dictated by an education curriculum, I assigned myself units. I sat on the blue living room rug early each June and listed the units I wanted to study each summer: Spanish, history, literature and, yes, even tap dance and juggling (neither of which I mastered).
In the movie Groundhog Day, Bill Murray becomes an excellent pianist, fluent in French, and a master ice sculptor because he has days upon days to learn, practice, and master these enterprises. While I would not want to relive the same day over and over, I would like to have an abundance of time to learn and master new skills and engage in creative undertakings.
In my adult life, I am more often than not taking some academic class as an extracurricular endeavor to explore a new area of study or deepen my understanding of a particular subject. When I am not taking an academic course, I tend to gravitate toward classes offered by local recreation centers: ceramics, stained glass, watercolor, guitar, ballet.
Intellectual stimulation certainly does not have to come from a formal structured class. One can embark upon a course of self-study, learn from friends, or simply take time for an extra mental challenge each day. While I do not have the patience, time (or let’s face it, intelligence) to solve the New York Times Sunday crossword puzzle, I do like the NYT daily mini cross word puzzle. It usually takes only a few minutes, but it is still a fun and engaging exercise in creative thinking. Recently, I’ve learned a lot about gardening and doggie discipline, both of which have been baffling and even frustrating at times. My work colleagues embark upon new learning constantly: perfecting culinary delights, gardening, astronomy, rock climbing, discovering how to train for a marathon or triathlon, traveling internationally, remodeling houses, caring for reptiles, and, of course, learning to rear children.
If we all had Bill Murray’s opportunity, we could be master chefs, gardeners, and builders; elite athletes; and have traveled to every country of our heart’s desire. While it was not a Bill Murray ice carving, my neighbor just showed me an ice sculpture of his own — a large ice candle made from water frozen in a 5-gallon bucket with the center hollowed out for a votive candle. It was a creative endeavor, and he loved doing it. Sometimes even simple, yet inspired, tasks are all we need to stimulate our intellectual well-being.
CHRISTINE GARVER-APGAR, Ph.D., Research Associate
For the first time in over 10 years, my husband and I are not parents of a little kid. Our youngest is in kindergarten this year, which means that both our children are “school-age” and gaining more independence each year. It is easy to think of our lives now as being no easier than when we were managing diapers and tantrums. But despite our hectic schedules and daily dramas, I have had to acknowledge the sense that one day in the not-too-distant future, I might have more available “head space” in which to entertain other intellectual or creative pursuits.
To rekindle artistic interests from my pre-family life, I have recently taken up oil painting. One evening each week, I join other students at the home studio of a professional artist in my neighborhood. We usually paint a still life set up in the center of the room – plastic fruit, colored wooden blocks, a bottle or vase, colorful napkins. The set-up isn’t particularly inspiring, but that doesn’t matter. We are re-learning how to see, training ourselves to paint what we perceive in front of us, rather than what we know is there. The challenge of discovering a combination of colors that will correctly convey relationships among objects is a perceptual puzzle I wasn’t expecting.
An apple looks red (to most people) because when we see one, our cognitive machinery automatically supplies us with some basic information — an average or summary of all the apples we’ve ever seen. I imagine little neurons in my head, labeled with adjectives, “Red,” “Round,” and “Pie” (in my case), all lighting up together when I see an apple. In real life, this automated process is handy because it saves time and energy as our brains go about the daily business of interpreting millions of incoming stimuli. The challenge for an artist is to divorce this cognitive ‘short cut’ from actual perception. What color is the apple? Red, of course! But is it really? The part in shadow might look blue or purple, or perhaps it reflects the green napkin it is sitting on. The other part may look bright yellow or orange, reflecting the yellow bulb in the spotlight that shines on it. If I squint hard enough, I may see no red at all. And if the apple actually looks orange, what color is the orange sitting next to it? For novices like myself, attempting to figure this out takes as much concentration as a Rubik’s Cube.
It feels good to expend mental energy on something that feels so…frivolous. I have to leave my ambitions at the studio door, turn off my inner critic, relinquish my need for goals and finished products, and embrace the idea that when it comes to painting, there are no real consequences of my efforts and no right or wrong solutions to the puzzle. For me, these are probably the biggest challenges of all.
The mission of the Behavioral Health and Wellness Program is to improve quality of life by facilitating evidence-based health behavior change for communities, organizations, and individuals