2012 NAPCRG Annual Meeting Presentations with DFM faculty members as presenters, co-presenters or co-authors

14 Sessions



P051 An Alternative Treatment for Anxiety: A Systematic Review of Ashwagandha (Withania Somnifera)

Morgan A. Pratte; Christopher Morley, PhD, MA, CAS; Kaushal Nanavati, MD; Virginia Young, MLS

Context: Ashwagandha (Withania Somnifera – WS) is an Ayurvedic herb that is increasingly being used as a supplement for control of Generalized Anxiety Disorder (GAD) and stress. Objective: To determine the extent to which Ashwagandha has been subjected to clinical testing, and the outcomes. Design: Systematic review of the literature. Searches conducted in PubMed, CINHAL, SCOPUS and databases using terms including Ashwagandha or Withania Somnifera and mental health term combinations. Inclusion criteria: human studies with treatment arm that included Ashwagandha as a treatment for anxiety or stress. A medical librarian conducted the literature searches, and an undergraduate student conducted the clinical trial search. Three study team members reviewed abstracts in tandem and applied criteria. Intervention: Formulations of WS. Main and Secondary Outcome Measures: Number and results of studies identified in the review. Anticipated Results/Results to date: 48 journal abstracts and five CT protocols were reviewed; three human trials met inclusion criteria. A manufacturer-funded four-arm study compared three dosage levels of WS extract (Sensoril™) vs. placebo. All three treatment arms showed significant decreases in scores from baseline on a modified Hamilton Anxiety Scale (mHAM-A) relative to placebo. Study 2 compared Beck Anxiety Inventory (BAI) scores for naturopathic care including WS vs. psychotherapy intervention with placebo, and found a 56.5% greater improvement in scores of the naturopathic group (p<.0001). Study 3 was a two-arm trial comparing supplements containing WS extract vs. placebo, assessing anxiety by Hamilton Anxiety Scale, and found a two-fold greater decrease in Hamilton scores (p<.05) vs. placebo. Conclusions: Limited human evidence suggests that Ashwagandha is a promising and safe treatment for anxiety and stress. However, additional human clinical trials are necessary to validate the healing abilities of the herb. Next steps include searches of conference presentations and design of a new human trial of WS.


P066 Shifts in Medical Student Idealism, Measured as Changes in Interest in Primary and Underserved Care

Christopher Morley, PhD, MA, CAS; Jordan Smith BS; Carrie Roseamelia, MA; Ana Villarreal, MS, MA-IR

Context: Acceptance into medical school often hinges on students having “the right stuff” necessary for physicians, including a sense of idealism towards medical practice and patient care. However, numerous studies have reported a drop in idealism over the course of medical education. Objective: To examine differences in interest in primary and underserved care between first year medical students (MS1) at the beginning of MS1 year, and second year medical students (MS2) at the end of MS2 year. Human Subjects Review: Exempt. Design: MS1s and MS2s were administered a survey at the start of the 2010 academic year (T1), and again at the end of the year (T2), that captured Likert-scaled responses to questions about interest specialties, special populations, practice contexts, and attitudes about primary care. Mean differences between MS1 at T1 and MS2 at T2 were compared by Mann-Whitney U test. Setting: Required clinical skills course taught over the first two years at a public medical university. Patients or Other Participants: MS1 & MS2. Main and Secondary Outcome Measures: Significant increase or decrease in Likert scaled responses between MS1/T1 and MS2/T2. Results: Significant or nominally significant decreases were observed in “Desire to do Primary Care” (p=.054), and variables indicating interest in underserved care (p=.027), global health (p=.002), public health (p=.001), Family Medicine specialty (p=.003), and several other areas. Significant increases were observed in economic factors influence on specialty choice, including “Available Jobs” (p=.02), “High Income Potential” (p<.001), “Ability to balance my work with my family responsibilities” (p=.02), and “Length of Residency” (p=.029). Significant increases were also seen in several negative attitudes about primary care. Conclusions: This study lends evidence to specific changes in attitudes, which may indicate underlying decline in idealism. Next steps include multivariate analysis of factors which contribute to attitudes, and curricular innovations to counteract the observed trends.


P120 Primary Care Diagnosis and Management of Vitamin D Deficiency

John W. Epling, MD, MSEd; Christopher Morley, PhD, MA, CAS; Carrie Roseamelia, MA; Natalie Jones, BA

Context: Vitamin D deficiency is increasingly recognized and crosses all demographics in the United States. Because there is no clear evidence or primary-care guideline to shape emerging practice, physicians may adopt a variety of practices. Furthermore, treatment of vitamin D deficiency (VDD) also varies due to lack of familiarity with the deficiency, and multiple sources of data about the problem. Objective: To describe variation in practice concerning the diagnosis and management of VDD. Design: Qualitative phenomenological study using focus groups of primary care providers. Setting: Primary Care practices in a primary care practice-based research network in Central and Northern New York. Participants: Primary care physicians and mid-level primary care providers. Intervention: Focus groups participants are asked to 1) discuss their diagnostic and management practice around VDD and 2) describe information sources used to formulate these practices. Participants then participate in a CME-generating activity on current VDD screening and treatment guidelines. Main outcome measures: Focus group data will be analyzed to detect emerging themes regarding the ranges of practice and of information sources physicians use to screen, test and treat VDD. Results to date: One focus group with three physicians has been conducted to date. Screening criteria varied considerably ranging from one physician who screens every regularly-seen patient under the age of 18; to another who regularly screens para-menopausal women and men with gastrointestinal disorders; and the third, who has stopped screening altogether. Screening and prescription procedures varied considerably, with treatment triggers ranging from 20.0-32.7 ng/ml, and typical treatment varying between 800-4000 IU/day to 17,0000-50,000 IU/week. Sources of VDD varied as well, with none citing the same source. Conclusions: We will describe emerging clinical practice around vitamin D deficiency and the information sources used to develop these practices. This information will direct further study of vitamin D deficiency and emerging practice.


OT15 State-level Tobacco Control and Adult Smoking Rate in the United States: An Analysis of Structural Factors

Christopher Morley, PhD, MA, CAS

Context: Primary care physicians are on the front lines of individual-level tobacco control, and often face a frustrating task of convincing their patients to consider smoking cessation or harm-reduction techniques. However, the literature suggests that population-level interventions, such as excise taxation or restrictions on smoking behavior, have the largest effect upon smoking rates. Objective: To evaluate the relative effects of state-level, population-wide tobacco control strategies in the U.S. Secondarily, to analyze contextual factors that may influence the extent of tobacco control measures, including party control of state government and level of tobacco manufacturing. Design: Secondary data analysis of merged variables from BRFSS, American Lung Association, and National Conference of State Legislators data sets. Adult smoking rate for each state in 2010 was modeled as a result of funding level, cigarette tax rate, smoking prohibitions, and insurance mandates for smoking cessation, using forward stepwise OLS regression. Main outcome measures: Individual hypothesis tests and beta coefficients for each predictor. Results: Consistent with earlier literature, excise tax rate on cigarettes (?=-1.091, p=.032) and smoking prohibitions (?= -111, p=.003) have the largest effect on the adult smoking rate in each state, with each dollar of tax equating roughly to a 1% reduction in adult smoking rate, and for each venue in which smoking is prohibited (schools, restaurants, casinos, etc.), a roughly 0.1% in adult smoking rate. Funding tobacco control according to CDC guidelines, and smoking cessation insurance mandates, were not significant. Republican control of the lower state legislative house and tobacco manufacturing as a percent of state gross domestic product appear to be consistent predictors of the magnitude of successful tobacco control measures. Conclusions: Excise taxes and smoking restrictions are effective population-level tobacco control measures. Primary care providers may seek to emphasize the costliness and inconvenience of smoking when counseling patients to quit.


WS17 Qualitative Research Methods and Design: A Basic Primer/Review

Christopher Morley, PhD, MA, CAS; Carrie Roseamelia, MA; Lindsey Kingston, PhD; Jennifer Flad, PhD

Objectives of the session: When conducting and reporting primary care qualitative research, essential methodological concepts like sampling strategy, validity, sample characteristics, and coding methods are just as important to consider and address as in quantitative work. However, many qualitatively-based conference and journal submissions suffer from a lack of rigor. Issues include nebulous results, failure to present clear research questions, or disconnectedness between research questions, methods, and results. Content of the Session: This session will cover the basic elements of research design and reporting from a qualitative perspective, including: 1) Hypothesis generation and testing in qualitative research ; 2) Forming a Research Question, and selection of an appropriate method to answer it ; 3) Sampling - methods, sample characteristics, representativeness; 4) Methodological approach - Grounded Theory, Phenomenology, Institutional Ethnography, etc.; 5) Evaluating and analyzing the data - coding/theming 6) Reporting findings; 7) A quick review of software that can make analysis easier, or which allows for novel mixing of methods. Method and Extent of Audience Participation: The format will include a brief panel presentation, hand-out of take-home materials, a break-out session with participants practicing interviewing techniques in small groups, and an open question-and-answer session with panel members. Prerequisite Knowledge: Participants should have a basic understanding of what qualitative research is. It may be beneficial for participants to have a project in mind, but this is not required.


P236 Evaluating a Rural Training Track Experience From the Hospital Administrator and Student Perspectives

Roseamelia Carrie, MA; Christopher Morley, PhD, MA, CAS; Epling John, MD, MSEd; Carin McAbee, BS

Context: The benefits of having a rural track in medical education are documented insofar as they replenish the supply of needed physicians and offer a training ground for students interested in serving rural communities. This study evaluates one rural track from the perspective of hospital directors and medical students. Objective: To describe the experiences of hospital directors in recruiting and medical students in training for careers in rural towns. Design: Qualitative phenomenological study using in depth interviews of hospital directors and rural medical students. Setting: A rural training track fulfilling Family Medicine, General Surgery, and other training requirements, with longitudinal placement at rural clinical sites Central and Northern New York. Participants: Hospital CEOs, medical directors and rural medical students affiliated with Upstate's Rural Medical Scholars Program. Intervention: Hospital directors and students will be asked of the benefits and challenges associated with their affiliation with the rural medical education program. Main outcome measures: Interview data will be analyzed for content to detect emerging themes related to the perceived strengths and weakness of this rural medical education track. Results to date: Two rural sites have been recruited to participate to date. Both directors and students find the program to be useful for recruiting and training rural physicians. Matching the right students to sites and preceptors can be challenging as hospital resources are limited and preceptor pools are saturated with competing interests. Students report the experience is ideal for those with general or primary care career interests, fewer opportunities to see "the rarest of the rare" cases, but excellent exposure to "bread and butter cases" and continuity-of-care. Conclusions: We will describe emerging themes related to finding the right "student fit" for participating in rural medical education and how rural medical programs can better support those affiliated hospitals and preceptor offices.


BP26 Family Support, Mental Health, and Weight Loss Program Participation in an Adolescent and Pre-adolescent Population

Christopher Morley, PhD, MA, CAS; Wendy Scinta, MD

Context: A comprehensive medical weight loss program, incorporating biguanide with lifestyle modification and family-based behavioral modification, has been developed as an alternative to bariatric surgery in children and adults. Objective: To test the effect of full family support and mental health on the likelihood of adolescent and pre-adolescent patient drop-out from a comprehensive weight loss program. Design: Retrospective Case series. We compared program drop outs (n=28) vs. those who were enrolled at the time of data extraction or who had completed the program (n=25) on lack of family support (LFS; 1= less than full support, vs. 0= full support), the presence of mental health symptoms (MH; 1=present or probably mental health issues, vs. 0=not present) using ?2 statisics. LFS and MH were then entered as predictors of drop-out, with age, initial weight, and gender as covariates, in a binary logistic regression model. Setting: Outpatient family medicine and medical bariatrics office in a suburban setting. Patients: Adolescent and near-adolescent (aged 7-19 years) overweight or obese program enrollees, including program completers (achieving BMI ?85th percentile for age and gender), present enrollees, and program drop-outs. Main outcome measures: Drop out vs. program continuation or completion. Results: A total of 25 patients were coded as not having full family support, based upon clinician observation, and 4 patients had probable or apparent mental health symptoms (all were related to mood disorders). MH was marginally associated with drop out (?2=3.863, p=.049); LFS was significantly associated with dropping out (?2=14.018, p<.001). Binary logistic regression revealed that having at least one of the two predictors (LFS or MH) increased the odds of drop out nearly 15-fold (O.R.=14.667, p<.001). Gender, age, and initial weight were not significant predictors of drop-out. Conclusions: Observed mental health symptoms were less prevalent in this sample, but had an effect. All patients with MH dropped out. Family Support appears to be a major predictor of juvenile patient adherence to a comprehensive weight loss program.


P339 Evaluation of the Extent and Methods of Public Health Training in US Medical Schools and Family Medicine Training Programs

Jacob Prunuske, MD, MSPH; Christopher Morley, PhD, MA, CAS; Ranit Mishori, MD, MHS; Linda Chang, PharmD, MPH, BCBH

Context: Family physicians regularly address patient health concerns associated with lifestyle-related conditions, social disparities, and global factors. In an increasingly complex environment, collaborative interdisciplinary groups and physicians with mastery of basic public health competencies may be most effective in improving health outcomes. The Institute of Medicine and Association of American Medical Colleges have called for increased public health training in medical education. The extent and methods used for public health training in medical schools and family medicine training programs nationally is not well known. Objective: To assess public health training curricula in medical schools and residency training programs. Design: National survey, incorporating two matrix questions designed to determine the extent and prevalent methods of delivery of required public health training in US medical schools and family medicine residency training programs. Setting: CAFM Education Research Alliance (CERA) survey Participants: Directors of allopathic Family Medicine Clerkships in the United States. Additional family medicine faculty in different roles, as well as those from osteopathic and Canadian medical schools, may receive the questions in future targeted CERA surveys. Main outcome measures: Time devoted to each content area, and methods of delivery, will be modeled via multivariate linear and logistic regression techniques as a result of school and program characteristics, controlling for individual respondent characteristics. Expected Results: Estimates of institutional characteristics that predict, promote, or detract from the teaching of public and population health skills in medical school curricula. Conclusions: Results of this project will be useful to: 1) Family Medicine educators for developing and strengthening public health curricula, 2) Deans of curriculum for use in resource allocation and curricular design, and 3) government agencies for use in resource allocation.


P346 R U 4 PC?: Texting and Feedback on Primary Care During Medical School

Andrea Wudyka, MD; Christopher Morley, PhD, MA, CAS; Andrea Wendling, MD; Julie Phillips , MD, MPH; Anne Victoria Neale, PhD, MPH; Diane Levine, MD; Elie Mulhelm, MD

Context: Medical students are often asked about their planned choice of specialty, and teaching physicians routinely offer feedback on this complex and important decision. Additional data regarding this aspect of the “hidden curriculum” are needed to better understand how to attract student interest in primary care. Objective: To estimate balance of positive/negative feedback on primary care as a career choice; secondarily, to determine efficacy of texting as a data collection method. Design: Multicenter observational prospective trial. Medical students from four universities will collect data for a 30-day period by sending a text message whenever a comment regarding primary care is heard in the context of formal educational activities, and will complete pre/post surveys regarding demographics, career plans, content of comments heard, and attitudes toward primary care. Setting: Pre-doctoral curriculum at four medical schools. Participants: Medical students at participating universities. Main outcome measures: Descriptive statistics of comment types heard; themes derived from qualitative content of messages; compliance/satisfaction with text messaging as a survey response methodology. Analyses will explore the relationships between feedback, attitudes toward primary care, and career intentions. Results: Initial data from the pilot study phase revealed that 63% of feedback was positive toward primary care, and 37% negative. We anticipate that the multi-institutional study will continue the observed trends, identify student factors predictive of comments, and uncover variation between institutions in comments. Conclusions: Attracting and retaining interest in primary care is essential in order to meet the health care needs of the nation. Aspects of the “hidden curriculum” may be important in shaping career decisions of medical students, and we used a novel strategy to obtain student perceptions of faculty feedback on specialty career choice. This study will demonstrate a mechanism for quantitatively describing and assessing the hidden curriculum about primary care across institutions.


ID42 Analysis of Immunization Funding Effect On Influenza Vaccination Rates In New York State

Nicholas Moore, JD; Christopher Morley, PhD, MA, CAS; Martha Wojtowicz, PhD; John Epling, MD, MSEd

Context: Vaccination rates are demonstrably affected by a number of demographic factors. However, the relationship between the amount of public funding devoted to immunization purposes and its effect on immunization rates has been understudied. Objective: To evaluate the effect of public funding for immunization on rates of influenza vaccination in New York State, and to assess the impact of increased funding on individual likelihood of being vaccinated. Design: Secondary analysis of a merged data set combining BRFSS-reported influenza vaccination rates and other data with aggregated funding levels per year, from 2001-2010.Linear regression modeling was employed to estimate the effect of NYS per capita funding for immunization on the immunization rate per year, as measured by the BRFSS. Logistic regression was used to estimate the effect of a major increase in funding, post-2005, upon the likelihood of an individual being vaccinated (N=54,804). Setting: New York State. Participants: Respondents to the BRFSS, 2001-2010. Main outcome measures: ? coefficient and t-test for per-capita funding level for the time-series analysis; odds-ratio of flu vaccination and chi-square test for post-increase in the individual level analysis. Results: Mean flu vaccination rate from 2001-2005 was 33.02%, when mean funding per capita for immunization in NYS was $.45; the vaccination rate jumped to 45.8% for the period 2006-2010, when mean per capita funding was $2.16. Each dollar spent over the whole ten-year period, per-capita, on immunization rates led to an approximately 4.6% increase in immunization rate (? = 4.639, p=.04). Individuals were about 1.5 times as likely to be vaccinated following a large increase in funding in 2006 (O.R. = 1.513, p>.001), controlling for marital status, employment status, number of children, income, and general health. Conclusions: Increases in public funding for vaccination appear to result in increased influenza vaccination rates.

CL43 A Retrospective Chart Study of a Comprehensive Medical Weight Loss Approach to Pediatric Obesity: Initial Results From the Bounce Program

Wendy Scinta, MD; Christopher Morley, PhD, MA, CAS

Context: Children and adolescents suffering from overweight and obesity are more frequently being referred for bariatric surgery. The current standard treatment of childhood obesity is lifestyle modification, including diet and exercise, but data suggest that a more comprehensive and aggressive approach may be necessary. A more comprehensive medical intervention may also be a good alternative to bariatric surgery as well. Objective: To evaluate a comprehensive medical weight loss program. Design: Single-arm case series. Setting: Outpatient family medicine and medical bariatrics office in a suburban setting. Patients: Adolescent and near-adolescent (aged 9-19 years) overweight or obese program enrollees with two weight and height measurements, including program completers, present enrollees, and program drop-outs. Intervention: A comprehensive medical weight loss program, incorporating biguanide; family-based behavioral modification; metabolism optimization; food journaling; pedometer usage; elimination dieting; encouragement of physical activity and exercise. Main outcome measures: Percent excess weight lost, total weight lost, and BMI lost. Results: The study cohort was predominantly female (70%), with an average age of slightly over 14 years (range 9-19 years, SD=3.05 yrs). Subjects participated for a mean of 7.53 months (SD=7.19), and lost an average of 14.75 lbs. over that time. The mean BMI at program start was 33.85 (SD=6.67), and 30.08 at the second measurement (SD=6.24). Completers (n=6) lost a mean of 64.1% of excess weight, 25.83 lbs. overall, and 5.13 BMI points, compared with a mean of 27.17% of excess weight, 18.79 lbs. overall, and 3.56 BMI points for current participants (n=18), and 13.39% of excess weight, 9.74 lbs. overall, and 1.93 BMI points for drop-outs (n=26). Conclusions: Comprehensive medical approaches to adolescent weight loss warrant further development and study, especially as an alternative to more restricted medical approaches, as well as to more invasive and riskier bariatric surgical procedures in pediatric patients.

CL45 Return to Work Patterns for Those With Occupational Respiratory Disease: Clinical and Structural Factors

Jeanette Zoeckler, MPH; Christopher Morley, PhD, MA, CAS; Donald Cibula, PhD; Michael Lax, MD, MPH

Context: Return to Work (RTW) after occupational injury has been examined extensively for musculoskeletal disease, with a number of factors appearing to be predictive. However, RTW after respiratory illness has been understudied. Objective: To identify prognostic factors for RTW patterns following the development of work related respiratory disease. Design: Retrospective chart review of patients with work-related respiratory disease using an exploratory, sequential mixed methods research design. Multinomial (n=188) and Cox regressions (n=130) assessed predictors of work status. A subset (n=21) underwent in-depth interviews. Setting: The Occupational Health Clinical Center (OHCC) in Syracuse, New York serves 26 counties by providing diagnostic, treatment, and prevention services. Patients: Patients aged 18-63 with demonstrated work- related respiratory illness for two years or more. Main outcome measures: Odds Ratios (OR) of predictor variables for never leaving work as a result of illness, returning to work after a leave, or not returning to work, and Cox Proportional Hazard Ratios (HR) for time to return. Results: Greater number of diagnoses (OR=.741, p = .001) and non-union status (OR=.391 p =.021) reduced the likelihood of staying at work. Patients who took less than a year from the onset of their illness or injury until their first appointment in the clinic were 3.55 times more likely (OR = 3.551, p =.028) to have returned to work compared to not having returned to work through the study period. Patients who smoke (HR = 2.89, p =.003) and who are union members at the time of onset or injury (HR = 2.30, p =.013) are more likely to experience a swifter return to work. Conclusions: Other than exposure controls, facilitated access to occupational health services would likely reduce disease severity and improve RTW rates. Additional factors, such as smoking and union membership, and employer policies, attitudes, and behaviors, warrant further study.

CL46 A Qualitative Exploration of Factors Influencing Return to Work for Those With Occupational Respiratory Disease

Jeanette Zoeckler, MPH; Christopher Morley, PhD, MA, CAS; Michael Lax, MD, MPH; Donald Cibula, PhD

Context: Return to Work (RTW) after occupational respiratory injury is a complex phenomenon that has been understudied. Objective: To explore the phenomenological aspects of factors influencing RTW. Design: Retrospective chart review of patients with work-related respiratory disease using an exploratory, sequential mixed methods research design. A subset (n=21) underwent in-depth interviews, which were transcribed and analyzed for emerging themes using NVivo 9.® Setting: The Occupational Health Clinical Center (OHCC) in Syracuse, New York serves 26 counties by providing diagnostic, treatment, and prevention services. Patients: Patients aged 18-63 with demonstrated work- related respiratory illness for two years or more. Main outcome measures: Major themes identified as influencing the RTW decision from transcripts of patient interviews. Results: Worker/patients must navigate complex webs of legal, financial, social, and medical circumstances during recovery from the onset of work-related respiratory disease. Interviews identified nuanced RTW patterns and specific impeding social and medical structures. Access to occupational health services was deemed important. Disease severity, employer-generated obstacles, and uncontrolled exposures each impacted work status outcomes. Conclusions: Access to occupational health services plays a vital role in returning workers to employment, and as expected, RTW is potentially a less useful, and more distal, therapeutic goal for those with more severe disease and poorer overall health status. Exposure controls and facilitated access to occupational health services would likely reduce disease severity and improve return to work rates. Factors outside the direct influence of the healthcare system, such as working conditions (i.e. new or unremitting exposures to environmental agents) and employer attitudes, need to be considered by the treating physician in treating occupationally-related respiratory illnesses to establish effective therapeutic goals. Improving employers’ responses to workplace respiratory illnesses, and recognizing the beneficial role of unions, are additional next steps that may be taken by physician advocates or other social/political actors.

Wednesday, December 5, 2012 11:00 AM Room: Bayside C

WS43 Family & Peer Health Coaching for PBRNs: Catalytic Innovation for Transformational Leaders, Researchers & Trainers

Richard Botelho, MD; Christopher Morley, PhD, MA, CAS; John W. Epling, MD, MSEd

Objective: Learn how to implement Family & Peer Health Coaching (F-PHC) programs for motivating healthy habits. Content: Catalytic innovations are defined as socio-psychological interventions that are convenient, inexpensive, easy-to-use and beneficial to diverse populations. To enhance the impact of these innovations, we can use blended learning methods (including social media and Health 2.0 online learning programs) to take advantage of the greatest untapped resource in healthcare: namely, our patients. Catalytic innovations that empower 4p-patients (Prepared, Proactive, Proficient and Partnering) enhance the participation rates in health promotion programs. F-PHC programs use self-reflective learning exercises to set up ongoing coaching experiences. To cultivate learning organizations, we can build social networks of transformational leadership development to implement F-PHC programs in health education and clinical settings. Our learning organizations can create professional movements that improve the health habits of practitioners and staff within the health sector. In turn, our learning organizations can disseminate F-PHC programs to patients and their families. Alignment of our health education and clinical organizations can generate the momentum to create professional movements for health. In turn, these professional movements can cultivate learning communities to develop social movements for health. Together, professional and social movements can work synergistically together in reversing the epidemics of unhealthy habits and reduce mounting burdens of chronic diseases. Methods: Attendees will: 1) experience the F-PHC learning process, 2) Learn from a case example about how to implement a F-PHC program 3) have an opportunity to participate in an online learning community about how to disseminate F-PHC programs. Prerequisite Knowledge: This workshop is for leaders, researchers, trainers and PBRNs interested in implementing and evaluating dynamic, complex process interventions for health behavior change. For more details, go to