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Building a learning and responsive healthcare system that improves care among medically underserved populations  
WELCOME TO THE
iRACE LAB
iRACE - intervention Research Advancing Care Equity.
The intervention Research Advancing Care Equity – iRACE laboratory is a health psychology laboratory located in the College of Medicine at Florida State University. Guided by a dissemination and implementation science framework, the goal of our research is to improve patient care among medically underserved populations through evidence-based behavioral interventions in the context of learning healthcare systems. The iRACE lab aims to understand and intervene on factors that influence health outcomes among patients coping with substance misuse, depression, HIV infection and other chronic diseases. We investigate the influence of individual, social, and structural barriers using an interdisciplinary team approach.

In addition, our laboratory works with the Southern HIV Alcohol Research Consortium (SHARC) to examine issues related to HIV and substance use specifically in order to develop, tailor and disseminate effective interventions.

The long term goal of our laboratory is disseminate and implement innovations in evidence-based care that creates healthcare systems that are responsive to patient care needs. For further information regarding the iRACE laboratory, please contact Lab Director Dr. Nicole Ennis.​
Active Projects

HIV SBIRT


STUDY Although screening, brief intervention and referral to treatment (SBIRT) is a proven technique that has been shown in some health care settings to reduce substance there is limited data available for it effectiveness among HIV care settings. HIV+ individuals have high rates of substance abuse but access to intervention is limited. Substance abuse increases the risk for poor treatment adherence and is a recognized contributor to the spread of HIV. There is a need to develop treatments specifically for HIV+ individuals. We aim to implement SBIRT in HIV care settings to optimize health outcomes. This protocol describes an assessment of SBIRT feasibility and acceptability in the UF Health Infectious Disease-Medical Specialties Clinic at the University of Florida. One hundred participants will be recruited from the Clinic. The intervention group will receive a brief intervention, referral to treatment, and peer navigator support. The control group will receive screening and standard referral to treatment as seen in high-quality usual care. The primary study outcomes are feasibility and acceptability of the SBIRT model. Secondary outcomes include engagement in substance use treatment and reduction in alcohol and drug use.

Medical Marijuana and Driving Outcomes


The long-range goal of this work is to improve our understanding of the consequences of medical marijuana use in later life. A study that examines older adults pre-exposure to medical marijuana and systematically tracks medical marijuana initiation, dosage, and psychomotor functioning is needed. Thus, the current study will test medical marijuana use as the exposure variable in adults age 50 and older and simulated driving performance (i.e. errors in response time, attention, and executive functioning tasks that predict on-road performance) as the primary outcome. Medical marijuana use is increasing among adults 50 and older. Both the National Institute on Drug Abuse (NIDA) and the National Institute on Aging (NIA) have identified the need to understand how habitual use of medical marijuana affects psychomotor functioning in real world tasks such as driving. The current proposal will address this question by examining medical marijuana use in the context of driving performance among adults 50 and older.

Cannabis Assessment Poject (C.A.P.)


With the emergence of increasing legalization of medical cannabis across the United States, researchers have been invested in distinguishing between cannabis use for medical and for non-medical purposes, prevalence of use for each of these motivations, and potentially differentiating characteristics of medical and non-medical cannabis users. The goals of this project are to examine cannabis use patterns among medical and recreational users aged 18 to 85, characterize participants

FLEX Housing Project


The overall goal of the current demonstration project is to develop and implement holistic navigation services for youth ages 15-29 through the Florida Department of Health’s Ryan White Part B and Housing Opportunities for Persons with AIDS (HOPWA) programs. Through the use of peer navigation and tailored motivational interviewing, including ongoing monitoring and follow-up, youth living with HIV and AIDS are able to connect with services in a variety of domains including housing, healthcare, substance use treatment, education, job placement, and legal assistance, as needed.

Completed Projects
  • COMPLETED STUDY

    Project C.A.R.E

    5-year study funded by the National Cancer Institute conducted through the University of Miami Miller School of Medicine and the Sylvester Comprehensive Cancer Center.

  • STUDY

    Opioid Abuse among NFL Vets

    Examining the association between psychological pain dimensions and opioid use, depressive symptoms, and HRQOL.

  • COMPLETED STUDY

    Project R.E.A.C.H.

    Project R.E.A.C.H. (Recover, Empower, Adapt, Cope and Heal) is a mHealth intervention study that aims to improve health outcomes by educating underserved women who are fighting breast cancer.

  • COMPLETED STUDY

    Project SUPPORT

    Examining the role of social support, affective states and health behaviors among African Americans 50 and older living with HIV.

Opioid Use in the NFL


STUDY With over 60% of former NFL athletes reporting moderate to severe pain intensity in retirement, individuals in this population are at risk of reporting greater depressive symptoms, opioid use, and lower HRQOL compared to the general population. Though previous studies have examined the influence of pain on depressive symptoms and opioid use among NFL retirees, these investigations have been limited by examining the physical aspects of pain (i.e., intensity) and have not accounted for the psychological dimensions of pain perception. Therefore, the purpose of the present study is to examine the association between psychological pain dimensions and opioid use, depressive symptoms, and HRQOL. Delineating between the unique effects of different aspects of pain (i.e., intensity, catastrophizing, interference, or acceptance) on opioid use, depressive symptoms, and HRQOL may help to inform effective interventions among NFL retirees. Consequently, the current study may improve the quality of life in NFL retirees by elucidating salient, treatable correlates of these factors.

Project R.E.A.C.H


STUDY Project R.E.A.C.H. (Recover, Empower, Adapt, Cope and Heal) is a mHealth intervention study that aims to understand the best way to disseminate health information to underserved women coping with breast cancer. We recently created this intervention which combines support and health information into a digital format for broader reach. The purpose of Project REACH is to test the acceptability of this this mHealth intervention and measure its influence on health related quality of life. We use 10 short, highly engaging, films to deliver valuable breast cancer health information content and structured support consistently delivered over a ten week period to engage patients in self-management of their treatment process. Successful completion of Project REACH will provide pilot data needed to examine clinical outcomes in this population. The expected result of this work is the creation of an effective mHealth intervention with broad national reach that will improve mortality in low income Black women diagnosed with breast cancer.

Project SUPPORT


STUDY Project SUPPORT examines the role of social support, affective states and health behaviors among African Americans 50 and older living with HIV. In partnership with the UF CARES (Center for AIDS Research Education and Service) Jacksonville, we recruited 96 HIV+ men and women age 50 and older who identify as Black. The investigators will use data obtained from Project Support to enhance our understanding of the psychosocial and behavioral influences impacting people aging with HIV in order to develop effective interventions that promote positive health outcomes in this population. The intervention Research Advancing Care Equality (iRACE) laboratory -Nicole Ennis Whitehead, PI- in conjunction with the University of Florida / SHARC will serve as the analysis unit for the study.

Project C.A.R.E.


STUDY Project C.A.R.E. is a 5-year study funded by the National Cancer Institute conducted through the University of Miami Miller School of Medicine and the Sylvester Comprehensive Cancer Center. The study was a randomized clinical trial comparing a cognitive behavioral stress management (CBSM) intervention to an enhanced breast cancer education condition on psychosocial adjustment, endocrine and immune functioning among black breast cancer survivors. Both the CBSM and psychoeducation condition were adapted to be culturally sensitive to breast cancer survivors who self-identify as African American or black. Patients showed improvement in multiple indicators of psychosocial adaptation (fewer intrusive thoughts, lower anxiety, lower depressive symptoms, and greater satisfaction with care). This study was completed in conjunction with Suzanne Lechner, PhD and her research team at the Braman Family Breast Cancer Institute of the University of Miami Sylvester Comprehensive Cancer Center.

BW-CPA


STUDY Lack of physical activity is an independent risk factor for various health conditions including cardiovascular disease, type II diabetes, obesity, and select cancers. Lack of physical activity has also been implicated in a multitude of negative psychological outcomes including depression, anxiety and decreased quality of life. Despite the noted benefits of physical activity, engagement among minorities and women; particularly Black women remains low. Although rates of inactivity for Black women are problematic across the lifespan, rates of inactivity begin to increase during young adulthood. In response to the lower rates of physical activity among Black women, there has been an increase in intervention studies promoting physical activity. However, inadequate attention to the potential influence of culture on physical activity among Black women may contribute to the mixed success of current interventions. Further, lack of theoretical models that adequately account for the complexity of culture in relation to physical activity limit the understanding of the mechanisms influencing physical activity. The project will examine the influence of culture on physical activity attitudes and behaviors among Black female college students using the Theory of Planned Behavior (TBP) and PEN-3 model grounded in an ecological approach. The objectives of the proposed study are to: (a) examine the relationship between TPB constructs and physical activity engagement among Black female college students, (b) examine the influence of PEN-3 factors on physical activity engagement among Black female college students, and (c) evaluate the relative contributions of TPB and PEN-3 constructs on physical activity engagement among Black female college students. This study extends the health disparities literature by applying theoretical models to investigate leisure time physical activity behaviors of Black female college students. This research is situated to inform the future development and implementation of physical activity interventions for Black women.

Condom Use Norms


STUDY The Association of Adolescent Perceived Peer Condom Use Norms and Sexual Health in Adult Men is a secondary data analysis utilizing data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). This investigation uses longitudinal data from a nationally representative sample of men in the United States. The primary aim of the study is to determine if perceived peer norms measured during adolescence are associated with self-reported condom use behavior during adulthood. The investigations will also examine the association between perceived norms and sexually transmitted infections. Additionally, the project will explore the role of sexual identity in the association between perceived norms and both condom use and sexually transmitted infections. This project will address significant gaps in the literature related to health dipartites among MSM populations while simultaneously examining a potential target for intervention among this group.

iRACE News
iRACE Publications
The Association of Therapeutic Versus Recreational Marijuana Use and Antiretroviral Adherence among Adults Living with HIV in Florida.
Mannes, Z.L., Burrell, L.E., Zhou, Z., Ferguson, E.G., Lu, H., Somboonwit, C., Cook R., & Ennis, N (2018).

Patient Preference and Adherence.
The Prevalence and Patterns of Substance Use Across Birth Cohorts Among HIV+ Adults Within the State of Florida
Mannes, Z.L., Bryant, V., Burrell, L.E., Zhou, Z., Lu, H., Ferguson, E.G., Cook R., & Ennis, N. (2018).

Aging and Mental Health
DOI: 10.1080/13607863.2018.1430740
 Association between alcohol consumption trajectories and clinical profiles among men and women living with HIV
Kelso-Chichetto, N.E., Chen, X., Plankey, M., Ennis, N.E., Abraham, A.G., Bolan, R., Cook, R.L., (2017)

The American Journal of Drug and Alcohol Abuse, 1-10.
Narcissistic Personality Disorder in clinical health psychology practice: Case studies of comorbid psychological distress and life-limiting illness
Kacel, E., Ennis, N., Pereira, D. B. (2017).

Behavioral Medicine, 43(3), 156-164.
Prevalence and Correlates of Psychological Distress among Former High-Performance Athletes: A Systematic Review
Mannes, Z.L., Waxenberg, L., Cottler, L.B., Perlstein W., Burrell, L.E., Ferguson, E.G., Edwards, M. & Ennis N. (2018).

International Review of Sport and Exercise Psychology.
One Step at A Time: A Latent Transitional Analysis on Changes in Substance Use, Exposure to Violence, And HIV/AIDS Risk Behaviors Among Female Offenders
Jones, A., Gerke, T., Striley, C., Whitehead, N., Osborne, V., Cottler, L. (2017)

American Journal of Criminal Justice, 1-15
 Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study
Cook, R.L., Zhou, Z., Kelso-Chichetto, N. E., Janelle, J., Morano, J. P., Somboonwit, C., Carter, W., Ibanez, G. E., Ennis, N.,… & Cohen, R. A. (2017)

Addiction science & clinical practice, 12(1), 22.
Barriers to Hepatitis C Screening in a Minority Population: A Comparison of Hepatitis C and Human Immunodeficiency Virus Screening Rates at a Community STD Clinic in Miami, Florida
Feldman, E.B., Balise, R., Schiff, E., Whitehead, N., Thomas, E. (2017).

Journal of Community Health, 1-5.
iRACE Lab Members

Meet our awesome team

Dan is a Postdoctoral Research Fellow at the FSU Center for Translational Behavioral Science. His work broadly focuses on public health policy, with particular emphasis on behavioral health problems. He takes an evidence-based approach to the examination of diagnostic reliability and treatment efficacy. He is currently editing a book on the topic of antidepressant withdrawal. His interests include meta-science and issues around open science/open access.
Dan Dunleavy, PhD, MSW
Postdoctoral Associate
Abbey Folsom is a Research Assistant in the iRACE Lab. Also, she is a practicing Florida Licensed Dietitian/Nutritionist and holds the national credential, Certified Nutrition Specialist (CNS). Her unique life experiences as a professional with disabilities, plus due-diligence of a scientific background, is a unified perspective to research medical cannabis.
Abbey Folsom, MS, CNS, LDN
Research Assistant
Katie Kloss is a Research Assistant in the Department of Behavioral Science & Social Medicine in the College of Medicine at Florida State University. They are also the Peer Navigator on Dr. Ennis’ SBIRT-PN study and the Study Coordinator on the CAN Pandemic Telesurvey and Medical Marijuana & Driving studies. They received their Bachelor of Arts degree in French with a minor in Teaching English to Speakers of Other Languages (TESOL) from the University of Florida in 2010.
Katie Kloss, BA
Lab Manager/Study Coordinator
iRACE Alumni
Eugene Dunne, PhD

Researcher – Brown, Alpert Medical School

Larry Burrell II, PhD

Staff Psychologist – Martinez VA (Martinez, CA)

Savannah Calleson, MS

Student – FSU College of Medicine (Tallahassee, FL)

Allyson Diggins, PhD

Staff Psychologist at Cleveland Clinic (Cleveland, OH)

Justin Hoover, MS

Student – FSU College of Medicine (Tallahassee, FL)

Zachary Mannes, PhD

Interning – Yale, School of Medicine

Resources

Substance Abuse Resources

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SAMHSA’s National Helpline: 1-800-662-HELP (4357)

SAMHSA’s National Helpline, also known as the Treatment Referral Routing Service, is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.

https://www.samhsa.gov/find-help
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National Institute on Drug Abuse

NIDA’s mission is to advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health.  NIDA enacts its mission by strategically supporting and conducting basic and clinical research on drug use (including nicotine), its consequences, and the underlying neurobiological, behavioral, and social mechanisms involved, as well as by ensuring the effective translation, implementation, and dissemination of scientific research findings to improve the prevention and treatment of substance use disorders and enhance public awareness of addiction as a brain disorder.

https://www.drugabuse.gov

HIV Resources

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The Foundation of AIDS Research (AmFAR)

AmfAR is dedicated to ending the global AIDS epidemic through innovative research.  AmFAR generates awareness of the need for better treatment and prevention methods, and publishes educational materials on important AIDS-related research, treatment, prevention, and policy issues. AmfAR provides media commentary and educational videos on research developments and other aspects of the epidemic.

http://www.amfar.org/about.html
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National AIDS and Education Service for Minorities (NAESM)

NAESM exists to provide national and local leadership to address the myriad of health and wellness issues confronted by black gay men through advocacy, services, and education.  NAESM provides services, volunteer opportunities, has events, and helps build awareness for black gay men who are struggling with, or would like to help fight H.I.V.

http://www.naesm.org
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AVERT- Averting HIV

Working to avert HIV and AIDS worldwide, through education, treatment, and care.  AVERT provides a wide range of information to educate people about HIV and AIDS across the world. The website has information on all aspects of HIV and AIDS, as well as having specific areas for young people, interactive quizzes, an extensive photo gallery, and videos. The website is one of the most widely accessed HIV and AIDS websites in the world.

http://www.avert.org

Cancer Resources

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National Cancer Institute

To coordinate the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.  Website resources include cancer facts and statistics, information regarding ongoing clinical trials for treating and combating cancer, as well as research and funding opportunities for anyone interested.

http://www.cancer.gov
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Avon Foundation for Women

To promote or aid charitable, scientific, educational, and humanitarian activities, with a special emphasis on those activities that improve the lives of women and their families.  From informational resources, to donating to the cause, or check locations for the Avon Walk for Breast Cancer, the Avon Foundation provides a number of different opportunities to educate yourself and make a difference in the fight against breast cancer.

http://www.avonfoundation.org
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Susan G. Komen Foundation

To save lives and end breast cancer forever by empowering others, ensuring quality care for all and investing in science to find the cures.  To utilize website resources such as learning about risk factors, screening and detection, life after treatment, or to share your story with thousands of other individuals diagnosed with breast cancer, visit the link below.
http://ww5.komen.org
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National Breast Cancer Foundation

The National Breast Cancer Foundation’s mission is to help women now by providing help and inspiring hope to those affected by breast cancer through early detection, education and support services.  Among the numerous informational resources provided the National Breast Cancer Foundation, the website allows you to create personalized early detection plans, host fundraisers to help provide mammograms for women in need, and provides you with the opportunity to post and watch videos of other cancer survivors all across the country.
http://www.nationalbreastcancer.org/breast-cancer-awareness-month
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Breastcancer.org

To help women and their loved ones make sense of the complex medical and personal information about breast health and breast cancer, so they can make the best decisions for their lives.  Breastcancer.org has information regarding how to find out about breast cancer symptoms and diagnosis, treatment and its side effects, day to day matters such as nutrition and exercise, and how to lower your risk of being diagnosed with breast cancer.

http://www.breastcancer.org
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Sisters Network

Sisters Network® Inc. is committed to increasing local and national attention to  the devastating impact that breast cancer has in the African American community.

Click the links below for free informational brochures about the organization, the warning signs of breast cancer, and the key questions to ask your doctor after you have been diagnosed with breast cancer.
http://www.sistersnetworkinc.org

Click the links below for free informational brochures about the organization, the warning signs of breast cancer, and the key questions to ask your doctor after you have been diagnosed with breast cancer.

http://www.sistersnetworkinc.org/downloads/sni-national-brochure-web.pdf
http://www.sistersnetworkinc.org/downloads/sni-breast-health-awareness-brochure.pdf
http://www.sistersnetworkinc.org/downloads/sni-key-questions-brochure.pdf

Florida Resources

UF Health Florida Recovery Center: https://floridarecoverycenter.ufhealth.org

Alcoholics Anonymous (AA) in Gainesville: http://www.northcentralflaa.org

Narcotics Anonymous (NA) in Gainesville: http://www.uncoastna.org

Tobacco Free Florida: http://www.tobaccofreeflorida.com

Southern HIV and Alcohol Research Consortium: http://sharc-research.org

Florida Department of Health-HIV and AIDS: http://www.floridahealth.gov/diseases-and-conditions/aids

Breast Cancer Care Locations: https://ufhealth.org/breast-cancer/locations

Additional Resources

College of Public Health and Health Professions http://phhp.ufl.edu

Department of Clinical and Health Psychology http://chp.phhp.ufl.edu