Tonja Renae Nansel, Ph.D.

Behavioral Intervention in Health Care

Dr. Nansel's research is aimed at integrating knowledge from the behavioral sciences into health care practice. Chronic disease and other behavior-related or behavior-managed conditions account for the majority of morbidity, mortality, and health care costs. However, standard health care delivery does not yet adequately incorporate mechanisms for facilitating health-promoting and disease-management behaviors. To address this need, Dr. Nansel seeks to examine the determinants of health-promoting behaviors and develop effective strategies for assisting persons to engage in them. Her research includes a series of studies involving children and adolescents with type 1 diabetes, including the Diabetes Personal Trainer Study, the Family Management of Type 1 Diabetes study and the recently completed Cultivating Healthy Eating in Families of Youth with Type 1 Diabetes (CHEF) study. Dr. Nansel's current work is now extending to a broader population, with the forthcoming Pregnancy Eating Attributes (PEAs) study, a longitudinal observational study on dietary behaviors among pregnant women.

Dr. Nansel's work addressing type 1 diabetes management included two multi-site efficacy trials – the Diabetes Personal Trainer Study and the Family Management of Type 1 Diabetes study. The behavioral intervention approach developed in these studies utilized applied problem-solving flexibly applied to areas of diabetes management difficulty identified by the child and parents. This approach was first tested with families in the home setting in the Diabetes Personal Trainer study, and was then refined and modified for use in the clinical setting in the Family Management of Type 1 Diabetes study. Findings from both trials indicted that among adolescents, the intervention resulted in better glycemic control relative to control youth receiving standard diabetes care. However, an effect was not observed for pre-adolescents. Given the well-documented deterioration in glycemic control that occurs during adolescence, the development of an effective approach for this age group is of particular clinical significance.

Dr. Nansel's current research focuses primarily on determinants of dietary intake and strategies to promote healthful eating. She is leading the Cultivating Healthy Eating in Families of Youth with Type 1 Diabetes (CHEF) study testing the efficacy a family-based behavioral intervention designed to improve diet quality. The intervention approach, which is grounded in social cognitive theory, self-regulation, and self-determination theory, integrates motivational interviewing, active learning, and applied problem-solving to target increased dietary intake of fruits, vegetables, whole grains, legumes, nuts, and seeds. The Pregnancy Eating Attributes Study (PEAS) study, currently in recruiting participants, will address this knowledge gap by examining the implications of findings on the importance of the food reward response for understanding and influencing maternal diet and weight change. The semi-structured approach allows for flexibility in delivery to accommodate differences in youth age as well as family cultural and socioeconomic differences. Conduct of the CHEF efficacy trial was recently completed; analyses of findings are underway.

In light of the crucial need to develop effective approaches to facilitate healthful eating for the broader population, and given evidence that pregnancy may be a critical developmental period for impacting long-term health outcomes, Dr. Nansel's work has recently shifted to an examination of the determinants of dietary intake and appropriate weight gain during pregnancy. Over half of women of reproductive age now enter pregnancy overweight or obese, and the majority experience gestational weight gain in excess of Institute of Medicine guidelines, leading to increased perinatal and chronic health risks for both mother and child. Well-documented inadequacies of traditional weight-management interventions relying on existing paradigms suggest the need for a shift in the theoretical framework underlying the determinants of eating behavior. Recent findings from basic neuroscience research suggest that a critical missing element may be the brain reward response to food. This rapidly-expanding body of work has not yet been incorporated into population-based research. The Pregnancy Eating Attributes (PEAs) study, currently in development, will address this knowledge gap by examining the implications of findings on the importance of the food reward response for understanding and influencing maternal diet and weight change. The overarching goal of this research is to advance understanding of the determinants of eating behavior in order to develop and test novel interventions for improving maternal diet and weight change, leading to improved maternal and child health trajectories.

Tonja R. Nansel, Ph.D. is a senior investigator in the Health Behavior Branch of the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development. Dr. Nansel received a Bachelor of Science in Nursing from Fort Hays State University in 1988, and a doctoral degree in Community/Clinical Psychology from Wichita State University in 1998. She completed a predoctoral internship with Kansas State Extension Office of Community Health and a postdoctoral fellowship with NICHD Prevention Research Branch. Dr. Nansel has been an investigator in the Health Behavior Branch (previously the Prevention Research Branch), since 2001.