Division of Preventive and Behavioral Medicine marks 30 years of preventing disease, improving health

By Sandra Gray

UMass Medical School Communications

October 17, 2013
cooking-at-shaw
Members of the Division of Preventive and Behavioral Medicine at UMass Medical School are pictured here in the kitchen where they teach patients and health care providers how to cook healthy meals.

In 1983, McDonald’s introduced Chicken McNuggets, the Marlboro Man loomed large across highway billboards, and most doctors focused on treating diseases instead of preventing them.

Preventive and behavioral medicine was more of a concept than a discipline when, that same year, then-Chair of Medicine James Dalen, MD, asked Judith Ockene, PhD, MEd, MA, Robert Goldberg, PhD, and Jon Kabat-Zinn, PhD, to establish a new division focused on just that. With its mission to enhance the health of the public through teaching, research, policy and service in health promotion, disease prevention and adaptation to illness, the UMMS Division of Preventive and Behavioral Medicine became the first of its kind nationwide to reside in a medical school’s department of medicine.

“My vision was a center for prevention based in the Department of Medicine because I believed it would have more credibility there. It put prevention in the mainstream,” recalled Dr. Dalen. “And because prevention means life style, I believed the unit should have a strong focus on behavioral science.”

Dalen appointed behavioral psychologist Dr. Ockene chief of the division, a position she has held since.

The division marked 30 years of groundbreaking education, research and public service with a celebration on Thursday, Oct. 17. Dalen delivered Department of Medicine Grand Rounds Diet and Cardiovascular Disease," then stayed on hand for a campus wide reception later in the day. The event brought the founders and many other faculty and friends from across the state and the nation together to reflect on their impact over three decades—and to look ahead to the expanding role of preventive and behavioral medicine in health and health care.

“Prevention was front and center to me as a behavioral scientist,” said Ockene, the Barbara Helen Smith Chair in Preventive & Behavioral Medicine, professor of medicine and associate vice provost for gender and equity. “It became clear that we needed much more collaboration between medicine and behavior to prevent and manage major public health threats like cardiovascular disease and cancer. Our division was the first to put together prevention and behavior.”

Preventive and behavioral medicine is now a keystone of health care, in large part due to the achievements of the division’s four founding faculty. All of them have become internationally renowned for their groundbreaking efforts to improve health at the intersection of medicine and behavior. Now boasting a cadre of scientists and clinicians who study and promote smoking cessation, stress reduction, weight control, nutrition and other behaviors that can reduce the burden of cardiovascular disease, type 2 diabetes, cancer and other preventable diseases, the Division of Preventive and Behavioral Medicine has received significant funding from the National Institutes of Health and the Massachusetts Department of Public Health as well as foundations and other public and private agencies.

Three major focuses of prevention and behavior in health care—smoking cessation, heart-healthy lifestyle habits and the mind-body connection—have deep roots at UMMS thanks to Dalen, Ockene, Dr. Goldberg and Dr. Kabat-Zinn. Individual luminaries in their respective fields of inquiry, together they formed a powerhouse of research, clinical care and community engagement that has helped establish the field’s vital role in the scientific and medical communities and, most importantly, its value in the mind of the public.

Kabat-Zinn, professor emeritus of medicine, founded The Center for Mindfulness in Medicine, Health Care, and Society at UMMS in 1995. Since then it has become a visionary force and global leader in mind-body medicine, pioneering the integration of mindfulness meditation and other mindfulness-based approaches in mainstream medicine and health care through patient care, research, academic medical and professional education, and into the broader society through diverse outreach and public service initiatives. The center is an outgrowth of the acclaimed Stress Reduction Clinic, also founded by Kabat-Zinn at UMMS, which is the oldest and largest academic medical center-based stress reduction program in the world.

Goldberg, a cardiovascular epidemiologist also recruited to UMMS by Dalen, is the principal investigator for the Worcester Heart Attack Study, which has followed more than 14,000 greater Worcester residents hospitalized with acute myocardial infarction (heart attack) at all medical centers in the Worcester metropolitan area since 1985. Goldberg, professor of medicine and quantitative health sciences and director of the Master of Science in Clinical Science program at UMMS, is proud that the study, now in its 28th year of continuous funding, has yielded more than 100 publications that have helped frame efforts to prevent second heart attacks.

“Dr. Dalen was way ahead of his time,” said Goldberg, recalling the support he received for establishing the study. “In its own way, without us realizing it at first, the study has put the importance of population-based studies and the importance of learning from communities on the map.”

Ockene has mentored countless protégés as division chief, all the while conducting her own research as a co-principal investigator on the landmark Women’s Health Initiative. Now principal investigator for the current National Cancer Institute-funded Randomized Clinical Trials for Smoking Cessation in Medical Schools project, Ockene continues work in the area in which she first made her mark—her early initiatives for smoking cessation led to her appointment as a scientific editor for the 1989 and 1990 Surgeon General’s Report on Smoking. “Obesity now looms large but we didn’t let go of other foci like smoking cessation,” she said of the evolution of the UMMS division as well as the entire discipline of preventive and behavioral medicine.

Asked what she is most proud of, Ockene replied simply, “I’m proud of it all.” Citing exciting new tools from information technology applications to help modify behaviors, to health geography mapping to target communities in the greatest need of public health interventions, she looks forward to making new and ongoing contributions to a field whose day has come.

“We have an unprecedented window of opportunity given the growing recognition at all levels of health care and government that clinical and community interventions that promote and support health behaviors will be essential for success in reducing the nation's most prevalent and costly heath problems and untenable health-care costs and disparities,” said Ockene. “This is the kind of opportunity that propelled the founders of our field 30 years ago, and we are better prepared than ever in our history to seize it.”

Related links on UMassMedNow:
Clinicians urged to help patients improve diet, exercise and healthy behaviors
Drs. Glew, Grisso, Irwin and Ockene receive 2013 Chancellor’s Medals for distinction
Envisioning an alternative future for medicine
A new model of community research tackles obesity in Worcester County
New study to use social media to get dog owners out walking
Doctors cook up heart-healthy dinners