Center on Stress & Health
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The UCI Center on Stress & Health has several on-going applied behavioral research studies being conducted in multiple medical settings. The multi-disciplinary research team is dedicated to the goal of changing current practice in healthcare to better assist children and families manage pain, anxiety and stress surrounding the medical environment and disease burden.

Perioperative Anxiety and Pain

A Tailored Internet-Based Preparation Program for Pediatric Perioperative Anxiety and Pain (WebTIPS)
The purpose of this multisite randomized control trial is to test the efficacy of a Web-based Tailored Intervention Preparation for Surgery (WebTIPS) versus WebINFO, the attention control group program, targeted at children ages 1-12 undergoing outpatient elective surgery, and their parents.

Healthcare Provider Behavior and Children's Perioperative Distress (PTIPS)
The purpose of this multisite Randomized controlled trial was to examine effectiveness of a behavioral training program for adult management of children preoperative anxiety. Data collection concluded in 2017. Data analysis and manuscript preparation ongoing.

Psychosocial Oncology

Pain Buddy Treating Pain in Children with Cancer: A 21st Century Innovative Approach
The purpose of this multisite randomized control trial is to examine the feasibility of the ambulatory monitoring protocol, called Pain Buddy, in documenting children’s pain, symptoms and quality of life while receiving outpatient chemotherapy and effectiveness of Pain Buddy in reducing pain severity. The long term goal of Pain Buddy is to help doctors, nurses, and parents get the information they need to give children treatments for pain and symptom management that work.

Influence of Acculturation and Social Support on Health-Related Quality of Life in Survivors of Childhood Cancer
The purpose of this mixed-method, cross-sectional study is to explore the influence of perceived social support and acculturation on health outcomes in childhood cancer survivors ages 6-21 years-old. Social support can serve as a buffer to the development of illness and this study will examine the relationship between perceived social support and HRQOL. Acculturation of both survivors and their parents will be examined as another variable in relation to HRQOL. In addition, this study aims increase the understanding of the efficacy of resilience as a buffer to maladaptive health habits of childhood cancer survivors.

Children impacted by Cancer in the Latino Community
The purpose of this study is to conduct community based participatory research (CBPR), which will involve partnering with a community group of low income Latino families at CHOC impacted by childhood cancer in order to identify research questions relevant to the Latino population. The second phase of this project will be the development of a culturally tailored intervention to improve the quality of life and wellbeing of Spanish Speaking Latinx caregivers of a child with cancer.

Building mHealth Capacity to Manage Pain in Young Children with Cancer: Needs Assessment and Usability Testing for a Caregiver-led Pain Management App
This study will use a two-phased and user-centered approach to refine an existing mHealth pain management app (Pain Squad+) for use in young children, utilizing their caregivers in a pain assessment and management role. Specifically, this research involves: (1) conducting an interview-based needs assessment with caregivers and clinicians to determine the needed features for the app, (2) modifying a prototype app (developed using information from Phase 1) for caregivers using iterative cycles of usability testing and software revision.

Non-invasive Monitoring of Adrenal Suppression in Children Diagnosed with Acute Lymphoblastic Leukemia
The purpose of this study is to examine the feasibility of the proposed assessment strategy in monitoring adrenal suppression among children with ALL. Utilizing salivary cortisol measurements is a non-invasive and reliable method of detecting adrenal suppression, and can be especially informative in the childhood ALL population for whom no current standard guidelines exist to diagnose and treat adrenal suppression.

Retrospective analysis of analgesic patterns among pediatric oncology population
The purpose of this retrospective study is to examine the rates of opioid prescription in children in the oncology setting. The study team will compare objective analgesic prescription data from medical records to patient self-report of opioid use in the pediatric cancer population.

Patient Experience

Predictors of Patient Satisfaction in the Oncology Setting
The overall primary objective of the study is to prospectively identify clinical, demographic and behavioral predictors of patient satisfaction scores in a pediatric oncology patient population receiving outpatient chemotherapy and/or receiving follow-up services from the cancer clinics at Children’s Hospital of Orange County (CHOC Children’s). The overall hypothesis is that the key predictors will have a significant impact on patient satisfaction scores.

Predictors of Patient Experience
The overall purpose of the study is to prospectively identify clinical, demographic and behavioral predictors of patient satisfaction scores in a pediatric patient population in the outpatient procedure center, urology clinic, and the Emergency Department. The study will also be looking at the associations between physician personality and patient satisfaction scores. The overall hypothesis is that the key predictors and physician characteristics will have a significant impact on patient satisfaction scores.

Patient Experience: Predictors and Outcomes (UCI)
The overall purpose of the study is to identify demographics and clinical predictors of patient satisfaction scores in an adult patient population.

  • Specific aim 1: To examine if patient ethnicity, controlling for confounding variables such as socioeconomic status, is affecting patient satisfaction scores.
  • Specific aim 2: To examine if demographic variables such as age, gender and insurance status are affecting patient satisfaction scores.
  • Specific aim 3: To examine if clinical variables such as severity of disease, site of hospitalization, pain scores, use of opioids as well as other variables are affecting is affecting patient satisfaction scores.


Asthma Study
The purpose of this study is to conduct a daily diary study of positive affect and asthma in a pediatric population. Two additional unique components of this study will be an examination of different types of positive affect based on arousal level (e.g., high arousal vigor vs. low arousal calm) and whether positive affect has a stress buffering effect.
This project has the potential to discover how positive affect may promote resilience in pediatric asthma symptom frequency and severity. Given the costs associated with asthma related symptoms, understanding positive affect as a marker of resilience may provide avenues for future intervention work.

Leveraging Big Data from a Population Health Program of Children with Asthma in a Children’s Hospital Setting
The primary aim of this study is to assess the predictors of asthma outcomes from the Population Health Emergency department data, and primary care appointment retention associated with Emergency department visits. Findings from the current project may direct hospital administration as to where revisions in treatment and intervention are needed. Moreover, knowledge of sociodemographic disparities in pediatric asthma can initiate further research in this area examining how to alleviate such disparities.

Opioid Pandemic

Opioids and CHOC Electronic Medical Records
The primary aim of this study of this database study is to examine the rates of opioid prescription, use, and misuse in children in the hospital setting and by medical specialists. The secondary aim of this study is determine how opioid prescription, use, and misuse is related to pain, sociodemographic factors, and parent satisfaction.

Emergency Room Anxiety and Pain

A Virtual Reality Biofeedback Computer Game for Pediatric Pain Relief: Analyses of Video Data (CalmCraft)
This is a multisite study with Children’s Hospital of Atlanta (CHOA, coordinating site) and CHOC Children’s. The purpose of the original (initial) study conducted by CHOA was to reduce children’s anxiety and pain during emergency department (ED) medical procedures. The current study will utilize previously collected video data from CHOA to adapting the Modified Yale Preoperative Anxiety Scale (mYPAS) to assess pre-procedural anxiety in children undergoing invasive procedures in the ED. An expert panel consisting of an anesthesiologist, ED physician, ED nurse, pediatric psychologist, developmental psychologist, and psychometrician will review video data, suggest measure changes, and review the content validity of the adapted mYPAS-ED.

Predictors and Outcomes of Anxiety Surrounding Invasive Procedures in the Emergency Department (MYPAS-ED)
The objective of this two-phase study is to examine the reliability and validity of the ED version of the mYPAS to assess anxiety in Spanish- and English-speaking children undergoing ED invasive procedures, and to examine child, parent and provider predictors and outcomes associated with anxiety surrounding ED procedures. We will recruit a total of 144 children undergoing invasive ED procedures (e.g., laceration repair, bone fracture repair) and their families. Reliability and validity analyses of the adapted mYPAS will be conducted with 54 children (27 children per language group). In addition, we will examine the effect of child, parent and provider factors on child procedural anxiety and child behavioral, pain and patient-centered (i.e., patient satisfaction) outcomes 3-, 7- and 14-days following discharge from the ED.


Cultivating Relational Attachment Despite Limited Engagement (CRADLE) Study
This study aims to boost mothers’ wellness by strengthening the parent-infant bond via relational savoring – a cognitive practice pioneered by Dr. Jessica Borelli. Drawing from a strong research base related to positive emotion, attachment theory, and mindfulness, relational savoring encourages mothers’ capacity to focus on moments of emotional connectedness with children and has shown impressive effects in other populations. In addition, because accessibility to treatment is an obstacle for many NICU families, the proposed intervention will be implemented using a smartphone platform that is designed to reach mothers as they go about their daily activities.

Sub Awards

STAR: Surgery in Teens - Assessing Recover
The objective of this research is to identify acute recovery patterns that predict development of Chronic postsurgical pain (CPSP), and to identify psychosocial and psychophysical mechanisms underlying the transition from acute to CPSP in youth, consistent with the priorities of the Federal Pain Research Strategy. Findings are expected to inform future research developing interventions to reduce exposure to opioids and prevent CPSP, with the goal of improving long-term outcomes in youth after musculoskeletal surgery.