A Risk-Based Model Predictive Control Approach to Adaptive Interventions in Behavioral Health

This brief examines how control engineering and risk management techniques can be applied in the field of behavioral health through their use in the design and implementation of adaptive behavioral interventions. Adaptive interventions are gaining increasing acceptance as a means to improve prevention and treatment of chronic, relapsing disorders, such as abuse of alcohol, tobacco, and other drugs, mental illness, and obesity. A risk-based model predictive control (MPC) algorithm is developed for a hypothetical intervention inspired by Fast Track, a real-life program whose long-term goal is the prevention of conduct disorders in at-risk children. The MPC-based algorithm decides on the appropriate frequency of counselor home visits, mentoring sessions, and the availability of after-school recreation activities by relying on a model that includes identifiable risks, their costs, and the cost/benefit assessment of mitigating actions. MPC is particularly suited for the problem because of its constraint-handling capabilities, and its ability to scale to interventions involving multiple tailoring variables. By systematically accounting for risks and adapting treatment components over time, an MPC approach as described in this brief can increase intervention effectiveness and adherence while reducing waste, resulting in advantages over conventional fixed treatment. A series of simulations are conducted under varying conditions to demonstrate the effectiveness of the algorithm

Adolescent substance use: a prospective longitudinal model of substance use onset among South African adolescents

Substance use onset among Colored adolescents between eighth and ninth grades in an urban area of Cape Town, South Africa was examined using latent transition analysis. Longitudinal self-report data regarding substance use (N = 1118, 50.9% female) were collected in 2004 and 2005. Results indicated that the pattern of onset was similar across genders; adolescents first tried either alcohol or cigarettes, followed by both, then dagga (cannabis), and then inhalants. The prevalence of lifetime cigarette use was slightly greater for females; dagga (cannabis) and inhalant use were greater for males. The similarity of developmental onset in the current sample to previous international work supports the promise of adapting prevention programs across contexts. The study’s limitations are noted.Web of Scienc

Translational research in South Africa: evaluating implementation quality using a factorial design

Background: HealthWise South Africa: Life Skills for Adolescents (HW) is an evidence- based substance use and sexual risk prevention program that emphasizes the positive use of leisure time. Since 2000, this program has evolved from pilot testing through an efficacy trial involving over 7,000 youth in the Cape Town area. Beginning in 2011, through 2015, we are undertaking a new study that expands HW to all schools in the Metro South Education District. Objective: This paper describes a research study designed in partnership with our South African collaborators that examines three factors hypothesized to affect the quality and fidelity of HW implementation: enhanced teacher training; teacher support, structure and supervision; and enhanced school environment. Methods: Teachers and students from 56 schools in the Cape Town area will participate in this study. Teacher observations are the primary means of collecting data on factors affecting implementation quality. These factors address the practical concerns of teachers and schools related to likelihood of use and cost-effectiveness, and are hypothesized to be "active ingredients" related to high-quality program implementation in real-world settings. An innovative factorial experimental design was chosen to enable estimation of the individual effect of each of the three factors. Results: Because this paper describes the conceptualization of our study, results are not yet available. Conclusions: The results of this study may have both substantive and methodological implications for advancing Type 2 translational research

A Conceptual Framework for Adaptive Preventive Interventions

Recently, adaptive interventions have emerged as a new perspective on prevention and treatment. Adaptive interventions resemble clinical practice in that different dosages of certain prevention or treatment components are assigned to different individuals, and/or within individuals across time, with dosage varying in response to the intervention needs of individuals. To determine intervention need and thus assign dosage, adaptive interventions use prespecified decision rules based on each participant's values on key characteristics, called tailoring variables. In this paper, we offer a conceptual framework for adaptive interventions, discuss principles underlying the design and evaluation of such interventions, and review some areas where additional research is needed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45501/1/11121_2004_Article_490385.pd

Youths’ Substance Use and Changes in Parental Knowledge-Related Behaviors During Middle School: A Person-Oriented Approach

Parental knowledge is a key protective factor for youths’ risky behavior. Little is known about how longitudinal combinations of knowledge-related behaviors are associated with youths’ substance use. This longitudinal study uses Latent Transition Analysis to identify latent patterns of parental knowledge-related behaviors occurring in mother-youth dyads during middle school and to investigate how changes in knowledge-related patterns are associated with youths’ substance use in Grade 6 and the initiation of substance use from Grade 6 to 8. Using a sample of 536 rural dyads (53% female, 84% White), we assessed mother and youths’ reports of parental knowledge, active parental monitoring efforts, youth disclosure, and parent-youth communication to identify six latent patterns of knowledge-related behaviors: High Monitors, Low Monitors, Communication-Focused, Supervision-Focused, Maternal Over-Estimators, and Youth Over-Estimators. Fifty percent or more of dyads in the High Monitors, Communication-Focused and Youth Over-Estimators were in the same status in both 6th and 8th grade: 98% of Low Monitors in Grade 6 were also in this status in Grade 8. The initiation of alcohol, smoking, and marijuana was associated significantly with transitions between patterns of knowledge-related behaviors. The initiation of alcohol and smoking were associated with increased odds of transitions into the Low Monitors from the Communication-Focused, Supervision-Focused, and Maternal Over-Estimators. However, the initiation of substance use was associated with decreased odds of transitions from the High Monitors to the Low Monitors and with increased odds of transitions from High Monitors to Supervision-Focused. The discussion focuses on the value of using a person-oriented dyadic approach with multiple reporters to study changes in knowledge-related behaviors over the middle school period

The Micro-Randomized Trial for Developing Digital Interventions: Data Analysis Methods

Although there is much excitement surrounding the use of mobile and wearable technology for the purposes of delivering interventions as people go through their day-to-day lives, data analysis methods for constructing and optimizing digital interventions lag behind. Here, we elucidate data analysis methods for primary and secondary analyses of micro-randomized trials (MRTs), an experimental design to optimize digital just-in-time adaptive interventions. We provide a definition of causal "excursion" effects suitable for use in digital intervention development. We introduce the weighted and centered least-squares (WCLS) estimator which provides consistent causal excursion effect estimators for digital interventions from MRT data. We describe how the WCLS estimator along with associated test statistics can be obtained using standard statistical software such as SAS or R. Throughout we use HeartSteps, an MRT designed to increase physical activity among sedentary individuals, to illustrate potential primary and secondary analyses

Clinical and Economic Outcomes of Rabbit Antithymocyte Globulin Induction in Adults Who Received Kidney Transplants from Living Unrelated Donors and Received Cyclosporine‐Based Immunosuppression

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90167/1/phco.29.10.1166.pd

STS in management education: connecting theory and practice

This paper explores the value of science and technology studies (STS) to management education. The work draws on an ethnographic study of second year management undergraduates studying decision making. The nature and delivery of the decision making module is outlined and the value of STS is demonstrated in terms of both teaching method and module content. Three particular STS contributions are identified and described: the social construction of technological systems; actor network theory; and ontological politics. Affordances and sensibilities are identified for each contribution and a discussion is developed that illustrates how these versions of STS are put to use in management education. It is concluded that STS has a pivotal role to play in critical management (education) and in the process offers opportunities for new forms of managin

Using the Multiphase Optimization Strategy (MOST) to optimize an HIV care continuum intervention for vulnerable populations : a study protocol

Abstract: Background. More than half of persons living with HIV (PLWH) in the United States are insufficiently engaged in HIV primary care and not taking antiretroviral therapy (ART), mainly African Americans/Blacks and Hispanics. In the proposed project, a potent and innovative research methodology, the multiphase optimization strategy (MOST), will be employed to develop a highly efficacious, efficient, scalable, and cost-effective intervention to increase engagement along the HIV care continuum. Whereas randomized controlled trials are valuable for evaluating the efficacy of multi-component interventions as a package, they are not designed to evaluate which specific components contribute to efficacy. MOST, a pioneering, engineering-inspired framework, addresses this problem through highly efficient randomized experimentation to assess the performance of individual intervention components and their interactions. We propose to use MOST to engineer an intervention to increase engagement along the HIV care continuum for African American/Black and Hispanic PLWH not well engaged in care and not taking ART. Further, the intervention will be optimized for cost-effectiveness. A similar set of multi-level factors impede both HIV care and ART initiation for African American/Black and Hispanic PLWH, primary among them individual- (e.g., substance use, distrust, fear), social- (e.g., stigma), and structural-level barriers (e.g., difficulties accessing ancillary services). Guided by a multi-level social cognitive theory, the study will evaluate five distinct intervention components (i.e., Motivational Interviewing counseling sessions, pre-adherence preparation, support groups, peer mentorship, and patient navigation), each designed to address a specific barrier to HIV care and ART initiation. These components are well-grounded in the empirical literature and were found acceptable, feasible, and promising with respect to efficacy in a preliminary study. Methods/design. Study aims are: 1) using a highly efficient fractional factorial experimental design, identify which of five intervention components contribute meaningfully to improvement in HIV viral suppression, and secondary outcomes of ART adherence and engagement in HIV primary care; 2) identify mediators and moderators of intervention component efficacy; and 3) using a mathematical modeling approach, build the most cost-effective and efficient intervention package from the efficacious components. A heterogeneous sample of African American/Black and Hispanic PLWH (with respect to age, substance use, and sexual minority status) will be recruited with a proven hybrid sampling method using targeted sampling in community settings and peer recruitment (N=512). Discussion. This is the first study to apply the MOST framework in the field of HIV prevention and treatment. This innovative study will produce an HIV care continuum intervention for the nation's most vulnerable PLWH, optimized for cost-effectiveness, and with exceptional levels of efficacy, efficiency, and scalability

The potential health impact of restricting less-healthy food and beverage advertising on UK television between 05.30 and 21.00 hours: A modelling study

Funder: National Institute for Health Research; funder-id: http://dx.doi.org/10.13039/501100000272Funder: British AcademyBackground: Restrictions on the advertising of less-healthy foods and beverages is seen as one measure to tackle childhood obesity and is under active consideration by the UK government. Whilst evidence increasingly links this advertising to excess calorie intake, understanding of the potential impact of advertising restrictions on population health is limited. Methods and findings: We used a proportional multi-state life table model to estimate the health impact of prohibiting the advertising of food and beverages high in fat, sugar, and salt (HFSS) from 05.30 hours to 21.00 hours (5:30 AM to 9:00 PM) on television in the UK. We used the following data to parameterise the model: children’s exposure to HFSS advertising from AC Nielsen and Broadcasters’ Audience Research Board (2015); effect of less-healthy food advertising on acute caloric intake in children from a published meta-analysis; population numbers and all-cause mortality rates from the Human Mortality Database for the UK (2015); body mass index distribution from the Health Survey for England (2016); disability weights for estimating disability-adjusted life years (DALYs) from the Global Burden of Disease Study; and healthcare costs from NHS England programme budgeting data. The main outcome measures were change in the percentage of the children (aged 5–17 years) with obesity defined using the International Obesity Task Force cut-points, and change in health status (DALYs). Monte Carlo analyses was used to estimate 95% uncertainty intervals (UIs). We estimate that if all HFSS advertising between 05.30 hours and 21.00 hours was withdrawn, UK children (n = 13,729,000), would see on average 1.5 fewer HFSS adverts per day and decrease caloric intake by 9.1 kcal (95% UI 0.5–17.7 kcal), which would reduce the number of children (aged 5–17 years) with obesity by 4.6% (95% UI 1.4%–9.5%) and with overweight (including obesity) by 3.6% (95% UI 1.1%–7.4%) This is equivalent to 40,000 (95% UI 12,000–81,000) fewer UK children with obesity, and 120,000 (95% UI 34,000–240,000) fewer with overweight. For children alive in 2015 (n = 13,729,000), this would avert 240,000 (95% UI 65,000–530,000) DALYs across their lifetime (i.e., followed from 2015 through to death), and result in a health-related net monetary benefit of £7.4 billion (95% UI £2.0 billion–£16 billion) to society. Under a scenario where all HFSS advertising is displaced to after 21.00 hours, rather than withdrawn, we estimate that the benefits would be reduced by around two-thirds. This is a modelling study and subject to uncertainty; we cannot fully and accurately account for all of the factors that would affect the impact of this policy if implemented. Whilst randomised trials show that children exposed to less-healthy food advertising consume more calories, there is uncertainty about the nature of the dose–response relationship between HFSS advertising and calorie intake. Conclusions: Our results show that HFSS television advertising restrictions between 05.30 hours and 21.00 hours in the UK could make a meaningful contribution to reducing childhood obesity. We estimate that the impact on childhood obesity of this policy may be reduced by around two-thirds if adverts are displaced to after 21.00 hours rather than being withdrawn