Linda Collins

Linda Collins
Linda Collins
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Professor of Social and Behavioral Sciences

Professional overview

Linda M. Collins is Professor of Global Public Health in the Department of Social and Behavioral Sciences, with a secondary appointment in the Department of Biostatistics. She earned her B.A. in Psychology at the University of Connecticut and her Ph.D. in Quantitative Psychology at the University of Southern California.

Collins’ research interests are focused on the development, dissemination, and application of the multiphase optimization strategy (MOST), a framework for the optimization of behavioral, biobehavioral, and social-structural interventions. The objective of MOST is to improve intervention effectiveness, efficiency, economy, and scalability. She is currently collaborating on research applying MOST in the areas of smoking cessation, the prevention of excessive drinking and risky sex in college students, and HIV services.

Collins’ research has been funded by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Science Foundation, among others. She has given more than 150 presentations on MOST around the world, and her publications have appeared in journals in the fields of behavioral science, quantitative methodology, medicine, and engineering.

Collins has held tenured faculty positions at the University of Southern California and at Penn State University, where she was Distinguished Professor of Human Development and Family Studies and Director of The Methodology Center. She is a Fellow of the American Psychological Association, the Association for Psychological Science, the Society of Behavioral Medicine, and is a past president of the Society of Multivariate Experimental Psychology and the Society for Prevention Research.

Education

BA, Psychology, University of Connecticut, Storrs, CT
PhD, Quantitative Psychology, University of Southern California, Los Angeles, CA

Honors and awards

Fulbright Specialist, National University of Ireland Galway (2018)
Pauline Schmitt Russell Distinguished Career Award, Pennsylvania State University’s College of Health and Human Development (2017)
Evan G. and Helen G. Pattishall Outstanding Research Achievement Award, Pennsylvania State University’s College of Health and Human Development (2011)
President’s Award, Society for Prevention Research (2004)
Faculty Scholar Medal for the Social and Behavioral Sciences, Pennsylvania State University (2000)
Psychology Department Teacher of the Year, University of Southern California (1992)
Psychology Department Mentorship Award, University of Southern California (1991)
Society of Multivariate Experimental Psychology Award for Distinguished Early Career Contributions to Multivariate Behavioral Research (1991)

Areas of research and study

Behavioral Science
Cost Effectiveness
Cost-effective Health Programs and Policies
Dissemination and Implementation of Evidence-based Programs

Publications

Publications

Optimizing Interventions for Equitability: Some Initial Ideas

Strayhorn, J. C., Vanness, D. J., & Collins, L. M. (n.d.).

Publication year

2024

Journal title

Prevention Science
Abstract
Abstract
Interventions (including behavioral, biobehavioral, biomedical, and social-structural interventions) hold tremendous potential not only to improve public health overall but also to reduce health disparities and promote health equity. In this study, we introduce one way in which interventions can be optimized for health equity in a principled fashion using the multiphase optimization strategy (MOST). Specifically, we define intervention equitability as the extent to which the health benefits provided by an intervention are distributed evenly versus concentrated among those who are already advantaged, and we suggest that, if intervention equitability is acknowledged to be a priority, then equitability should be a key criterion that is balanced with other criteria (effectiveness overall, as well as affordability, scalability, and/or efficiency) in intervention optimization. Using a hypothetical case study and simulated data, we show how MOST can be applied to achieve a strategic balance that incorporates equitability. We also show how the composition of an optimized intervention can differ when equitability is considered versus when it is not. We conclude with a vision for next steps to build on this initial foray into optimizing interventions for equitability.

Using decision analysis for intervention value efficiency to select optimized interventions in the multiphase optimization strategy

Strayhorn, J. C., Cleland, C. M., Vanness, D. J., Wilton, L., Gwadz, M., & Collins, L. M. (n.d.).

Publication year

2024

Journal title

Health psychology : official journal of the Division of Health Psychology, American Psychological Association

Volume

43

Issue

2

Page(s)

89-100
Abstract
Abstract
OBJECTIVE: Optimizing multicomponent behavioral and biobehavioral interventions presents a complex decision problem. To arrive at an intervention that is both effective and readily implementable, it may be necessary to weigh effectiveness against implementability when deciding which components to select for inclusion. Different components may have differential effectiveness on an array of outcome variables. Moreover, different decision-makers will approach this problem with different objectives and preferences. Recent advances in decision-making methodology in the multiphase optimization strategy (MOST) have opened new possibilities for intervention scientists to optimize interventions based on a wide variety of decision-maker preferences, including those that involve multiple outcome variables. In this study, we introduce decision analysis for intervention value efficiency (DAIVE), a decision-making framework for use in MOST that incorporates these new decision-making methods. We apply DAIVE to select optimized interventions based on empirical data from a factorial optimization trial. METHOD: We define various sets of hypothetical decision-maker preferences, and we apply DAIVE to identify optimized interventions appropriate to each case. RESULTS: We demonstrate how DAIVE can be used to make decisions about the composition of optimized interventions and how the choice of optimized intervention can differ according to decision-maker preferences and objectives. CONCLUSIONS: We offer recommendations for intervention scientists who want to apply DAIVE to select optimized interventions based on data from their own factorial optimization trials. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

What to do after smoking relapse? A sequential multiple assignment randomized trial of chronic care smoking treatments

Schlam, T. R., Baker, T. B., Piper, M. E., Cook, J. W., Smith, S. S., Zwaga, D., Jorenby, D. E., Almirall, D., Bolt, D. M., Collins, L. M., Mermelstein, R., & Fiore, M. C. (n.d.).

Publication year

2024

Journal title

Addiction
Abstract
Abstract
Aim: To compare effects of three post-relapse interventions on smoking abstinence. Design: Sequential three-phase multiple assignment randomized trial (SMART). Setting: Eighteen Wisconsin, USA, primary care clinics. Participants: A total of 1154 primary care patients (53.6% women, 81.2% White) interested in quitting smoking enrolled from 2015 to 2019; 582 relapsed and were randomized to relapse recovery treatment. Interventions: In phase 1, patients received cessation counseling and 8 weeks nicotine patch. Those who relapsed and agreed were randomized to a phase 2 relapse recovery group: (1) reduction counseling + nicotine mini-lozenges + encouragement to quit starting 1 month post-randomization (preparation); (2) repeated encouragement to quit starting immediately post-randomization (recycling); or (3) advice to call the tobacco quitline (control). The first two groups could opt into phase 3 new quit treatment [8 weeks nicotine patch + mini-lozenges plus randomization to two treatment factors (skill training and supportive counseling) in a 2 × 2 design]. Phase 2 and 3 interventions lasted ≤ 15 months. Measurements: The study was powered to compare each active phase 2 treatment with the control on the primary outcome: biochemically confirmed 7-day point-prevalence abstinence 14 months post initiating phase 2 relapse recovery treatment. Exploratory analyses tested for phase 3 counseling factor effects. Findings: Neither skill training nor supportive counseling (each on versus off) increased 14-month abstinence rates; skills on versus off 9.3% (14/151) versus 5.2% (8/153), P = 0.19; support on versus off 6.6% (10/152) versus 7.9% (12/152), P = 0.73. Phase 2 preparation did not produce higher 14-month abstinence rates than quitline referral; 3.6% (8/220) versus 2.1% [3/145; risk difference = 1.5%, 95% confidence interval (CI) = −1.8−5.0%, odds ratio (OR) = 1.8, 95% CI = 0.5–6.9]. Recycling, however, produced higher abstinence rates than quitline referral; 6.9% (15/217) versus 2.1% (three of 145; risk difference, 4.8%, 95% CI = 0.7–8.9%, OR = 3.5, 95% CI = 1.0–12.4). Recycling produced greater entry into new quit treatment than preparation: 83.4% (181/217) versus 55.9% (123/220), P < 0.0001. Conclusions: Among people interested in quitting smoking, immediate encouragement post-relapse to enter a new round of smoking cessation treatment (‘recycling’) produced higher probability of abstinence than tobacco quitline referral. Recycling produced higher rates of cessation treatment re-engagement than did preparation/cutting down using more intensive counseling and pharmacotherapy.

A Posterior Expected Value Approach to Decision-Making in the Multiphase Optimization Strategy for Intervention Science

Strayhorn, J. C., Collins, L. M., & Vanness, D. J. (n.d.).

Publication year

2023

Journal title

Psychological Methods
Abstract
Abstract
In current practice, intervention scientists applying the multiphase optimization strategy (MOST) with a 2k factorial optimization trial use a component screening approach (CSA) to select intervention components for inclusion in an optimized intervention. In this approach, scientists review all estimated main effects and interactions to identify the important ones based on a fixed threshold, and then base decisions about component selection on these important effects. We propose an alternative posterior expected value approach based on Bayesian decision theory. This newapproach aims to be easier to apply and more readily extensible to a variety of intervention optimization problems.We used Monte Carlo simulation to evaluate the performance of a posterior expected value approach and CSA (automated for simulation purposes) relative to two benchmarks: random component selection, and the classical treatment package approach. We found that both the posterior expected value approach and CSA yielded substantial performance gains relative to the benchmarks. We also found that the posterior expected value approach outperformed CSA modestly but consistently in terms of overall accuracy, sensitivity, and specificity, across a wide range of realistic variations in simulated factorial optimization trials. We discuss implications for intervention optimization and promising future directions in the use of posterior expected value to make decisions in MOST.

Application of the multiphase optimisation strategy (MOST) to optimise HIV prevention targeting people on medication for opioid use disorder (MOUD) who have cognitive dysfunction: protocol for a MOST study

Mistler, C. B., Shrestha, R., Gunstad, J., Collins, L., Madden, L., Huedo-Medina, T., Sibilio, B., Copenhaver, N. M., & Copenhaver, M. (n.d.).

Publication year

2023

Journal title

BMJ open

Volume

13

Issue

6
Abstract
Abstract
Introduction People who inject drugs (PWID) have remained a contributor to the consistent HIV incidence rates in the US for decades. Pre-exposure prophylaxis (PrEP) is a promising biomedical intervention for HIV prevention among individuals at risk for HIV infection, including PWID. However, PWID report the lowest rates of PrEP uptake and adherence among at-risk groups. Tailored HIV prevention interventions must include strategies that compensate for cognitive dysfunction among PWID. Methods and analysis Using the multiphase optimisation strategy, we will be conducting a 16-condition factorial experiment to investigate the effects of four different accommodation strategy components to compensate for cognitive dysfunction among 256 PWID on medication for opioid use disorder. This innovative approach will inform optimisation of a highly effective intervention to enhance PWID's ability to process and utilise HIV prevention content to improve PrEP adherence and HIV risk reduction in a drug treatment setting. Ethics and dissemination The institutional review board at the University of Connecticut approved this protocol (H22-0122) with an institutional reliance agreement with APT Foundation Inc. All participants are required to sign an informed consent form prior to engaging in any study protocols. The results of this study will be disseminated on national and international platforms through presentations at major conferences and journals. Trial registration number NCT05669534.

Cost-Effectiveness of Smoking Cessation Approaches in Emergency Departments

Miller, T. R., Johnson, M. B., Dziura, J. D., Weiss, J., Carpenter, K. M., Grau, L. E., Pantalon, M. V., Abroms, L., Collins, L. M., Toll, B. A., & Bernstein, S. L. (n.d.).

Publication year

2023

Journal title

American journal of preventive medicine

Volume

65

Issue

1

Page(s)

39-44
Abstract
Abstract
Introduction: Americans of lower SES use tobacco products at disproportionately high rates and are over-represented as patients of emergency departments. Accordingly, emergency department visits are an ideal time to initiate tobacco treatment and aftercare for this vulnerable and understudied population. This research estimates the costs per quit of emergency department smoking-cessation interventions and compares them with those of other approaches. Methods: Previously published research described the effectiveness of 2 multicomponent smoking cessation interventions, including brief negotiated interviewing, nicotine replacement therapy, quitline referral, and follow-up communication. Study 1 (collected in 2010–2012) only analyzed the combined interventions. Study 2 (collected in 2017–2019) analyzed the intervention components independently. Costs per participant and per quit were estimated separately, under distinct intervention with dedicated staff and intervention with repurposed staff assumptions. The distinction concerns whether the intervention used dedicated staff for delivery or whether time from existing staff was repurposed for intervention if available. Results: Data were analyzed in 2021–2022. In the first study, the cost per participant was $860 (2018 dollars), and the cost per quit was $11,814 (95% CI=$7,641, $25,423) (dedicated) and $227 per participant and $3,121 per quit (95% CI=$1,910, $7,012) (repurposed). In Study 2, the combined effect of brief negotiated interviewing, nicotine replacement therapy, and quitline cost $808 per participant and $6,100 per quit (dedicated) (95% CI=$4,043, $12,274) and $221 per participant and $1,669 per quit (95% CI=$1,052, $3,531) (repurposed). Conclusions: Costs varied considerably per method used but were comparable with those of other smoking cessation interventions.

Effects of Behavioral Intervention Components for African American/Black and Latino Persons Living with HIV with Non-suppressed Viral Load Levels: Results of an Optimization Trial

Cleland, C. M., Gwadz, M., Collins, L. M., Wilton, L., Leonard, N. R., Ritchie, A. S., Martinez, B. Y., Silverman, E., Sherpa, D., & Dorsen, C. (n.d.).

Publication year

2023

Journal title

AIDS and Behavior

Volume

27

Issue

11

Page(s)

3695-3712
Abstract
Abstract
There is an urgent need for efficient behavioral interventions to increase rates of HIV viral suppression for populations with serious barriers to engagement along the HIV care continuum. We carried out an optimization trial to test the effects of five behavioral intervention components designed to address barriers to HIV care continuum engagement for African American/Black and Latino persons living with HIV (PLWH) with non-suppressed HIV viral load levels: motivational interviewing sessions (MI), focused support groups (SG), peer mentorship (PM), pre-adherence skill building (SB), and navigation with two levels, short (NS) and long (NL). The primary outcome was HIV viral suppression (VS) and absolute viral load (VL) and health-related quality of life were secondary outcomes. Participants were 512 African American/Black and Latino PLWH poorly engaged in HIV care and with detectable HIV viral load levels in New York City, recruited mainly through peer referral. Overall, VS increased to 37%, or 45% in a sensitivity analysis. MI and SG seemed to have antagonistic effects on VS (z = − 1.90; p = 0.057); the probability of VS was highest when either MI or SG was assigned, but not both. MI (Mean Difference = 0.030; 95% CI 0.007–0.053; t(440) = 2.60; p = 0.010) and SB (Mean Difference = 0.030; 95% CI 0.007–0.053; t(439) = 2.54; p = 0.012) improved health-related quality of life. This is the first optimization trial in the field of HIV treatment. The study yields a number of insights into approaches to improve HIV viral suppression in PLWH with serious barriers to engagement along the HIV care continuum, including chronic poverty, and underscores challenges inherent in doing so.

Exploring behavioral intervention components for African American/Black and Latino persons living with HIV with non-suppressed HIV viral load in the United States: a qualitative study

Cluesman, S. R., Gwadz, M., Freeman, R., Collins, L. M., Cleland, C. M., Wilton, L., Hawkins, R. L., Leonard, N. R., Silverman, E., Maslow, C. B., Israel, K., Ritchie, A., & Ory, S. (n.d.).

Publication year

2023

Journal title

International Journal for Equity in Health

Volume

22

Issue

1
Abstract
Abstract
Background: The persistence of racial/ethnic inequities in rates of engagement along the HIV care continuum signals the need for novel approaches. We developed six behavioral intervention components for use in an optimization trial, grounded in a model that integrates critical race theory, harm reduction, and self-determination theory, designed to address various barriers that African American/Black and Latino persons living with HIV (PLWH) experience to the HIV care continuum. The components were: health education, motivational interviewing sessions, pre-adherence skill building, peer mentorship, focused support groups, and navigation. The present qualitative exploratory study describes participants’ perspectives on the components’ acceptability, feasibility, and impact. Methods: Participants were African American/Black and Latino PLWH poorly engaged in HIV care and with non-suppressed HIV viral load in New York City. From a larger trial, we randomly selected 46 participants for in-depth semi-structured interviews. Interviews were audio-recorded and transcribed verbatim, and data were analyzed using directed content analysis. Quantitative data on sociodemographic and background characteristics and components’ acceptability and feasibility were also collected. Results: On average, participants were 49 years old and had lived with HIV for 19 years. Most were cisgender-male and African American/Black. Participants reported a constellation of serious social and structural challenges to HIV management including chronic poverty, unstable housing, and stigma. Across components, a non-judgmental and pressure-free approach and attention to structural and cultural factors were seen as vital to high levels of engagement, but lacking in most medical/social service settings. Prominent aspects of individual components included establishing trust (health education); developing intrinsic motivation, goals, and self-reflection (motivational interviewing sessions); learning/practicing adherence strategies and habits (pre-adherence skill building); reducing social isolation via peer role models (peer mentorship); reflecting on salient goals and common challenges with peers without stigma (focused support groups); and circumventing structural barriers to HIV management with support (navigation). Components were found acceptable and feasible. Findings suggested ways components could be improved. Conclusions: The present study advances research on interventions for African American/Black and Latino PLWH, who experience complex barriers to engagement along the HIV care continuum. Future study of the components is warranted to address racial/ethnic health inequities in HIV.

Investigation of Active Ingredients Within Internet-Delivered Cognitive Behavioral Therapy for Depression: A Randomized Optimization Trial

Watkins, E., Newbold, A., Tester-Jones, M., Collins, L. M., & Mostazir, M. (n.d.).

Publication year

2023

Journal title

JAMA Psychiatry

Volume

80

Issue

9

Page(s)

942-951
Abstract
Abstract
Importance: There is limited understanding of how complex evidence-based psychological interventions such as cognitive behavioral therapy (CBT) for depression work. Identifying active ingredients may help to make therapy more potent, brief, and scalable. Objective: To test the individual main effects and interactions of 7 treatment components within internet-delivered CBT for depression to investigate its active ingredients. Design, Setting, and Participants: This randomized optimization trial using a 32-condition, balanced, fractional factorial optimization experiment (IMPROVE-2) recruited adults with depression (Patient Health Questionnaire-9 [PHQ-9] score ≥10) from internet advertising and the UK National Health Service Improving Access to Psychological Therapies service. Participants were randomized from July 7, 2015, to March 29, 2017, with follow-up for 6 months after treatment until December 29, 2017. Data were analyzed from July 2018 to April 2023. Interventions: Participants were randomized with equal probability to 7 experimental factors within the internet CBT platform, each reflecting the presence vs absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, and self-compassion training). Main Outcomes and Measures: The primary outcome was depression symptoms (PHQ-9 score). Secondary outcomes include anxiety symptoms and work, home, and social functioning. Results: Among 767 participants (mean age [SD] age, 38.5 [11.62] years; range, 18-76 years; 635 women [82.8%]), 506 (66%) completed the 6-month posttreatment follow-up. On average, participants receiving internet-delivered CBT had reduced depression (pre-to-posttreatment difference in PHQ-9 score, -7.79 [90% CI, -8.21 to -7.37]; 6-month follow-up difference in PHQ-9 score, -8.63 [90% CI, -9.04 to -8.22]). A baseline score-adjusted analysis of covariance model using effect-coded intervention variables (-1 or +1) found no main effect on depression symptoms for the presence vs absence of activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, or self-compassion training (posttreatment: largest difference in PHQ-9 score [functional analysis], -0.09 [90% CI, -0.56 to 0.39]; 6-month follow-up: largest difference in PHQ-9 score [relaxation], -0.18 [90% CI, -0.61 to 0.25]). Only absorption training had a significant main effect on depressive symptoms at 6-month follow-up (posttreatment difference in PHQ-9 score, 0.21 [90% CI, -0.27 to 0.68]; 6-month follow-up difference in PHQ-9 score, -0.54, [90% CI, -0.97 to -0.11]). Conclusions and Relevance: In this randomized optimization trial, all components of internet-delivered CBT except absorption training did not significantly reduce depression symptoms relative to their absence despite an overall average reduction in symptoms. The findings suggest that treatment benefit from internet-delivered CBT probably accrues from spontaneous remission, factors common to all CBT components (eg, structure, making active plans), and nonspecific therapy factors (eg, positive expectancy), with the possible exception of absorption focused on enhancing direct contact with positive reinforcers. Trial Registration: isrctn.org Identifier: ISRCTN24117387.

Preventing mental health problems in children after high conflict parental separation/divorce study: An optimization randomized controlled trial protocol

O’Hara, K. L., Wolchik, S. A., Sandler, I. N., West, S. G., Reis, H. T., Collins, L. M., Lyon, A. R., & Cummings, E. M. (n.d.).

Publication year

2023

Journal title

Mental Health and Prevention

Volume

32
Abstract
Abstract
Parental divorce is a childhood stressor that affects approximately 1.1 million children in the U.S. annually. The children at greatest risk for deleterious mental health consequences are those exposed to high interparental conflict (IPC) following the separation/divorce. Research shows that children's emotional security and coping efficacy mediate the impact of IPC on their mental health. Interventions targeting their adaptive coping in response to IPC events may bolster their emotional security and coping efficacy. However, existing coping interventions have not been tested with children exposed to high post-separation/divorce IPC, nor has any study assessed the effects of individual intervention components on children's coping with IPC and their mental health. This intensive longitudinal intervention study examines the mechanisms through which coping intervention components impact children's responses to interactions in interparental relationships. A 23 factorial experiment will assess whether, and to what extent, three candidate intervention components demonstrate main and interactive effects on children's coping and mental health. Children aged 9–12 (target N = 144) will be randomly assigned to one of eight combinations of three components with two levels each: (1) reappraisal (present vs. absent), (2) distraction (present vs. absent), (3) relaxation (present vs. absent). The primary outcomes are child-report emotional security and coping efficacy at one-month post-intervention. Secondary outcomes include internalizing and externalizing problems at the three-month follow-up. Based on data from this optimization phase RCT, intervention components will be selected to comprise a multi-component intervention and assessed for effectiveness in a subsequent evaluation phase RCT.

Successful Optimization of Tobacco Dependence Treatment in the Emergency Department: A Randomized Controlled Trial Using the Multiphase Optimization Strategy

Bernstein, S. L., Dziura, J., Weiss, J., Brooks, A. H., Miller, T., Vickerman, K. A., Grau, L. E., Pantalon, M. V., Abroms, L., Collins, L. M., & Toll, B. (n.d.).

Publication year

2023

Journal title

Annals of Emergency Medicine

Volume

81

Issue

2

Page(s)

209-221
Abstract
Abstract
Study objective: Tobacco dependence treatment initiated in the hospital emergency department (ED) is effective. However, trials typically use multicomponent interventions, making it difficult to distinguish specific components that are effective. In addition, interactions between components cannot be assessed. The Multiphase Optimization Strategy allows investigators to identify these effects. Methods: We conducted a full-factorial, 24 or 16-condition optimization trial in a busy hospital ED to examine the performance of 4 tobacco dependence interventions: a brief negotiation interview; 6 weeks of nicotine replacement therapy with the first dose delivered in the ED; active referral to a telephone quitline; and enrollment in SmokefreeTXT, a free short-messaging service program. Study data were analyzed with a novel mixed methods approach to assess clinical efficacy, cost-effectiveness, and qualitative participant feedback. The primary endpoint was tobacco abstinence at 3 months, verified by exhaled carbon monoxide using a Bedfont Micro+ Smokerlyzer. Results: Between February 2017 and May 2019, we enrolled 1,056 adult smokers visiting the ED. Odd ratios (95% confidence intervals) from the primary analysis of biochemically confirmed abstinence rates at 3 months for each intervention, versus control, were: brief negotiation interview, 1.8 (1.1, 2.8); nicotine replacement therapy, 2.1 (1.3, 3.2); quitline, 1.4 (0.9, 2.2); SmokefreeTXT, 1.1 (0.7, 1.7). There were no statistically significant interactions among components. Economic and qualitative analyses are in progress. Conclusion: The brief negotiation interview and nicotine replacement therapy were efficacious. This study is the first to identify components of ED-initiated tobacco dependence treatment that are individually effective. Future work will address the scalability of the brief negotiation interview and nicotine replacement therapy by offering provider-delivered brief negotiation interviews and nicotine replacement therapy prescriptions.

Understanding heterogeneity of responses to, and optimizing clinical efficacy of, exercise training in older adults: NIH NIA Workshop summary

Erickson, M. L., Allen, J. M., Beavers, D. P., Collins, L. M., Davidson, K. W., Erickson, K. I., Esser, K. A., Hesselink, M. K., Moreau, K. L., Laber, E. B., Peterson, C. A., Peterson, C. M., Reusch, J. E., Thyfault, J. P., Youngstedt, S. D., Zierath, J. R., Goodpaster, B. H., LeBrasseur, N. K., Buford, T. W., & Sparks, L. M. (n.d.).

Publication year

2023

Journal title

GeroScience

Volume

45

Issue

1

Page(s)

569-589
Abstract
Abstract
Exercise is a cornerstone of preventive medicine and a promising strategy to intervene on the biology of aging. Variation in the response to exercise is a widely accepted concept that dates back to the 1980s with classic genetic studies identifying sequence variations as modifiers of the VO2max response to training. Since that time, the literature of exercise response variance has been populated with retrospective analyses of existing datasets that are limited by a lack of statistical power from technical error of the measurements and small sample sizes, as well as diffuse outcomes, very few of which have included older adults. Prospective studies that are appropriately designed to interrogate exercise response variation in key outcomes identified a priori and inclusive of individuals over the age of 70 are long overdue. Understanding the underlying intrinsic (e.g., genetics and epigenetics) and extrinsic (e.g., medication use, diet, chronic disease) factors that determine robust versus poor responses to various exercise factors will be used to improve exercise prescription to target the pillars of aging and optimize the clinical efficacy of exercise training in older adults. This review summarizes the proceedings of the NIA-sponsored workshop entitled, “Understanding Heterogeneity of Responses to, and Optimizing Clinical Efficacy of, Exercise Training in Older Adults” and highlights the importance and current state of exercise response variation research, particularly in older adults, prevailing challenges, and future directions.

Advances in clinical trials methodology: Intervention optimization approaches in emergency medicine

Bernstein, S. L., Carter, P. M., Meurer, W., Walton, M. A., Kidwell, K. M., Cunningham, R. M., Dziura, J., & Collins, L. M. (n.d.).

Publication year

2022

Journal title

American Journal of Emergency Medicine

Volume

53

Page(s)

6-11
Abstract
Abstract
The classical two-arm randomized clinical trial (RCT) is designed to test the efficacy or effectiveness of an intervention, which may consist of one or more components. However, this approach does not enable the investigator to obtain information that is important in intervention development, such as which individual components of the intervention are efficacious, which are not and possibly should be removed, and whether any components interact. The Multiphase Optimization Strategy (MOST) is a new framework for development, optimization, and evaluation of interventions. MOST includes the RCT for purposes of evaluation, but inserts a phase of research before the RCT aimed at intervention optimization. The optimization phase requires one or more separate trials similar in scope to an RCT, but employing a different experimental design. The design of the optimization trial is selected strategically so as to maximize the amount of scientific information gained using the available resources. One consideration in selecting this experimental design is the type of intervention to be optimized. If a fixed intervention, i.e. one in which the same intervention content and intensity is provided to all participants, is to be optimized, a factorial experiment is often appropriate. If an adaptive intervention, i.e. one in which intervention content or intensity is varied in a principled manner, is to be optimized, a sequential multiple-assignment randomized trial (SMART) is often a good choice. The objective of this article is to describe MOST and the scientific rationale for its use; describe two current applications of MOST in emergency medicine research, one using a factorial experiment and the other using a SMART; and discuss funding strategies and potential future applications in studying the care of individuals with acute illness, injury, or behavioral disorders.

Advancing behavioral interventions for African American/Black and Latino persons living with HIV using a new conceptual model that integrates critical race theory, harm reduction, and self-determination theory: a qualitative exploratory study

Gwadz, M., Cluesman, S. R., Freeman, R., Collins, L. M., Dorsen, C., Hawkins, R. L., Cleland, C. M., Wilton, L., Ritchie, A. S., Torbjornsen, K., Leonard, N. R., Martinez, B. Y., Silverman, E., Israel, K., & Kutnick, A. (n.d.).

Publication year

2022

Journal title

International Journal for Equity in Health

Volume

21

Issue

1
Abstract
Abstract
Background: Rates of participation in HIV care, medication uptake, and viral suppression are improving among persons living with HIV (PLWH) in the United States. Yet, disparities among African American/Black and Latino PLWH are persistent, signaling the need for new conceptual approaches. To address gaps in services and research (e.g., insufficient attention to structural/systemic factors, inadequate harm reduction services and autonomy support) and improve behavioral interventions, we integrated critical race theory, harm reduction, and self-determination theory into a new conceptual model, then used the model to develop a set of six intervention components which were tested in a larger study. The present qualitative study explores participants’ perspectives on the study’s acceptability, feasibility, and impact, and the conceptual model’s contribution to these experiences. Methods: Participants in the larger study were African American/Black and Latino PLWH poorly engaged in HIV care and with non-suppressed HIV viral load in New York City (N = 512). We randomly selected N = 46 for in-depth semi-structured interviews on their experiences with and perspectives on the study. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis. Results: On average, participants were 49 years old (SD = 9) and had lived with HIV for 19 years (SD = 7). Most were male (78%) and African American/Black (76%). All had taken HIV medication previously. Challenging life contexts were the norm, including poverty, poor quality/unstable housing, trauma histories exacerbated by current trauma, health comorbidities, and substance use. Participants found the study highly acceptable. We organized results into four themes focused on participants’ experiences of: 1) being understood as a whole person and in their structural/systemic context; 2) trustworthiness and trust; 3) opportunities for self-reflection; and 4) support of personal autonomy. The salience of nonjudgment was prominent in each theme. Themes reflected grounding in the conceptual model. Participants reported these characteristics were lacking in HIV care settings. Conclusions: The new conceptual model emphasizes the salience of systemic/structural and social factors that drive health behavior and the resultant interventions foster trust, self-reflection, engagement, and behavior change. The model has potential to enhance intervention acceptability, feasibility, and effectiveness with African American/Black and Latino PLWH.

Components of smartphone cognitive-behavioural therapy for subthreshold depression among 1093 university students: A factorial trial

Sakata, M., Toyomoto, R., Yoshida, K., Luo, Y., Nakagami, Y., Uwatoko, T., Shimamoto, T., Tajika, A., Suga, H., Ito, H., Sumi, M., Muto, T., Ito, M., Ichikawa, H., Ikegawa, M., Shiraishi, N., Watanabe, T., Sahker, E., Ogawa, Y., … Furukawa, T. A. (n.d.).

Publication year

2022

Journal title

Evidence-Based Mental Health

Volume

25

Issue

1

Page(s)

E18-E25
Abstract
Abstract
Background Internet-based cognitive-behavioural therapy (iCBT) is effective for subthreshold depression. However, which skills provided in iCBT packages are more effective than others is unclear. Such knowledge can inform construction of more effective and efficient iCBT programmes. Objective To examine the efficacy of five components of iCBT for subthreshold depression. Methods We conducted an factorial trial using a smartphone app, randomly allocating presence or absence of five iCBT skills including self-monitoring, behavioural activation (BA), cognitive restructuring (CR), assertiveness training (AT) and problem-solving. Participants were university students with subthreshold depression. The primary outcome was the change on the Patient Health Questionnaire-9 (PHQ-9) from baseline to week 8. Secondary outcomes included changes in CBT skills. Findings We randomised a total of 1093 participants. In all groups, participants had a significant PHQ-9 reduction from baseline to week 8. Depression reduction was not significantly different between presence or absence of any component, with corresponding standardised mean differences (negative values indicate specific efficacy in favour of the component) ranging between-0.04 (95% CI-0.16 to 0.08) for BA and 0.06 (95% CI-0.06 to 0.18) for AT. Specific CBT skill improvements were noted for CR and AT but not for the others. Conclusions There was significant reduction in depression for all participants regardless of the presence and absence of the examined iCBT components. Clinical implication We cannot yet make evidence-based recommendations for specific iCBT components. We suggest that future iCBT optimisation research should scrutinise the amount and structure of components to examine. Trial registration number UMINCTR-000031307.

Optimization of a technology-supported physical activity promotion intervention for breast cancer survivors: Results from Fit2Thrive

Phillips, S. M., Penedo, F. J., Collins, L. M., Solk, P., Siddique, J., Song, J., Cella, D., Courneya, K. S., Ackermann, R. T., Welch, W. A., Auster-Gussman, L. A., Whitaker, M., Cullather, E., Izenman, E., & Spring, B. (n.d.).

Publication year

2022

Journal title

Cancer

Volume

128

Issue

5

Page(s)

1122-1132
Abstract
Abstract
Background: The benefits of moderate to vigorous physical activity (MVPA) for breast cancer survivors are well established. However, most are insufficiently active. Fit2Thrive used the Multiphase Optimization Strategy methodology to determine the effect of 5 intervention components on MVPA in this population. Methods: Two hundred sixty-nine participants (mean age, 52.5 years; SD, 9.9 years) received a core intervention (the Fit2Thrive self-monitoring app and Fitbit) and were randomly assigned to 5 intervention components set to on/off in a full factorial experiment: support calls, deluxe app, buddy, online gym, and text messages. The intervention was delivered over 12 weeks with a 12-week follow-up. MVPA was measured via accelerometry at the baseline (T1), at 12 weeks (T2), and at 24 weeks (T3). The main effects and interaction effects at each time point were examined for all components. Results: Trial retention was high: 91.8% had valid accelerometer data at T2 or T3. Across all conditions, there were significant increases in MVPA (+53.6 min/wk; P <.001) and in the proportion of survivors meeting MVPA guidelines (+22.3%; P <.001) at T2 that were maintained but attenuated at T3 (MVPA, +24.6 min/wk; P <.001; meeting guidelines, +12.6%; P <.001). No individual components significantly improved MVPA, although increases were greater for the on level versus the off level for support calls, buddy, and text messages at T2 and T3. Conclusions: The Fit2Thrive core intervention (the self-monitoring app and Fitbit) is promising for increasing MVPA in breast cancer survivors, but the components provided no additional increases in MVPA. Future research should evaluate the core intervention in a randomized trial and determine what components optimize MVPA behaviors in breast cancer survivors.

Recruiting and retaining first-year college students in online health research: Implementation considerations

Guastaferro, K., Tanner, A. E., Rulison, K. L., Miller, A. M., Milroy, J. J., Wyrick, D. L., & Collins, L. M. (n.d.).

Publication year

2022

Journal title

Journal of American College Health
Abstract
Abstract
Objective: Decreasing participation in intervention research among college students has implications for the external validity of behavioral intervention research. We describe recruitment and retention strategies used to promote participation in intervention research across a series of four randomized experiments. Method: We report the recruitment and retention rates by school for each experiment and qualitative feedback from students about recommendations for improving research participation. Results: There was considerable variation among schools’ recruitment (4.9% to 64.7%) and retention (12% to 67.8%) rates. Student feedback suggested study timing (e.g., early in the semester), communication strategies (e.g., social media), and incentive structure (e.g., guaranteed incentives) could improve research participation. The highest survey participation rate was observed at the university which mandated students to complete the intervention (but not the survey). Conclusions: Intervention scientists must consider the population and study context to make informed decisions related to recruitment and retention strategies.

The Microrandomized Trial for Developing Digital Interventions: Experimental Design and Data Analysis Considerations

Qian, T., Walton, A. E., Collins, L. M., Klasnja, P., Lanza, S. T., Nahum-Shani, I., Rabbi, M., Russell, M. A., Walton, M. A., Yoo, H., & Murphy, S. A. (n.d.).

Publication year

2022

Journal title

Psychological Methods

Volume

27

Issue

5

Page(s)

874-894
Abstract
Abstract
Just-in-time adaptive interventions (JITAIs) are time-varying adaptive interventions that use frequent opportunities for the intervention to be adapted-weekly, daily, or even many times a day. The microrandomized trial (MRT) has emerged for use in informing the construction of JITAIs. MRTs can be used to address research questions about whether and under what circumstances JITAI components are effective, with the ultimate objective of developing effective and efficient JITAI. The purpose of this article is to clarify why, when, and how to use MRTs; to highlight elements that must be considered when designing and implementing an MRT; and to review primary and secondary analyses methods for MRTs. We briefly review key elements of JITAIs and discuss a variety of considerations that go into planning and designing an MRT. We provide a definition of causal excursion effects suitable for use in primary and secondary analyses of MRT data to inform JITAI development. We review the weighted and centered least-squares (WCLS) estimator which provides consistent causal excursion effect estimators from MRT data. We describe how the WCLS estimator along with associated test statistics can be obtained using standard statistical software such as R (R Core Team, 2019). Throughout we illustrate the MRT design and analyses using the HeartSteps MRT, for developing a JITAI to increase physical activity among sedentary individuals. We supplement the HeartSteps MRT with two other MRTs, SARA and BariFit, each of which highlights different research questions that can be addressed using the MRT and experimental design considerations that might arise. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Using factorial mediation analysis to better understand the effects of interventions

Strayhorn, J. C., Collins, L. M., Brick, T. R., Marchese, S. H., Pfammatter, A. F., Pellegrini, C., & Spring, B. (n.d.).

Publication year

2022

Journal title

Translational Behavioral Medicine

Volume

12

Issue

1

Page(s)

84-89
Abstract
Abstract
To improve understanding of how interventions work or why they do not work, there is need for methods of testing hypotheses about the causal mechanisms underlying the individual and combined effects of the components that make up interventions. Factorial mediation analysis, i.e., mediation analysis applied to data from a factorial optimization trial, enables testing such hypotheses. In this commentary, we demonstrate how factorial mediation analysis can contribute detailed information about an intervention's causal mechanisms. We briefly review the multiphase optimization strategy (MOST) and the factorial experiment. We use an empirical example from a 25 factorial optimization trial to demonstrate how factorial mediation analysis opens possibilities for better understanding the individual and combined effects of intervention components. Factorial mediation analysis has important potential to advance theory about interventions and to inform intervention improvements.

A Hybrid Evaluation-Optimization Trial to Evaluate an Intervention Targeting the Intersection of Alcohol and Sex in College Students and Simultaneously Test an Additional Component Aimed at Preventing Sexual Violence

Tanner, A. E., Guastaferro, K. M., Rulison, K. L., Wyrick, D. L., Milroy, J. J., Bhandari, S., Thorpe, S., Ware, S., Miller, A. M., & Collins, L. M. (n.d.).

Publication year

2021

Journal title

Annals of Behavioral Medicine

Volume

55

Issue

12

Page(s)

1184-1187
Abstract
Abstract
Background: Using the multiphase optimization strategy (MOST), we previously developed and optimized an online behavioral intervention, itMatters, aimed at reducing the risk of sexually transmitted infections (STI) among first-year college students by targeting the intersection of alcohol use and sexual behaviors. Purpose: We had two goals: (a) to evaluate the optimized itMatters intervention and (b) to determine whether the candidate sexual violence prevention (SVP) component (included at the request of participating universities) had a detectable effect and therefore should be added to create a new version of itMatters. We also describe the hybrid evaluation-optimization trial we conducted to accomplish these two goals in a single experiment. Methods: First year college students (N = 3,098) at four universities in the USA were individually randomized in a hybrid evaluation-optimization 2 × 2 factorial trial. Data were analyzed using regression models, with pre-test outcome variables included as covariates in the models. Analyses were conducted separately with (a) immediate post-test scores and (b) 60-day follow-up scores as outcome variables. Results: Experimental results indicated a significant effect of itMatters on targeted proximal outcomes (norms) and on one distal behavioral outcome (binge drinking). There were no significant effects on other behavioral outcomes, including the intersection of alcohol and sexual behaviors. In addition, there were mixed results (positive short-term effect; no effect at 60-day follow-up) of the SVP component on targeted proximal outcomes (students' self-efficacy to reduce/prevent sexual violence and perceived effectiveness of protective behavioral strategies). Conclusions: The hybrid evaluation-optimization trial enabled us to evaluate the individual and combined effectiveness of the optimized itMatters intervention and the SVP component in a single experiment, conserving resources and providing greatly improved efficiency. Trial Registration: NCT04095065.

A Tribute to the Mind, Methodology and Mentoring of Wayne Velicer

Harlow, L. L., Aiken, L., Blankson, A. N., Boodoo, G. M., Brick, L. A. D., Collins, L. M., Cumming, G., Fava, J. L., Goodwin, M. S., Hoeppner, B. B., MacKinnon, D. P., Molenaar, P. C., Rodgers, J. L., Rossi, J. S., Scott, A., Steiger, J. H., & West, S. G. (n.d.).

Publication year

2021

Journal title

Multivariate Behavioral Research

Volume

56

Issue

3

Page(s)

377-389
Abstract
Abstract
Wayne Velicer is remembered for a mind where mathematical concepts and calculations intrigued him, behavioral science beckoned him, and people fascinated him. Born in Green Bay, Wisconsin on March 4, 1944, he was raised on a farm, although early influences extended far beyond that beginning. His Mathematics BS and Psychology minor at Wisconsin State University in Oshkosh, and his PhD in Quantitative Psychology from Purdue led him to a fruitful and far-reaching career. He was honored several times as a high-impact author, was a renowned scholar in quantitative and health psychology, and had more than 300 scholarly publications and 54,000+ citations of his work, advancing the arenas of quantitative methodology and behavioral health. In his methodological work, Velicer sought out ways to measure, synthesize, categorize, and assess people and constructs across behaviors and time, largely through principal components analysis, time series, and cluster analysis. Further, he and several colleagues developed a method called Testing Theory-based Quantitative Predictions, successfully applied to predicting outcomes and effect sizes in smoking cessation, diet behavior, and sun protection, with the potential for wider applications. With $60,000,000 in external funding, Velicer also helped engage a large cadre of students and other colleagues to study methodological models for a myriad of health behaviors in a widely applied Transtheoretical Model of Change. Unwittingly, he has engendered indelible memories and gratitude to all who crossed his path. Although Wayne Velicer left this world on October 15, 2017 after battling an aggressive cancer, he is still very present among us.

African American/Black and Latino Adults with Detectable HIV Viral Load Evidence Substantial Risk for Polysubstance Substance Use and Co-occurring Problems: A Latent Class Analysis

Cleland, C. M., Gwadz, M., Collins, L. M., Wilton, L., Sherpa, D., Dorsen, C., Leonard, N. R., Cluesman, S. R., Martinez, B. Y., Ritchie, A. S., & Ayvazyan, M. (n.d.).

Publication year

2021

Journal title

AIDS and Behavior

Volume

25

Issue

8

Page(s)

2501-2516
Abstract
Abstract
Substance use problems are highly prevalent among persons living with (PLWH) in the United States and serve as serious barriers to engagement in HIV care. Yet, in contrast to studies of single substances, little is known about patterns of polysubstance use in this population. Moreover, other risk factors (e.g., financial hardship, incarceration, homelessness, and mental health distress) are also prevalent and complicate HIV management. The present study drew on a cross-sectional survey with African American/Black and Latino (AABL) adult PLWH from low socioeconomic status backgrounds in New York City who were insufficiently engaged in HIV care and evidenced detectable HIV viral load (N = 512). We used latent class analysis (LCA) to explore patterns of polysubstance use and their relationships to financial hardship, incarceration, homelessness, and mental health. LCA yielded three substance use classes: Class 1, a high polysubstance use/high-risk substance use class (9%); Class 2, a polysubstance use/moderate substance use risk class (18%); and Class 3, a moderate polysubstance use/moderate-to-low-risk substance use class (74%). Mental health symptoms were prevalent in all classes, but Class 1 had greater mental health distress than the other two classes. Current homelessness was more prevalent in Classes 1 and 2. We cannot end the HIV epidemic without engaging and treating AABL PLWH who have serious barriers to engagement along the HIV care continuum, and who evidence polysubstance use along with co-occurring risk factors. Clinical settings can develop outreach and engagement approaches to bring this subpopulation of PLWH into care settings, and further, specialized services are needed to successfully screen, treat, and retain them.

Are behaviour change techniques and intervention features associated with effectiveness of digital cardiac rehabilitation programmes? A systematic review protocol

Kenny, E., McEvoy, J. W., McSharry, J., Collins, L. M., Taylor, R. S., & Byrne, M. (n.d.).

Publication year

2021

Journal title

HRB Open Research

Volume

4
Abstract
Abstract
Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Cardiac rehabilitation (CR) is a complex intervention that aims to stabilise, slow, or reverse the progression of CVD and improve patients’ functional status and quality of life. Digitally delivered CR has been shown to be effective and can overcome many of the access barriers associated with traditional centre-based delivered CR programmes. However, there is a limited understanding of the behaviour change techniques (BCTs) and intervention features that maximise the effectiveness of digital programmes. Therefore, this systematic review will aim to identify the BCTs that have been used in digital CR programmes and to determine which BCTs and intervention features are associated with programme effectiveness. Methods: PubMed, MEDLINE (Ovid), EMBASE, CINHAL, PsycINFO and Cochrane Central Register of Controlled Trials will be searched from inception to June 2021 for randomised controlled trials of digital CR with CVD patients. Screening, data extraction, intervention coding and risk of bias will be performed by one reviewer with a second reviewer independently verifying a random 20% of the articles. Intervention content will be coded using the behaviour change technique taxonomy v1 and the Template for Intervention Description and Replication (TIDieR) checklist and intervention features will be identified. A meta-analysis will be conducted to calculate the pooled effect size of each outcome, and meta-regression analyses will investigate whether intervention features and the presence and absence of individual BCTs in interventions are associated with intervention effectiveness. Discussion: The review will identify BCTs and intervention features that are associated with digital CR programmes and adopt a systematic approach to describe the content of these programmes using the BCT taxonomy (v1) and TIDieR checklist. The results will provide key insights into the content and design of successful digital CR programmes, providing a foundation for further development, testing and refinement.

Black and Latino Persons Living with HIV Evidence Risk and Resilience in the Context of COVID-19: A Mixed-Methods Study of the Early Phase of the Pandemic

Gwadz, M., Campos, S., Freeman, R., Cleland, C. M., Wilton, L., Sherpa, D., Ritchie, A. S., Hawkins, R. L., Allen, J. Y., Martinez, B. Y., Dorsen, C., Collins, L. M., Hroncich, T., Cluesman, S. R., & Leonard, N. R. (n.d.).

Publication year

2021

Journal title

AIDS and Behavior

Volume

25

Issue

5

Page(s)

1340-1360
Abstract
Abstract
The COVID-19 pandemic has great potential to disrupt the lives of persons living with HIV (PLWH). The present convergent parallel design mixed-methods study explored the early effects of COVID-19 on African American/Black or Latino (AABL) long-term survivors of HIV in a pandemic epicenter, New York City. A total of 96 AABL PLWH were recruited from a larger study of PLWH with non-suppressed HIV viral load. They engaged in structured assessments focused on knowledge, testing, trust in information sources, and potential emotional, social, and behavioral impacts. Twenty-six of these participants were randomly selected for in-depth semi-structured interviews. Participants were mostly men (64%), African American/Black (75%), and had lived with HIV for 17 years, on average (SD=9 years). Quantitative results revealed high levels of concern about and the adoption of recommended COVID-19 prevention recommendations. HIV care visits were commonly canceled but, overall, engagement in HIV care and antiretroviral therapy use were not seriously disrupted. Trust in local sources of information was higher than trust in various federal sources. Qualitative findings complemented and enriched quantitative results and provided a multifaceted description of both risk factors (e.g., phones/internet access were inadequate for some forms of telehealth) and resilience (e.g., “hustling” for food supplies). Participants drew a direct line between structural racism and the disproportional adverse effects of COVID-19 on communities of color, and their knowledge gleaned from the HIV pandemic was applied to COVID-19. Implications for future crisis preparedness are provided, including how the National HIV/AIDS Strategy can serve as a model to prevent COVID-19 from becoming another pandemic of the poor.

Evaluating four motivation-phase intervention components for use with primary care patients unwilling to quit smoking: a randomized factorial experiment

Cook, J. W., Baker, T. B., Fiore, M. C., Collins, L. M., Piper, M. E., Schlam, T. R., Bolt, D. M., Smith, S. S., Zwaga, D., Jorenby, D. E., & Mermelstein, R. (n.d.).

Publication year

2021

Journal title

Addiction

Volume

116

Issue

11

Page(s)

3167-3179
Abstract
Abstract
Aims: To assess the effectiveness of intervention components designed to increase quit attempts and promote abstinence in patients initially unwilling to quit smoking. Design: A four-factor, randomized factorial experiment. Setting: Sixteen primary care clinics in southern Wisconsin. Participants: A total of 577 adults who smoke (60% women, 80% White) recruited during primary care visits who were currently willing to reduce their smoking but unwilling to try to quit. Interventions. Four factors contrasted intervention components administered over a 1-year period: (i) nicotine mini-lozenge versus none; (ii) reduction counseling versus none; (iii) behavioral activation (BA) counseling versus none; and (iv) motivational 5Rs counseling versus none. Participants could request cessation treatment at any time. Measurements: The primary outcome was 7-day point-prevalence abstinence at 52 weeks post enrollment; secondary outcomes were point-prevalence abstinence at 26 weeks and making a quit attempt by weeks 26 and 52. Findings: No abstinence main effects were found but a mini-lozenge × reduction counseling × BA interaction was found at 52 weeks; P = 0.03. Unpacking this interaction showed that the mini-lozenge alone produced the highest abstinence rate (16.7%); combining it with reduction counseling produced an especially low abstinence rate (4.1%). Reduction counseling decreased the likelihood of making a quit attempt by 52 weeks relative to no reduction counseling (P = 0.01). Conclusions: Nicotine mini-lozenges may increase smoking abstinence in people initially unwilling to quit smoking, but their effectiveness declines when used with smoking reduction counseling or other behavioral interventions. Reduction counseling decreases the likelihood of making a quit attempt in people initially unwilling to quit smoking.

Contact

linda.m.collins@nyu.edu 708 Broadway New York, NY, 10003