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Palmer S, Ciubotariu I, Ofori R, Saenz M, Ellison B, Prescott MP. School Nutrition Stakeholders Find Utility in MealSim: An Agent-Based Model. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:361-369. [PMID: 38583162 DOI: 10.1016/j.jneb.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To obtain feedback from school nutrition stakeholders on an agent-based model simulating school lunch to inform model refinement and future applications. DESIGN Qualitative study using online discussion groups. SETTING School nutrition professional stakeholders across the US. PARTICIPANTS Twenty-eight school nutrition stakeholders. PHENOMENON OF INTEREST Perceptions and applicability of MealSim for school nutrition stakeholders to help reduce food waste. ANALYSIS Deductive approach followed by inductive analysis of discussion group transcripts. RESULTS Stakeholders appreciated the customizability of the cafeteria characteristics and suggested adding additional characteristics to best represent the school meal system, such as factors relating to school staff supervision of students during meals. The perceived utility of MealSim was high and included using it to train personnel and to advocate for policy and budgetary changes. However, they viewed MealSim as more representative of elementary than high schools. Stakeholders also provided suggestions for training school nutrition administrators on how to use MealSim and requested opportunities for technical assistance. CONCLUSIONS AND IMPLICATIONS Although agent-based models were new to the school nutrition stakeholders, MealSim was viewed as a useful tool. Application of these findings will allow the model to meet the intended audience's needs and better estimate the system.
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Affiliation(s)
- Shelly Palmer
- Department of Food Science and Human Nutrition, College of Agricultural, Consumer and Environmental Sciences, University of Illinois Urbana Champaign, Urbana, IL
| | - Iulia Ciubotariu
- Department of Food Science and Human Nutrition, College of Agricultural, Consumer and Environmental Sciences, University of Illinois Urbana Champaign, Urbana, IL
| | - Roland Ofori
- Department of Food Science and Human Nutrition, College of Agricultural, Consumer and Environmental Sciences, University of Illinois Urbana Champaign, Urbana, IL
| | - Mayra Saenz
- Department of Agriculture and Consumer Economics, College of Agricultural, Consumer and Environmental Sciences, University of Illinois Urbana Champaign, Urbana, IL
| | - Brenna Ellison
- Department of Agricultural Economics, College of Agriculture, Purdue University, West Lafayette, IN
| | - Melissa Pflugh Prescott
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, OH.
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Brown CH, Johnson KA, Hills HA, Vermeer W, Clarke DL, Barnett JT, Newman RT, Burns TL, Pellan WA. Overdose deaths before and during the COVID-19 pandemic in a US county. Front Public Health 2024; 12:1366161. [PMID: 38859894 PMCID: PMC11163089 DOI: 10.3389/fpubh.2024.1366161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/23/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction Globally, overdose deaths increased near the beginning of the COVID-19 pandemic, which created availability and access barriers to addiction and social services. Especially in times of a crisis like a pandemic, local exposures, service availability and access, and system responses have major influence on people who use drugs. For policy makers to be effective, an understanding at the local level is needed. Methods This retrospective epidemiologic study from 2019 through 2021 compares immediate and 20-months changes in overdose deaths from the pandemic start to 16 months before its arrival in Pinellas County, FL We examine toxicologic death records of 1,701 overdoses to identify relations with interdiction, and service delivery. Results There was an immediate 49% increase (95% CI 23-82%, p < 0.0001) in overdose deaths in the first month following the first COVID deaths. Immediate increases were found for deaths involving alcohol (171%), heroin (108%), fentanyl (78%), amphetamines (55%), and cocaine (45%). Overdose deaths remained 27% higher (CI 4-55%, p = 0.015) than before the pandemic through 2021.Abrupt service reductions occurred when the pandemic began: in-clinic methadone treatment dropped by two-thirds, counseling by 38%, opioid seizures by 29%, and drug arrests by 56%. Emergency transport for overdose and naloxone distributions increased at the pandemic onset (12%, 93%, respectively) and remained higher through 2021 (15%, 377%,). Regression results indicate that lower drug seizures predicted higher overdoses, and increased 911 transports predicted higher overdoses. The proportion of excess overdose deaths to excess non-COVID deaths after the pandemic relative to the year before was 0.28 in Pinellas County, larger than 75% of other US counties. Conclusions Service and interdiction interruptions likely contributed to overdose death increases during the pandemic. Relaxing restrictions on medical treatment for opioid addiction and public health interventions could have immediate and long-lasting effects when a major disruption, such as a pandemic, occurs. County level data dashboards comprised of overdose toxicology, and interdiction and service data, can help explain changes in overdose deaths. As a next step in predicting which policies and practices will best reduce local overdoses, we propose using simulation modeling with agent-based models to examine complex interacting systems.
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Affiliation(s)
- C. Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kimberly A. Johnson
- Department of Mental Health Law and Policy (MHC 2636), College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States
| | - Holly A. Hills
- Department of Mental Health Law and Policy (MHC 2636), College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States
| | - Wouter Vermeer
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Joshua T. Barnett
- Department of Human Services, Pinellas County Government, Clearwater, FL, United States
| | - Reta T. Newman
- Pinellas County Forensic Lab, District Six Medical Examiner Office, Largo, FL, United States
| | - Tim L. Burns
- Department of Human Services, Pinellas County Government, Clearwater, FL, United States
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Anderle RV, de Oliveira RB, Rubio FA, Macinko J, Dourado I, Rasella D. Modelling HIV/AIDS epidemiological complexity: A scoping review of Agent-Based Models and their application. PLoS One 2024; 19:e0297247. [PMID: 38306355 PMCID: PMC10836677 DOI: 10.1371/journal.pone.0297247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE To end the AIDS epidemic by 2030, despite the increasing poverty and inequalities, policies should be designed to deal with population heterogeneity and environmental changes. Bottom-up designs, such as the Agent-Based Model (ABM), can model these features, dealing with such complexity. HIV/AIDS has a complex dynamic of structural factors, risk behaviors, biomedical characteristics and interventions. All embedded in unequal, stigmatized and heterogeneous social structure. To understand how ABMs can model this complexity, we performed a scoping review of HIV applications, highlighting their potentialities. METHODS We searched on PubMed, Web of Science, and Scopus repositories following the PRISMA extension for scoping reviews. Our inclusion criteria were HIV/AIDS studies with an ABM application. We identified the main articles using a local co-citation analysis and categorized the overall literature aims, (sub)populations, regions, and if the papers declared the use of ODD protocol and limitations. RESULTS We found 154 articles. We identified eleven main papers, and discussed them using the overall category results. Most studies model Transmission Dynamics (37/154), about Men who have sex with Men (MSM) (41/154), or individuals living in the US or South Africa (84/154). Recent studies applied ABM to model PrEP interventions (17/154) and Racial Disparities (12/154). Only six papers declared the use of ODD Protocol (6/154), and 34/154 didn't mention the study limitations. CONCLUSIONS While ABM is among the most sophisticated techniques available to model HIV/AIDS complexity. Their applications are still restricted to some realities. However, researchers are challenged to think about social structure due model characteristics, the inclusion of these features is still restricted to case-specific. Data and computational power availability can enhance this feature providing insightful results.
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Affiliation(s)
| | | | - Felipe Alves Rubio
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Ines Dourado
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
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Murry VM, Bradley C, Cruden G, Brown CH, Howe GW, Sepùlveda MJ, Beardslee W, Hannah N, Warne D. Re-envisioning, Retooling, and Rebuilding Prevention Science Methods to Address Structural and Systemic Racism and Promote Health Equity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:6-19. [PMID: 36223046 PMCID: PMC9554395 DOI: 10.1007/s11121-022-01439-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/09/2022]
Abstract
The historic momentum from national conversations on the roots and current impacts of racism in the USA presents an incredible window of opportunity for prevention scientists to revisit how common theories, measurement tools, methodologies, and interventions can be radically re-envisioned, retooled, and rebuilt to dismantle racism and promote equitable health for minoritized communities. Recognizing this opportunity, the NIH-funded Prevention Science and Methodology Group (PSMG) launched a series of presentations focused on the role of Prevention Science to address racism and discrimination guided by a commitment to social justice and health equity. The current manuscript aims to advance the field of Prevention Science by summarizing key issues raised during the series' presentations and proposing concrete research priorities and steps that hold promise for promoting health equity by addressing systemic racism. Being anti-racist is an active practice for all of us, whether we identify as methodologists, interventionists, practitioners, funders, community members, or an intersection of these identities. We implore prevention scientists and methodologists to take on these conversations with us to promote science and practice that offers every life the right to live in a just and equitable world.
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Affiliation(s)
- Velma McBride Murry
- Departments of Health Policy & Human and Organizational Development, Vanderbilt University, Nashville, TN, USA.
| | - Cory Bradley
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | - C Hendricks Brown
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - William Beardslee
- Harvard Medical School, Boston Children's Hospital, Judge Baker Children's Center, Boston, MA, USA
| | - Nanette Hannah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Donald Warne
- Center for Indigenous Health, Johns Hopkins University, Baltimore, MD, USA
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Kim B, Cruden G, Crable EL, Quanbeck A, Mittman BS, Wagner AD. A structured approach to applying systems analysis methods for examining implementation mechanisms. Implement Sci Commun 2023; 4:127. [PMID: 37858215 PMCID: PMC10588196 DOI: 10.1186/s43058-023-00504-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 09/23/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND It is challenging to identify and understand the specific mechanisms through which an implementation strategy affects implementation outcomes, as implementation happens in the context of complex, multi-level systems. These systems and the mechanisms within each level have their own dynamic environments that change frequently. For instance, sequencing may matter in that a mechanism may only be activated indirectly by a strategy through another mechanism. The dosage or strength of a mechanism may vary over time or across different health care system levels. To elucidate the mechanisms relevant to successful implementation amidst this complexity, systems analysis methods are needed to model and manage complexity. METHODS The fields of systems engineering and systems science offer methods-which we refer to as systems analysis methods-to help explain the interdependent relationships between and within systems, as well as dynamic changes to systems over time. When applied to studying implementation mechanisms, systems analysis methods can help (i) better identify and manage unknown conditions that may or may not activate mechanisms (both expected mechanisms targeted by a strategy and unexpected mechanisms that the methods help detect) and (ii) flexibly guide strategy adaptations to address contextual influences that emerge after the strategy is selected and used. RESULTS In this paper, we delineate a structured approach to applying systems analysis methods for examining implementation mechanisms. The approach includes explicit steps for selecting, tailoring, and evaluating an implementation strategy regarding the mechanisms that the strategy is initially hypothesized to activate, as well as additional mechanisms that are identified through the steps. We illustrate the approach using a case example. We then discuss the strengths and limitations of this approach, as well as when these steps might be most appropriate, and suggest work to further the contributions of systems analysis methods to implementation mechanisms research. CONCLUSIONS Our approach to applying systems analysis methods can encourage more mechanisms research efforts to consider these methods and in turn fuel both (i) rigorous comparisons of these methods to alternative mechanisms research approaches and (ii) an active discourse across the field to better delineate when these methods are appropriate for advancing mechanisms-related knowledge.
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Affiliation(s)
- Bo Kim
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Gracelyn Cruden
- Chestnut Health Systems, Lighthouse Institute-Oregon Group, 1255 Pearl Street, Eugene, OR, 97401, USA
| | - Erika L Crable
- UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Andrew Quanbeck
- University of Wisconsin-Madison, 610 North Whitney Way, Madison, WI, 53705, USA
| | - Brian S Mittman
- Kaiser Permanente Southern California, 200 North Lewis Street, Orange, CA, 92868, USA
- University of Southern California, 2025 Zonal Avenue, Los Angeles, CA, 90089, USA
- UCLA, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA
| | - Anjuli D Wagner
- University of Washington, 3980 15Th Avenue NE, Seattle, WA, 98195, USA
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Giabbanelli PJ, Vesuvala CX. Human Factors in Leveraging Systems Science to Shape Public Policy for Obesity: A Usability Study. INFORMATION 2023. [DOI: 10.3390/info14030196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Background: despite a broad consensus on their importance, applications of systems thinking in policymaking and practice have been limited. This is partly caused by the longstanding practice of developing systems maps and software in the intention of supporting policymakers, but without knowing their needs and practices. Objective: we aim to ensure the effective use of a systems mapping software by policymakers seeking to understand and manage the complex system around obesity, physical, and mental well-being. Methods: we performed a usability study with eight policymakers in British Columbia based on a software tool (ActionableSystems) that supports interactions with a map of obesity. Our tasks examine different aspects of systems thinking (e.g., unintended consequences, loops) at several levels of mastery and cover common policymaking needs (identification, evaluation, understanding). Video recordings provided quantitative usability metrics (correctness, time to completion) individually and for the group, while pre- and post-usability interviews yielded qualitative data for thematic analysis. Results: users knew the many different factors that contribute to mental and physical well-being in obesity; however, most were only familiar with lower-level systems thinking concepts (e.g., interconnectedness) rather than higher-level ones (e.g., feedback loops). Most struggles happened at the lowest level of the mastery taxonomy, and predominantly on network representation. Although participants completed tasks on loops and multiple pathways mostly correctly, this was at the detriment of spending significant time on these aspects. Results did not depend on the participant, as their experiences with the software were similar. The thematic analysis revealed that policymakers did not have a typical workflow and did not use any special software or tools in their policy work; hence, the integration of a new tool would heavily depend on individual practices. Conclusions: there is an important discrepancy between what constitutes systems thinking to policymakers and what parts of systems thinking are supported by software. Tools may be more successfully integrated when they include tutorials (e.g., case studies), facilitate access to evidence, and can be linked to a policymaker’s portfolio.
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Agent-based model projections for reducing HIV infection among MSM: Prevention and care pathways to end the HIV epidemic in Chicago, Illinois. PLoS One 2022; 17:e0274288. [PMID: 36251657 PMCID: PMC9576079 DOI: 10.1371/journal.pone.0274288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/24/2022] [Indexed: 11/20/2022] Open
Abstract
Our objective is to improve local decision-making for strategies to end the HIV epidemic using the newly developed Levers of HIV agent-based model (ABM). Agent-based models use computer simulations that incorporate heterogeneity in individual behaviors and interactions, allow emergence of systemic behaviors, and extrapolate into the future. The Levers of HIV model (LHM) uses Chicago neighborhood demographics, data on sex-risk behaviors and sexual networks, and data on the prevention and care cascades, to model local dynamics. It models the impact of changes in local preexposure prophylaxis (PrEP) and antiretroviral treatment (ART) (ie, levers) for meeting Illinois' goal of "Getting to Zero" (GTZ) -reducing by 90% new HIV infections among men who have sex with men (MSM) by 2030. We simulate a 15-year period (2016-2030) for 2304 distinct scenarios based on 6 levers related to HIV treatment and prevention: (1) linkage to PrEP for those testing negative, (2) linkage to ART for those living with HIV, (3) adherence to PrEP, (4) viral suppression by means of ART, (5) PrEP retention, and (6) ART retention. Using tree-based methods, we identify the best scenarios at achieving a 90% HIV infection reduction by 2030. The optimal scenario consisted of the highest levels of ART retention and PrEP adherence, next to highest levels of PrEP retention, and moderate levels of PrEP linkage, achieved 90% reduction by 2030 in 58% of simulations. We used Bayesian posterior predictive distributions based on our simulated results to determine the likelihood of attaining 90% HIV infection reduction using the most recent Chicago Department of Public Health surveillance data and found that projections of the current rate of decline (2016-2019) would not achieve the 90% (p = 0.0006) reduction target for 2030. Our results suggest that increases are needed at all steps of the PrEP cascade, combined with increases in retention in HIV care, to approach 90% reduction in new HIV diagnoses by 2030. These findings show how simulation modeling with local data can guide policy makers to identify and invest in efficient care models to achieve long-term local goals of ending the HIV epidemic.
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