Designing Optimal, Data-Driven Policies from Multisite Randomized Trials

Optimal treatment regimes (OTRs) have been widely employed in computer science and personalized medicine to provide data-driven, optimal recommendations to individuals. However, previous research on OTRs has primarily focused on settings that are independent and identically distributed, with little attention given to the unique characteristics of educational settings, where students are nested within schools and there are hierarchical dependencies. The goal of this study is to propose a framework for designing OTRs from multisite randomized trials, a commonly used experimental design in education and psychology to evaluate educational programs. We investigate modifications to popular OTR methods, specifically Q-learning and weighting methods, in order to improve their performance in multisite randomized trials. A total of 12 modifications, 6 for Q-learning and 6 for weighting, are proposed by utilizing different multilevel models, moderators, and augmentations. Simulation studies reveal that all Q-learning modifications improve performance in multisite randomized trials and the modifications that incorporate random treatment effects show the most promise in handling cluster-level moderators. Among weighting methods, the modification that incorporates cluster dummies into moderator variables and augmentation terms performs best across simulation conditions. The proposed modifications are demonstrated through an application to estimate an OTR of conditional cash transfer programs using a multisite randomized trial in Colombia to maximize educational attainment.

The Determinants of Infant Mortality in Brazil, 2010-2020: A Scoping Review

Despite the implementation of social and health policies that positively affected the health of the populations in Brazil, since 2009 the country has experienced a slower decline of infant mortality. After an economic and political crisis, Brazil witnessed increases in infant mortality that raised questions about what are the determinants of infant mortality after the implementation of such policies. We conducted a scoping review to identify and summarize those determinants with searches in three databases: LILACS, MEDLINE, and SCIELO. We included studies published between 2010 and 2020. We selected 23 papers: 83% associated infant mortality with public policies; 78% related infant mortality with the use of the health system and socioeconomic and living conditions; and 27% related to individual characteristics to infant mortality. Inequalities in the access to healthcare seem to have important implications in reducing infant mortality. Socioeconomic conditions and health-related factors such as income, education, fertility, housing, and the Bolsa Família. Program coverage was pointed out as the main determinants of infant mortality. Likewise, recent changes in infant mortality in Brazil are likely related to these factors. We also identified a gap in terms of studies on a possible association between employment and infant mortality.

Poverty-alleviation program participation and salivary cortisol in very low-income children

Correlational studies have shown associations between social class and salivary cortisol suggestive of a causal link between childhood poverty and activity of the stress-sensitive hypothalamic-pituitary-adrenocortical (HPA) system. Using a quasi-experimental design, we evaluated the associations between a family's participation in a large-scale, conditional cash transfer program in Mexico (Oportunidades, formerly Progresa) during the child's early years of life and children's salivary cortisol (baseline and responsivity). We also examined whether maternal depressive symptoms moderated the effect of program participation. Low-income households (income <20th percentile nationally) from rural Mexico were enrolled in a large-scale poverty-alleviation program between 1998 and 1999. A comparison group of households from demographically similar communities was recruited in 2003. Following 3.5 years of participation in the Oportunidades program, three saliva samples were obtained from children aged 2-6 years from intervention and comparison households (n=1197). Maternal depressive symptoms were obtained using the Center for Epidemiologic Studies-Depression Scale (CES-D). Results were that children who had been in the Oportunidades program had lower salivary cortisol levels when compared with those who had not participated in the program, while controlling for a wide range of individual-, household- and community-level variables. Reactivity patterns of salivary cortisol did not differ between intervention and comparison children. Maternal depression moderated the association between Oportunidades program participation and baseline salivary cortisol in children. Specifically, there was a large and significant Oportunidades program effect of lowering cortisol in children of mothers with high depressive symptoms but not in children of mothers with low depressive symptomatology. These findings provide the strongest evidence to date that the economic circumstances of a family can influence a child's developing stress system and provide a mechanism through which poverty early in life could alter life-course risk for physical and mental health disorders.