Individual-level Component Research Articles

Rationale, Design, and Methods for Nen Unkumbi/Edahiyedo ("We Are Here Now"): A Multi-Level Randomized Controlled Trial to Improve Sexual and Reproductive Health Outcomes in a Northern Plains American Indian Reservation Community.

American Indian (AI) youth in the United States experience disproportionate sexual and reproductive health (SRH) disparities relative to their non-Indigenous, white counterparts, including increased rates of sexually transmitted infections (STIs), earlier sexual debut, increased rates of teen birth, and reduced access to SRH services. Past research shows that to improve SRH outcomes for AI youth in reservation communities, interventions must address complex factors and multiple levels of community that influence sexual risk behaviors. Here, we describe development of a multi-level, multi-component randomized controlled trial (RCT) to intervene upon SRH outcomes in a Northern Plains American Indian reservation community. Our intervention is rooted in a community based participatory research framework and is evaluated with a stepped wedge design that integrates 5 reservation high schools into a 5-year, cluster-randomized RCT. Ecological Systems Theory was used to design the intervention that includes (1) an individual level component of culturally specific SRH curriculum in school, (2) a parental component of education to improve parent-child communication about SRH and healthy relationships, (3) a community component of cultural mentorship, and (4) a systems-level component to improve delivery of SRH services from reservation healthcare agencies. In this article we present the rationale and details of our research design, instrumentation, data collection protocol, analytical methods, and community participation in the intervention. Our intervention builds upon existing community strengths and integrates traditional Indigenous knowledge and values with current public health knowledge to reduce SRH disparities.

25 Years of road safety: The journey from thinking humans to systems-thinking

Research into road safety has evolved from individual level component analysis to a much broader, systemic approach that acknowledges the fusion of ‘socio’ and ‘technical’ system elements. Over the past four decades, Professor Neville Stanton has contributed to over 179 journal articles, book chapters and conference papers in the field of road safety. The journey from ‘thinking humans’ to ‘systems thinking’ is demonstrated in this paper through the novel application of the Risk Management Framework (RMF) to the categorisation of research activities. A systematic review of Neville's contributions to the field of road safety demonstrates that over the years, his research activities have evolved from investigating single technological or human performance aspects in isolation (e.g., in-vehicle information design and workload) through to the holistic analysis of much broader systems (e.g., investigating road safety as a whole). Importantly, this evolution goes hand in hand with a change in the focus and emphasis of recommendations for improvements to safety. Going forward, Neville has helped pave the way for fundamental changes and improvements to be made to road safety systems around the world.

Issue characterization of electoral change (and how recent elections in Western Europe were won on economic issues)

Results of the last electoral season in Western Europe have been mostly seen in the light of the success of challenger, anti-establishment parties. According to this narrative, past elections have been overwhelmingly dominated by cultural issues such as immigration and the EU. However, these accounts suffer from several limitations. First, they generally focus on the determinants of the static component of electoral results (i.e. vote choice) rather than the factors leading to vote change (i.e. the individual-level component of aggregate electoral change). Second, relying on party manifestos and programmatic platforms, they usually offer a party-based reconstruction of the general climate of elections. As a consequence, they provide only an indirect, at best limited, overview of the actual political issues that might have driven electoral results. To overcome these limitations, in this paper we introduce a new methodological strategy to characterize electoral results in comparative perspective. To do so we leverage an issue-rich public opinion dataset to estimate individual-level vote change towards each party as a function of issue-based party-voter affinity measures in 6 European countries. Relying on 38 logistic regression models (one for each party), our results contradict many current interpretations of electoral results in Western Europe, in fact showing that economic issues, rather than broad cultural ones, emerged as the most relevant predictors of vote inflows. Furthermore, it also demonstrates the relevance of “cross-ideological” mobilization across all the 6 countries covered in this study.

Introducing the Dynamic Destination Satisfaction Method: An Analytical Tool to Track Tourism Destination Satisfaction Trends with Repeated Cross-sectional Data

This study introduces a new method, named Dynamic Destination Satisfaction Method (DDSME), to model tourists’ satisfaction with a destination (and its attributes), breaking it down into an individual-level component (linked to the specific individual tourists’ perceptions) and a system-level (time-related) component (common to all the tourists). Moreover, this work develops a matrix “entropy/trend accuracy” that destination managers can use to understand to what extent managing a specific attribute has increased tourists’ satisfaction with the destination over multiyear time spans. We test the innovative method on a large data set, covering the period 1997-2015 and including almost 0.8 million observations. By doing so, we analyze tourists’ satisfaction with tourism-related sectors and attributes of Italy as an inbound tourism destination and we use the matrix to map out destination attributes over time. The findings indicate that courtesy, art, and food are strategic attributes to enhance satisfaction in the long term.

Design of a randomized trial testing a multi-level weight-control intervention to reduce obesity and related health conditions in low-income workers

Weight-control is a major public health focus for preventing multiple obesity-related health conditions. While clinic-based intensive lifestyle interventions are successful, low-socioeconomic-status (SES) populations, which have a higher burden of obesity, are difficult to reach; thus, the workplace offers a useful setting to target low-SES workers. The current paper presents the design of a study testing a workplace intervention aimed at low-SES employees. Partnering with a large healthcare system and affiliated university, this project will test an innovative multi-level intervention (“Working for You”) adapted from existing group- and individual-level intervention models to promote healthy weight among low-wage workers. The individual-level component is an interactive obesity treatment approach (iOTA) program that involves assessment of behavior risks, collaborative goal-setting with a health coach, and interactive SMS text-messages for ongoing support and self-monitoring. This mHealth intervention is embedded in the group-level component, a workplace participatory program that involves worker teams engaged in the design and implementation of interventions to change their workplace environments. These nested interventions are being tested in a group-randomized trial among 22 work groups (~1000 total workers, ~300 workers with obesity). The primary outcome will be program effects on weight at 2-year follow-up, compared to control, and the secondary outcomes will be effects on diet and physical activity; iOTA adherence, process measures, and work environment/support will also be examined. This pragmatic clinical trial will test scalable interventions that can be translated to other work settings to reduce obesity and related health risks among low-SES workers. Trial registrationClinicalTrials.gov Identifier: NCT02934113

¡Sólo Se Vive Una Vez! (You Only Live Once): A Pilot Evaluation of Individually Tailored Video Modules Aiming to Increase HIV Testing Among Foreign-Born Latino Men.

Although Latinos living in the United States are disproportionately affected by HIV, the development, implementation, and evaluation of HIV prevention, testing, and linkage to care interventions lag behind efforts occurring in other communities. To address sociocultural barriers to testing, we developed a multilevel intervention. This study is a pilot evaluation of the individual-level component of the intervention-animated video modules that address specific barriers to HIV testing common among foreign-born Latino men. We conducted a survey assessing HIV risk and barriers to testing with a convenience sample of 104 foreign-born Latino men in Baltimore, MD, who had not tested for HIV within the past year. Intention to test in the next 3 months was measured before and after viewing an intervention module selected based on survey responses. Fifty-two (50.0%) participants had never tested for HIV. Of the participants who had previously tested for HIV, the mean time since their last test was 3.48 years (SD = 3.55). Participants' intention to test for HIV significantly increased after watching the module (t = -8.28, P < 0.001). Increased intention to test was not associated with any socio-demographic characteristics (ie, age, country of origin) or reported sexual behaviors (ie, number of sex partners in the past year). These results suggest that our culturally sensitive, individually tailored intervention can be an additional tool to encourage HIV testing among previously untested foreign-born Latino men, one of the demographic groups at highest risk for delayed HIV diagnosis in the United States.

True Love: Effectiveness of a School-Based Program to Reduce Dating Violence Among Adolescents in Mexico City.

Dating violence is a significant problem in Mexico. National survey data estimated 76% of Mexican youth have been victims of psychological aggression in their relationships; 15.5% have experienced physical violence; and 16.5% of women have been the victims of sexual violence. Female adolescents perpetrate physical violence more frequently than males, while perpetration between genders of other types of violence is unclear. Furthermore, poor, marginalized youth are at a higher risk for experiencing dating violence. "Amor… pero del Bueno" (True Love) was piloted in two urban, low-income high schools in Mexico City to prevent dating violence. The intervention consisted of school-level and individual-level components delivered over 16weeks covering topics on gender roles, dating violence, sexual rights, and strategies for coping with dating violence. The short-term impact was assessed quasi-experimentally, using matching techniques and fixed-effects models. A sample of 885 students (381 students exposed to the classroom-based curriculum of the individual-level component (SCC, IL-1) and 540 exposed only to the school climate component (SCC)) was evaluated for the following: changes in dating violence behaviors (psychological, physical and sexual), beliefs related to gender norms, knowledge, and skills for preventing dating violence. We found a 58% (p < 0.05) and 55% (p < 0.05) reduction in the prevalence of perpetrated and experienced psychological violence, respectively, among SCC, IL-1 males compared to males exposed only to the SCC component. We also found a significant reduction in beliefs and attitudes justifying sexism and violence in dating relationships among SCC, IL-1 females (6%; p < 0.05) and males (7%; p < 0.05).

Tests of the effects of adolescent early alcohol exposures on adult outcomes.

To determine whether early adolescent alcohol use contributes to adult alcohol use, misuse and other adult substance-related and social outcomes. In a longitudinal study of twins assessed at target ages 11, 14 and 24 years, two techniques adjusted for confounding factors: a propensity score (PS) adjusting for the effects of measured background covariates and co-twin control (CTC) adjusting for confounding by unmeasured (including genetic) factors shared within early alcohol exposure-discordant pairs. The community-based Minnesota Twin Family Study. A total of 1512 (50.3% female) twins. Early adolescent alcohol exposures, adult substance-related and social outcomes and background variables reflecting behavioral, familial and environmental characteristics. Background covariates unbalanced between those with and without early alcohol exposure were balanced through PS-based weighting, leaving several adult outcomes related to substance use or social functioning remaining significantly associated with early alcohol exposure. Similarly, the within-pair individual-level component of a CTC indicated that early alcohol-exposed twins had higher risk than their non-exposed co-twins for several, but not all, of the same adult outcomes. For example, early alcohol use was associated with an adult index of alcohol use in both PS-weighted (β = 0.57, P < 0.001) and CTC (β = 0.21, P = 0.031) analyses. Early alcohol exposures predict adult alcohol problems and related outcomes, despite stringent adjustment for measured and non-measured sources of potential confounding using propensity score and co-twin control. Contrasting the methods indicated that exposure effect estimates from PS application were likely biased by unmeasured confounding factors.

Component costs of foodborne illness: a scoping review.

BackgroundGovernments require high-quality scientific evidence to prioritize resource allocation and the cost-of-illness (COI) methodology is one technique used to estimate the economic burden of a disease. However, variable cost inventories make it difficult to interpret and compare costs across multiple studies.MethodsA scoping review was conducted to identify the component costs and the respective data sources used for estimating the cost of foodborne illnesses in a population. This review was accomplished by: (1) identifying the research question and relevant literature, (2) selecting the literature, (3) charting, collating, and summarizing the results. All pertinent data were extracted at the level of detail reported in a study, and the component cost and source data were subsequently grouped into themes.ResultsEighty-four studies were identified that described the cost of foodborne illness in humans. Most studies (80%) were published in the last two decades (1992–2012) in North America and Europe. The 10 most frequently estimated costs were due to illnesses caused by bacterial foodborne pathogens, with non-typhoidal Salmonella spp. being the most commonly studied. Forty studies described both individual (direct and indirect) and societal level costs. The direct individual level component costs most often included were hospital services, physician personnel, and drug costs. The most commonly reported indirect individual level component cost was productivity losses due to sick leave from work. Prior estimates published in the literature were the most commonly used source of component cost data. Data sources were not provided or specifically linked to component costs in several studies.ConclusionsThe results illustrated a highly variable depth and breadth of individual and societal level component costs, and a wide range of data sources being used. This scoping review can be used as evidence that there is a lack of standardization in cost inventories in the cost of foodborne illness literature, and to promote greater transparency and detail of data source reporting. By conforming to a more standardized cost inventory, and by reporting data sources in more detail, there will be an increase in cost of foodborne illness research that can be interpreted and compared in a meaningful way.

The European Parliament Elections as an Arena for Ethnic Minority Representation

The political representation of minorities is regarded as a key indicator of the level of democracy in any contemporary political system, and, in the case of ethnic minorities, of their rights and integration in society. In post-communist Eastern Europe, external factors, and particularly the European Union integration process, have played an important role in establishing the framework of minority policy, including their integration and representation. This paper examines the behavior of ethnic parties and their electorates in four new EU member states at the 2009 European Parliament elections. The paper builds on earlier arguments that the EU-level political process influences the behavior of parties in post-communist Europe to a greater extent than that of the parties and party systems in Western Europe (Lewis 2008, Ladrech 2008); and that this trend is particularly strong in the case of ethnic parties and that this is observable at both programmatic and electoral level (Spirova and Stefanova, forthcoming). This paper develops and extends this argument and examines it in the context of the experience of ethnic minority parties in Bulgaria, Latvia, Romania and Slovakia. It uses the EuroManifesto and the Voter Studies of the European Elections Study (2009) to bring a stronger comparative base and an individual level component into the study.

Levels of Selection on Threshold Characters

Threshold models are useful for understanding the evolution of dimorphic traits with polygenic bases. Selection for threshold characters on individuals is expected to be frequency dependent because of the peculiar way that selection views underlying genetic and environmental factors. Selection among individuals is inefficient because individual phenotypes fall into only two discrete categories that map imperfectly to the underlying genes. Incidence, however, can be continuously distributed among groups, making among-group selection relatively more efficient. Differently put, the group-mean phenotype can be a better predictor of an individual's genotype than that individual's own phenotype. Because evolution in group-structured populations is governed by the balance of selection within and between groups, we can expect threshold traits to evolve in fundamentally different ways when group mean fitness is a function of morph frequency. We extend the theory of selection on threshold traits to include group selection using contextual analysis. For the simple case of linear group-fitness functions, we show that the group-level component of selection, like the individual-level component, is frequency dependent. However, the conditions that determine which component dominates when levels of selection are in conflict (as described by Hamilton's rule) are not frequency dependent. Thus, enhanced group selection is not an inherent property of threshold characters. Nevertheless, we show that predicting the effects of multiple levels of selection on dimorphic traits requires special considerations of the threshold model.

Maps between homotopy coherent diagrams

In this paper we prove the following two results: (a) Given a commutative diagram of spaces, if one changes the spaces involved by homotopy equivalences, one can build a homotopy coherent diagram from the given data. (b) Given a map between diagrams of spaces, if one changes each individual level component of the map by a homotopy, one can construct a homotopy coherent map between the two diagrams based on the new maps.