Building Better Adaptive Interventions by Expanding SMART

June 27, 2019:

John DziakBehavioral interventions for prevention and treatment are an important part of the fight against drug abuse and HIV/AIDS. Among the challenges faced by scientists is how and when to alter the course of treatment for participants in the intervention. Adaptive interventions change based on evidence about what is best for the participant at a given time.

For over a decade, Methodology Center researchers have developed and applied sequential, multiple assignment, randomized trials (SMARTs), which are experimental designs that can be used to build adaptive interventions that address a variety of health and behavioral challenges, such as substance abuse abstinence, weight loss, ADHD management, and language acquisition. Recently, researchers have begun developing methods to evaluate SMARTs by using multiple measures of the outcome over time rather than only considering the outcome at the end of the study. For example, a researcher who is developing an adaptive intervention to promote abstinence from alcohol may want to consider alcohol usage rates every month for six months to decide how to construct the intervention. In a recent article in Multivariate Behavioral Research by Methodology Center Investigator John Dziak, Methodology Center Affiliates Daniel Almirall and Inbal “Billie” Nahum-Shani, and others, the authors develop and demonstrate a new method for evaluating a SMART using repeated measures of a binary outcome (such as substance use versus nonuse).

The authors apply their method to the ENGAGE SMART study, which was conducted to help develop an adaptive intervention for promoting treatment engagement among cocaine- and alcohol-dependent individuals. The authors found that certain designs correlated to increased abstinence rates during the first two months but abstinence rates that were equivalent to other designs by the end of the study. Had the investigators measured relapse solely at six months, they would not have observed the relapse differences during the early months, which may have practical or clinical significance. The authors go on to provide guidelines for using multiple binary measurements of the outcome while analyzing data from a SMART.

Lead author John Dziak discussed the importance of the study. “SMART is a valuable method because conditions such as addiction and many other health problems, are chronic and often need treatment over time. In many cases, the appropriate treatment could change depending on the individual’s experiences. SMART trials can help scientists decide which set of adaptive treatment rules will work the best. In a lot of the past SMART literature, ‘work the best’ just meant having the best expected outcome at the end of the study.  But considering short-term and long-term effects together might help clinicians make better decisions to fit an individual’s  goals.  Also, it allows scientists to study delayed effects, where an early treatment choice affects how well later treatments work, and that could render theoretical insight into the treatments.”


Dziak, J. J., Yap, J. R., Almirall, D., McKay, J. R., Lynch, K. G., & Nahum-Shani, I. (2019). A data analysis method for using longitudinal binary outcome data from a SMART to compare adaptive interventions. Multivariate Behavioral Research, 1-24.

New Resource for Learning TVEM

simulated TVEM graphicMay 10, 2019:

Our newest resource helps scientists teach themselves how to use our time-varying effect modeling (TVEM) SAS macro. TVEM allows scientists to understand how associations between variables change over time. The TVEM Learning Path is designed to allow SAS users to efficiently teach themselves how to prepare data for, plan, and run a TVEM.

The Learning Path allows users to select from a variety of educational resources including videos, presentation slides, webpages, and hands-on SAS exercises. This format allows users to access the specific content they need in the format they desire to develop their skills as quickly as possible. Content is divided into

  • Conceptual introduction,
  • Detailed introduction,
  • Running a SAS macro,
  • Flipping data from long format to wide format,
  • Preparing to run a TVEM,
  • Running a TVEM,
  • Plotting results, and
  • Running the Weighted TVEM SAS macro.

We hope the Learning Path is useful and can be applied to other methods. Please send any thoughts, suggestions, or questions about the Learning Path to

Open the TVEM Learning Path.

New Study Aims to Prevent Spread of HIV in High-Risk Populations

photograph of a red ribbonMay 9, 2019:

Despite great strides in decreasing the HIV infection rate in the United States over the last three decades, certain populations remain at high risk of infection. Young men who have sex with men (YMSM), especially Black/African American and Hispanic/Latino YMSM who live in inner cities, account for the most new infections annually. A new paper in JMIR Research Protocols by researchers from Children’s Hospital Los Angeles, Methodology Center Investigators Bethany Bray and Cara Exten Rice, and graduate student Eric Layland, describes the protocol for a longitudinal research study designed to improve HIV care and prevention among Black/African American and Hispanic/Latino YMSM.

The goal of the Healthy Young Men’s Cohort Study is to prevent new HIV infections and improve engagement with HIV care among Black/African American and Hispanic/Latino YMSM. Investigators are collecting data on drug use, sexual risk and protective behaviors, health care connectedness, mental health, stress and discrimination, emotion regulation, personal history with trauma, and more. This mixed-methods study  combines qualitative data with quantitative and biological data in order to generate the richest and most accurate data possible. These data will help characterize Black/African American and Hispanic/Latino YMSM engagement in HIV care and prevention.

Methodology Center Investigator Bethany Bray spoke about why the Healthy Young Men’s Cohort Study will have a positive impact on the health of Black/African American and Hispanic/Latino YMSM in the future. “Research that can inform tailored approaches to prevention and treatment engagement is critical. Society cannot end the HIV epidemic by 2030 without focusing on the high-risk populations in these two cohorts. These data will serve as a resource to a broad range of researchers.”

In the Healthy Young Men’s Cohort Study, data will be collected eight times at six-month intervals. The study has retained 97% of participants over the first 12 months. We look forward to the insights this study will yield.


Kipke M. D., Kubicek K., Wong C. F., Robinson Y. A., Akinyemi I. C., Beyer W. J., Hawkins W., Rice C. E., Layland E., Bray B. C., & Belzer M. (2019). A focus on the HIV care continuum through the Healthy Young Men’s Cohort Study: Protocol for a mixed-methods study. JMIR Research Protocols 8(1). PMCID: PMC6365874

“MOST-ly Mingling” at SPR

May 1, 2019:

Kate GuastaferroMethodology Center Investigator Kate Guastaferro will host an informal gathering during the Society for Prevention Research 2019 Annual Meeting to socialize and network with people considering or applying the multiphase optimization strategy (MOST). The gathering will be held on Wednesday, May 29, at 7:00 p.m. at the Eclipse Kitchen & Bar in the Hyatt Regency San Francisco and is open to anyone who is interested. Kate will answer questions about MOST and facilitate connections between researchers with similar interests. We hope you can make it!

Join Us at SPR!

April 30, 2019:

Join us at the Society for Prevention Research (SPR) 2019 Annual Meeting, May 28 through 31 in San Francisco. Methodology Center researchers will present symposia, talks, posters, a technical demonstration, and participate in the SPR Cup. We hope to see you there! Below is a list of the places where you can find us.

Tuesday, May 28

5:30 – 7:00 p.m. Poster Session I

  • “Heavy drinking and academics: Daily-level associations, or do less serious students just drink more?” Hannah Allen
  • “Profiles of dysregulation moderate the impact of preschool teacher-student relationships on later school functioning” Benjamin Bayly
  • “Identifying substance use disorders among individuals with spinal cord injury: Using big data Sources via electronic health records” Scott Graupensperger
  • “Effects of a mindfulness training intervention on alcohol use in public school teachers” Natalia Van Doren

Wednesday, May 29

1:15 – 2:45 p.m. Roundtable: Enhancing the reach and impact of drug abuse and behavioral health preventive interventions: Mining existing data for bold new discoveries Stephanie Lanza, Discussant

5:45 – 7:00 p.m. Poster Session II

  • “Approaches to characterizing drinking episodes in college students from wearable alcohol sensors” John Felt
  • “Gender differences in the time-varying association between cigarette use and weight concerns across adolescence” Anna Hochgraf
  • “Drug use patterns among young men of color who have sex with men” Eric Layland

7:00 –8:30 MOST-ly Mingling Join Kate Guastaferro in the Eclipse Kitchen & Bar, located in the lobby of the Hyatt Regency San Francisco, to socialize and discuss issues related to the optimization of interventions.

Thursday, May 30

10:15 – 11:45 a.m. Organized Paper Symposium: Opioid and other nonmedical prescription drug use in the United States: Contemporary trends in use, co-use, and correlates to identify opportunities for prevention Stephanie Lanza, organizer

  • “Contemporary trends in nonmedical prescription drug use as a function of individual and sociodemographic characteristics: Ages 12 to 90” Stephanie Lanza
  • “Age-varying trends in co-use of marijuana and heavy episodic drinking: Implications for nonmedical prescription drug use” Ashley Linden-Carmichael

10:15 – 11:45 a.m. Sloboda and Bukoski Cup Team:  Hannah Allen, Andrew Dismukes, John Felt, Natalia Van Doren, and Adrienne Woods

10:15 – 11:45 a.m. Roundtable Discussion: SPR task force on reducing health disparities and improving equity through prevention Bethany Bray, Discussant

3:00 – 4:30 p.m. Individual paper presentations: Prevention related to drug abuse across developmental stage Bethany Bray, Moderator

3:00 – 4:30 p.m. Individual paper presentations:Family, individual, and neighborhood risk factors as predictors of long-term behavior and mental health problems 

  • “Constellations of family risk and long-term adolescent antisocial behavior: A latent profile analysis” Emily LoBracio

6:40 – 7:55 p.m. Poster Session III

  • Technology Demonstration: Software, instructional materials, videos, and other resources from The Methodology Center at Penn State Bethany Bray

Friday May 31

8:30 – 10:00 a.m. Organized Paper Symposium: Applying latent class models in prevention science: Practical solutions to everyday problems Bethany Bray, Organizer

  • “Multiple imputation of missing covariate information in latent class analysis: evaluation of a step-by-step approach” John Dziak
  • “Multilevel latent profile analysis for daily diary data: Understanding triadic family dynamics” Mengya Xia
  • “Combining latent class analysis and time-varying effect modeling: Understanding the epidemiology of alcohol use” Bethany Bray

8:30 – 10:00 a.m. Individual Paper Presentations: using mobile health techniques to understand and prevent substance use

  • “Day and within-day trends of drug cravings: Ecological momentary assessment among a sample of patients with prescription opiate dependence” Jamie Gajos

10:15 – 11:45 a.m. Plenary Session III, Mobile health (mHealth) in prevention science: Assessment, intervention, and analysis Stephanie Lanza, Chair

1:00 – 2:30 p.m. Plenary Session III Roundtable: Mobile health (mHealth) in prevention science: Assessment, intervention, and analysis Stephanie Lanza, Chair

2:45 – 4:15 p.m. Organized Paper Symposium: Using time-varying effect models to understand predictors of substance use and depression within-days and across developmental periods Benjamin Bayly, Organizer

  • “Age-varying association between childhood maltreatment and depression and substance use” Yuen Wai Hung
  • “Age-varying effects of parental warmth and closeness on adolescent and young adult substance use and depression” Benjamin Bayly

Video Overview of Latent Transition Analysis (LTA)

April 22, 2019:

Our latest video provides a 15-minute conceptual overview of latent transition analysis (LTA). Methodology Center Investigator Bethany Bray uses an analysis about ex-smokers to demonstrate the types of questions LTA can answer and how LTA differs from LCA.

Latent transition analysis (LTA) and latent class analysis (LCA) are closely related methods. LCA identifies unobservable (latent) subgroups within a population based on individuals’ responses to multiple observed variables. LTA is an extension of LCA that uses longitudinal data to identify movement between the subgroups over time.

Watch the video on YouTube.

Also available:

New TVEM SAS Macro Accommodates Survey Weights and Clusters

April 12, 2017:

TVEMWe are pleased to release the newest extension of our TVEM (time-varying effect model) software. The %WeightedTVEM SAS macro (version 2.6) fits TVEMs on complex datasets that involve clustering (e.g., students are nested within schools) and survey weights (e.g., participants represent different numbers of population members due to systematically unequal probabilities of selection). Before attempting to use %WeightedTVEM, users should familiarize themselves with the %TVEM SAS macro (version 3.1 or higher).

Traditional analytic methods assume that covariates have constant effects on a time-varying outcome. The TVEM SAS macros allow the effects of covariates to vary with time. These macros enable researchers to answer new research questions about how relationships change over time. By accounting for survey weights and clusters, %WeightedTVEM can enable users to potentially avoid biased standard errors and incorrect conclusions.

Read more

Understanding Health Disparities Among Sexual Minorities

March 27, 2019:

Cara RiceStephanie LanzaSexual minorities—people who report sexual attraction to or behavior with members of the same sex and people who identify as gay, lesbian, or bisexual—are at a higher risk for a broad range of health problems at different points in their lives. Previous research has shown that sexual minorities are more likely to experience health problems like substance-use disorders and mood or anxiety disorders. In a recent article in Annals of Epidemiology by Methodology Center Investigators Cara Exten Rice and Stephanie Lanza, the authors used time-varying effect modeling (TVEM) to examine whether the occurrence of problems changed as people aged. The authors found that the odds for anxiety and depression among sexual minorities was highest in their early 20s, while odds for poor cardiovascular health were higher in their 40s and 50s.

When asked about the reason for these disparities, Cara emphasized that this was not a causal study but indicated that disparities may result from increased stress due to discrimination and prejudice. “It’s generally believed that sexual minorities experience increased levels of stress throughout their lives as a result of discrimination, microaggressions, stigma, and prejudicial policies,” she said. “Those increased stress levels may then result in poor health in a variety of outcomes, including health behaviors like substance use and chronic diseases like heart disease .”

Stephanie said the results help shed light on understudied health risks. “Discussions about health disparities often focus on the differences between men and women, across racial and ethnic groups, or between people of different socioeconomic backgrounds. However, sexual minority groups suffer substantially disproportionate health burdens across a range of outcomes, including poor mental health and problematic substance-use behaviors.”

For the study, the researchers used data from about 30,999 participants between the ages of 18 and 65 from the National Epidemiologic Survey of Alcohol and Related Conditions-III. Data included information about past-year alcohol, tobacco and drug use disorders, as well whether the participants had a past-year history of depression, anxiety, sexually transmitted infections (STIs) or cardiovascular disease.

“We observed that odds of substance-use disorders remained constant across age for sexual minorities, while in the general population they tend to be concentrated in certain age groups,” Cara said. “We saw that sexual minorities were more likely to have these substance-use disorders even in their 40s and 50s when we see in the general population that drug use and alcohol use start to taper off.”

Cara said the findings could be used to develop programs to help prevent these health problems before they start. “A necessary first step was to understand how health disparities affecting sexual minorities vary across age,” Rice said. “These findings shed light on periods of adulthood during which intervention programs may have the largest public health impact. Additionally, future studies that examine possible drivers of these age-varying disparities, such as daily experiences of discrimination, will inform the development of intervention content to promote health equity.”

Sara A. Vasilenko, Syracuse University, and Jessica N. Fish, University of Maryland, also contributed to this research.

Esra Kurum Receives Distinguished Alumni Award

March 21, 2019:

Linda Collins and Esra KurumCongratulations to Esra Kurum, assistant professor of statistics at University of California Riverside, recipient of The Methodology Center 2018 Distinguished Alumni Award. Esra develops models for time series and repeated measures longitudinal data. More specifically, she models time-varying trends in data and explores relationships between variables that change over time.

Esra’s research has been applied across a broad array of disciplines. Dating back to her time at The Methodology Center, she has developed models for infectious diseases and studying vaccine impacts. She has also modeled the time-varying relationships in smoking cessation studies, the association between HIV progression and smoking status, and the effects of the pneumococcal vaccine in developing countries. Esra has published 26 peer-reviewed articles. She is the recipient of the Kenneth Rothman Epidemiology Prize in 2018 for developing novel statistical models to evaluate the impact of vaccines and other interventions related to public health.

Video: Two-Hour Webinar on Latent Class Analysis (LCA)

March 19, 2019:


Thanks to all who participated in our 1 & 1 workshop on latent class analysis (LCA). This is a video of the webinar that Methodology Center Associate Director Bethany Bray presented on Thursday, February 26, 2019. The video includes both the one-hour presentation and the one-hour question-and-answer session that followed. This recording is a great way to learn the basics of LCA or to use as a refresher.

Download the presentation slides.

Watch the video on YouTube.

Featured Article: LCA of How Child Maltreatment Affects Later Life

February 20, 2019:

Research has shown that exposure to child maltreatment increases the risk for many negative outcomes throughout the lifespan, including post-traumatic stress disorder, depression, and problem substance use. In a new article in Emerging Adulthood, Methodology Center Investigators Kate Guastaferro and Bethany Bray examined how the experience of different patterns of childhood maltreatment is associated with substance abuse and mental health outcomes. To understand these relationships, the authors applied latent class analysis (LCA) to a subsample of 5,194 emerging adults (ages 18-25) from the National Epidemiological Survey on Alcohol and Related Conditions-III.

The analysis revealed three classes of maltreatment: Rare Maltreatment; Occasional Maltreatment, Rare Sexual Abuse; and Frequent Maltreatment, Some Sexual Abuse. Membership in all latent classes was associated with substance use. This suggests that anyone who has suffered maltreatment as a child should be targeted in substance-abuse-prevention interventions. On the other hand, mental health diagnoses were more common among members of the Frequent Maltreatment, Some Sexual Abuse class, suggesting that mental health interventions become more critical for individuals who suffered more frequent maltreatment.

Kate discussed the significance of this research. “Child maltreatment is an experience unique to each victim—victims could experience any combination of type and frequency of maltreatment. LCA allows for exploration of these different patterns of maltreatment exposure and can inform prevention responses specific to these varied experiences. First and foremost, efforts should be made to reduce the experience of child maltreatment. If we cannot prevent maltreatment from occurring in the first place, then it is vital as prevention scientists that we design the best interventions to effectively and efficiently mitigate the resulting negative health outcomes. Studies like this can help inform the development of more effective and efficacious mental health and substance abuse interventions for those with a history of maltreatment.”

Open the article. (Journal access required.)



Guastaferro, K., & Bray, B. C. (2019). Substance use and mental health outcomes during emerging adulthood among individuals with different patterns of child maltreatment. Emerging Adulthood. Advance online publication.

Join us for “MOST-ly Mingling” at SBM

February 13,2019:

On March 6, Linda Collins and Kate Guastaferro will present the pre-conference workshop “Introduction to MOST for Building More Effective, Efficient, Economical, and Scalable Behavioral Interventions” at the Society for Behavioral Medicine 40th Annual Meeting. That evening, there will be an informal gathering from 6:30 to 7:30-ish at McClellan’s Sports Bar at Washington Hilton Hotel to socialize and network with other people considering or applying the multiphase optimization strategy (MOST).

The event is open to workshop participants, Optimization of Behavioral and Biobehavioral Interventions SIG members, and anyone else who is interested. Kate will be answering questions about MOST and facilitating connections between researchers with similar interests. We hope you can make it!

Summer Institute on Mixed-Effects Location Scale Modeling

January 28, 2019:

We are pleased to announce that Donald Hedeker will present this year’s Summer Institute on Innovative Methods, “Variability in Intensive Longitudinal Data: Mixed-Effects Location Scale Modeling.” During the Summer Institute, Don will provide attendees with the theoretical background and applied skills necessary to use basic two- and three-level mixed models, as well as extended mixed models for the analysis of intensive longitudinal data (ILD). A major focus of the workshop will be on the modeling of variances from ILD.

The Summer Institute will be held June 17 – 18, 2019 on Penn State’s University Park Campus. The Institute is sponsored by Penn State’s Methodology Center and the National Institute on Drug Abuse.

Read more or apply to attend.

Featured Article: How Often Should We Collect Data in Substance Abuse Research?

January 24, 2019:

Runze LiOne of the challenges facing investigators who study substance abuse is determining the proper frequency with which to assess participants’ behavior. Assess too frequently and participants might quit because the burden is too high. Assess too infrequently and the data collected may be less accurate. In a forthcoming article in Addictive Behaviors, graduate student Wanjun Liu and his mentor, Methodology Center Investigator Runze Li, lead a team of researchers who examine the differences between retrospective timeline follow-back (TLFB) data and prospective daily process data. Both types of data are collected extensively in drug abuse research, and the authors propose a new method for validating TFLB against daily process data. Continue reading

Free, Two-Hour, Webinar on Latent Class Analysis

Bethany BrayJanuary 22, 2019:

For our next 1 & 1 webinar, Methodology Center Associate Director Bethany Bray will present an introduction to latent class analysis (LCA). 1 & 1 workshops consist of a one-hour live video presentation on a method followed by a one-hour question-and-answer session with the presenter. The workshop will be held on Tuesday, February 26, from 3:00 to 5:00 p.m. ET. To join the webinar, click this link when the webinar is starting. Registration in advance is not necessary.

Latent class analysis (LCA) allows researchers to identify unobservable (latent) subgroups within a population based on individuals’ responses to multiple observed variables. LCA can be used to understand the impact of exposure to patterns of multiple risks, as well as the antecedents and consequences of complex behaviors, so that interventions can be tailored to target the subgroups that will benefit most. Bethany’s talk will be introductory in nature, but questions of all levels of complexity are welcome during the Q & A.

The webinar can accommodate up to 500 participants, so all interested people should be able to attend. If you try to attend the workshop but are unable to log on for any reason, please send an email to We hope you will join us.

Frequently Asked Questions about Micro-Randomized Trials (MRTs)

blank sample MRT schematicJanuary 17, 2019:

In micro-randomized trials (MRTs), individuals are randomized hundreds or thousands of times over the course of the study. The goal of these trials is to optimize mobile health interventions by assessing the effect of intervention components and assessing whether the intervention component effects vary with time or an individual’s current context. In an effort to help researchers understand MRTs, we have developed a list of answers to frequently asked questions about these trials. This webpage can be used to answer your specific questions, or you can read the entire page to understand the use and design of MRTs. ​

Open the FAQ.