Browsing by Author "Walters, Scott"
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Item A Longitudinal Study Among Permanent Supportive Housing Residents: Increase in Social Support Co-Occurring with Decrease in Depressive Symptoms and Substance Use Problems(2021) Tan, Zhengqi; Mun, Eun-Young; Nguyen, Uyen-Sa; Walters, ScottPurpose: Social support is a well-known protective factor against depressive symptoms and substance use problems, but very few studies have examined its protective effects among residents of Permanent Supportive Housing (PSH), a housing program for people with a history of chronic homelessness. We examined whether perceived social support improves when provided with regular health coaching visits and whether improved social support is associated with reduced depressive symptoms and substance use problems among this underserved population. Methods:Participants were 653 adult PSH residents in North Texas (56% female; 57% Black; mean age: 51 years) who participated in a monthly health coaching program from 2014 to 2017. We assessed their health behaviors at baseline and three follow-up visits for up to 18 months. We used latent growth curve models to capture changes over time and parallel process growth models to examine the associations between the trajectories of social support and the trajectories of each health measure. Results:PSH residents showed improved social support, and decreased depressive symptoms and substance use problems over time. In addition, individuals with greater needs at baseline tended to improve faster, although their improvements slowed over time. Further, those who improved in social support tended to show reduced depressive symptoms (coefficient: –0.67, p< 0.01) and substance use problems (coefficient: –0.52, p< 0.01). Conclusions:This study suggests that increases in social support may positively impact depressive symptoms and substance use problems among PSH residents. Future housing programs could emphasize social support as an early component. Supported by Medicaid1115Waiver & R01AA019511.Item Addressing Disparities in Treatment for Substance Use Disorder Among Individuals with Developmental Disabilities: Perspectives from Treatment Facility Employees(2024-03-21) Yip, Maggie; Phan, Cong-Bao; Espinoza, Anna; Walters, Scott; Barnett, Tracey E.; Bednar, Hannah; Garcia, Lizbeth; Taha, Suha; Miller, Jackson; Lopez, Cindy; Fulda, KimberlyPurpose Research on substance use disorder (SUD) among individuals with developmental disabilities (DD) is limited. The extant literature suggests that people with DD are less likely to use substances overall compared to people without a disability; however, they are more susceptible to SUD if they do use substances. Among facilities in the United States that provide aid for individuals with DD and treatment facilities for individuals with SUD, there are currently no interdisciplinary practice guidelines or training materials available for providers treating those with a co-diagnosis of DD and SUD. Our project aims to reduce the disparities between treatment guidelines and materials available for people with a co-diagnosis of both SUD and DD. The purpose of this analysis was to gauge overall awareness of providing treatment for individuals with SUD/DD co-diagnosis and reflect on current protocols regarding this population. Methods In this project, interviews were conducted with workers at facilities that primarily provide SUD services. Relevant facilities were identified and selected through systematic internet searches. In this study, 11 questions were asked to workers at facilities through 15-30 minute phone interviews. Questions that were used for this analysis revolved around themes of workers’ perspectives on the importance of integrating SUD/DD services, their current practices, and their future recommendations for integrating care for individuals with both SUD/DD. Results We conducted a total of 12 interviews. Responses came from the South and Midwest United States geographical regions. From these interviews, we found that most programs aim to individualize their approaches to treating this specific population. However, there is no standardized approach to how they individualize these cases. Furthermore, many programs expressed that they rarely refer individuals with a co-diagnosis of SUD/DD outside of their agency and feel inadequately prepared to treat individuals with SUD/DD co-diagnosis, which further emphasizes the need for accessible standardized guidelines. Overall, many workers expressed a need for improved access to screenings, assessment tools, specific guidelines, knowledge, training, and specialized programs for the variety of specific types of DDs. Conclusions People with DD that experience SUD are a vulnerable population with few resources. To meet the needs of this vulnerable population, standardized guidelines and training materials should be developed to address the specific needs of this patient population and equip healthcare providers and stakeholders with the tools necessary to ensure this population has proper and equitable access to treatment.Item Are Smokers More Likely to be Non-Compliant with their Medications? An Examination of Permanent Supportive Housing (PSH) Residents in Fort Worth, Texas(2018-03-14) Walters, Scott; Moore, Jonathan; Moore, JonathanPurpose: People with a history of chronic homelessness are disproportionately more likely to smoke and have problems with medication compliance. Moreover, smoking and medication adherence are often related; people who smoke tend to have more trouble taking their medications. However, no studies to our knowledge have investigated this relationship among a group of formerly homeless individuals who have mental health symptoms. The current study utilized a sample of permanent supportive housing (PSH) residents in Ft. Worth, TX who were participating in a health coaching program. It was hypothesized that people who smoked would have more difficulties adhering to their medication regimens. Methods: Data were from m.chat, a technology-enhanced health coaching program for PSH residents with mental health symptoms. Data from November 2014 - March 2017, which consisted of 567 participants, were included. Baseline smoking status was determined by the following question: do you currently smoke cigarettes, or use other forms of tobacco? (yes vs. no). Medication adherence was identified using a modified Morisky Medication Adherence Scale, which categorized people as low vs. medium/high adherence. Covariates were selected based on prior literature and the information available in our data. Logistic regression was used for the analysis. Results: Medication adherence was similar between smokers and non-smokers (aOR: 0.78, 95% CI: 0.41, 1.49). However, drug abuse was significantly associated with medication adherence; people who reported consuming any illicit drug or abusing a prescription medication in the past 90 days had 73% lower odds (aOR: 0.27, 95% CI: 0.12, 0.65) of adhering to medications compared to those who reported no drug abuse. Alcohol consumption was significant in the unadjusted analysis, but was not significant after adjusting for other factors. Conclusions: Among a group of PSH residents with a history of homelessness, smokers and non-smokers had similar rates of medication adherence. Although smoking was not associated with medication adherence, other forms of substance use were related to a poorer medication adherence. This research highlights the role of illicit drug use in predicting medication adherence; programs that attempt to improve rates of medication adherence should take drug use into account as a key predictor of compliance.Item Details and Deadlines: What Predicts Health Goal Completion Among Residents of Permanent Supportive Housing?(2017-03-14) Chhetri, Shlesma; Crayton, Leeshia; Walters, Scott; Spence-Almaguer, Emily; Ahmed, HijabBackground: Permanent Supportive Housing (PSH) is an intervention designed to solve chronic homelessness in the United States and includes supportive services to assist people with living independently. In Tarrant County, these services are augmented by m.chat, a health coaching program that is intended to improve the overall quality of life of PSH residents. Participants meet monthly with health coaches to establish health and wellness goals which are are documented using an online health coaching program. Purpose:This study examined the association between different “SMART” (Specific, Measurable, Attainable, Realistic and Time-limited) characteristics and goal completion among m.chat participants. Methods:There were 329 participants with 1057 recorded goals over the intervention period. We excluded inactive goals, and data from the first and last three months of the participant’s involvement. Each goal was coded based on SMART traits using a binary choice (0 and 1 for absence or presence of trait, respectively). The outcome of interest was goal completion status (completed vs. active). Results: Participants were almost equally divided between females (51%) and males (49%). The mean age was 52 years. Descriptive tests revealed that 73% of goals were specific and measurable and 21.5% of goals were time-limited. The characteristics of being attainable and realistic lacked variability and were not included in further analysis. At the participant’s most recent coaching visit, 30% of the goals were completed and 70% were still active. Out of active goals, 70.5% were specific and measurable and of the completed goals, 78.9% were specific and measurable (Chi square p=0.005). Likewise, of active goals, 19.3% goals were time-limited compared to 26.5% of completed goals that were time-limited (Chi square p=0.009). Logistic regression revealed that the odds of specific and measurable goals being completed was 46% higher than those not specific and measurable (p=0.023). Similarly, the odds of timely goals being completed was 39% higher compared to non-time limited (p=0.045). Conclusions: Successful health goals were more likely to be specific, measurable, and time-limited. Limitations of this study included difficulties in standard appraisal of attainability. Future studies could further establish a temporal link between SMART traits and goal completion.Item Detecting Alcohol Consumption Among Homeless Individuals Using Ecological Momentary Assessment, Transdermal Sensors, And Timeline Follow Back Methods(2020) Li, Xiaoyin; Mun, Eun-Young; Businelle, Michael; Lineberry, Shelby; Tan, Zhengqi; Walters, ScottPurpose: The present study examined the extent to which self-reported measures of alcohol use from ecological momentary assessment (EMA) among homeless drinkers corresponded with estimates from a transdermal alcohol sensor (SCRAM) and self-reported timeline follow-back (TLFB) recall measures. Methods: Participants were 63 homeless adults who were receiving services at a homeless shelter in Dallas, TX. Participants' alcohol consumption data were collected via EMA, SCRAM sensor, and a TLFB recall measure at the 4-week follow-up. For each assessment approach, we created two daily alcohol use variables: any use (1= alcohol use positive or 0 = alcohol use negative) and alcohol use quantity. We analyzed data using multilevel models, calculated intraclass correlation coefficients for inter-rater agreement, and estimated pairwise correlations and means across all three assessment methods. Results: Across the three assessment methods, the intraclass correlation coefficient for inter-rater agreement was 0.81 for any alcohol use and 0.76 for alcohol use quantity, indicating excellent agreement. Furthermore, the EMA assessed the quantity of alcohol used was highly correlated with SCRAM peak transdermal alcohol concentration estimate, whereas TLFB had low to modest correlations with EMA and SCRAM measures of alcohol use quantity. Conclusions: Compared with a transdermal alcohol measure, EMA is a valid measure of alcohol use among homeless drinkers. Given the substantial day-to-day variation in alcohol consumption and the ease of EMA compared to biological measures, EMA-based measures of alcohol consumption may be an important tool for clinical research, especially among underserved populations.Item Do Brief Motivational Interventions Reduce Drinking and Driving among College Students? A Meta-analysis of Individual Participant Data(2020) Mun, Eun-Young; Zhou, Zhengyang; Walters, Scott; Li, Xiaoyin; Tan, Zhengqi; Lineberry, ShelbyPurpose, Alcohol-impaired driving (AID) is a serious public health concern in the United States. Although often targeted in brief motivational interventions (BMIs), AID has rarely been examined as a primary outcome in trials. This study examined the effectiveness of BMIs on AID for college students using a two-step meta-analysis of individual participant data. Methods, The data came from Project INTEGRATE, a large-scale synthesis study of individual participant data from BMIs and other individual-focused interventions designed to reduce heavy drinking and related problems among college students. A total of 15 trials assessed AID at baseline and the most immediate follow-up within 12 months post intervention (N=9,992; 58.3% female; 71.8% White; 54.6% 1st-year). Two outcomes were driving shortly after consuming 2+ drinks (25 comparisons), and consuming 4+ drinks (21 comparisons), which were coded to 1 (yes) or 0 (no). We separately analyzed these outcomes in random-effects meta-analysis models using "metafor" for R. Results, Overall, there were no statistically significant intervention effects on AID. The pooled log odds ratios of the combined trials were -0.03 (95% CI: -0.15, 0.09) for driving shortly after consuming 2+ drinks, and -0.10 (95% CI: -0.26, 0.07) for driving shortly after consuming 4+ drinks. Conclusions, Although BMIs are efficacious for reducing drinking and alcohol-related negative consequences, the findings from this meta-analysis indicate that they have little to no effects on AID among college students. Given the public health implications of AID, more focused intervention efforts are needed.Item Does Alcohol Use Affect the Relationship Between Social Support and Depression? An Examination of Permanent Supportive Housing (PSH) Residents in Fort Worth, Texas(2018-03-14) Walters, Scott; Suzuki, Sumihiro; Tan, ZhengqiBackground: Social support tends to be protective against depression in a wide variety of groups. However, relatively little is known about how alcohol use might affect this relationship over time, especially among supportive housing residents, who are at risk for both depression and poor social support. Purpose: This study examined whether the association between social support and depression was modified by alcohol consumption among permanent supportive housing (PSH) residents in Fort Worth, Texas. Methods: We used the baseline and 6-month follow-up data from the Mobile Community Health Assistance for Tenants (m.chat) program, collected during 2014-2017. m.chat was a technology-assisted health coaching program for people with mental health conditions residing in PSH in Fort Worth, Texas. Participants’ current levels of depression and social support were measured using Patient Health Questionnaire-9 (PHQ-9) and Interpersonal Support Evaluation List (ISEL), respectively; alcohol consumption was measured via a self-report frequency measure that ranged from “0” (never) to “4” (more than 4 times a week). The association between social support and depression was studied using generalized estimating equation (GEE) models including alcohol use as an effect modifier and sex, age, race, marital status and perceived physical health as a priori covariates. This analysis included 567 participants. Results: At baseline, about 38.2% of participants reported some alcohol consumption in the past 90 days. Greater baseline social support was associated with improvements in depression severity. One unit increase in the baseline ISEL score predicted a 4.3% reduction (95%CI: 2.6%, 6.1%) in depression scores over time. Greater baseline alcohol consumption predicted an 11.9% increase (95%CI: 0.8%, 21.6%) in depression scores over time. We did not find a significant interaction between alcohol consumption and social support and changes in depression severity after adjusting for sex, age, race, marital status and perceived physical health. Conclusions: Among PSH residents in Fort Worth, Texas, greater social support was associated with a reduction in depression scores. Higher alcohol consumption was associated with an increase in depression scores. The protective effect of social support did not differ by alcohol consumption level. These findings can be used to design more robust health coaching programs for formerly homeless persons that integrate positive social support.Item Effectiveness of AI Use in Qualitative Abstract Coding(2024-03-21) Alkhatib, Sarah; Jiwa, Nadiya; Judd, Dallin; Walters, ScottPurpose: As the field of qualitative research continues to evolve, the integration of artificial intelligence (AI) methods into data analysis has garnered increasing attention. This research paper presents a comparative analysis that evaluates the effectiveness, advantages, and disadvantages of utilizing AI methods for qualitative analysis of innovation characteristics of grant abstracts from the NIH RePORTER database, compared to traditional manual approaches. By comparing AI results to manual coding results, this project explores the potential transformative impact of AI on qualitative research. Methods: As part of the NIH HEAL initiative, researchers manually coded over 700 HEAL abstracts to examine innovation characteristics of grants funded. Survey questions included the type of study, study innovation, primary goals, and expected outputs. To explore whether these abstracts, when prompted in ChatGPT v4.0 would yield the same results as a human coder, we will input 100 of the 700 coded abstracts into ChatGPT, entering the same instructions given to the human coders. A comparative analysis will then assess and score the output in terms of detail, depth, relevance, and completeness of the responses. Results: We expect there to be no major differences between human and ChatGPT coding. This would suggest that AI can produce valid qualitative coding outcomes, potentially streamlining some research processes that involve abstracting themes from textual data and opening new possibilities for large-scale qualitative analysis. Conclusions: Ultimately, the findings of this study have the potential to shape the direction of qualitative research, offering valuable guidance to researchers and practitioners on the feasibility and reliability of integrating AI methods into their work. This research will contribute to the ongoing discourse on the role of AI in qualitative research and provide a foundation for future investigations in this rapidly evolving field.Item Electronic Goal Reminders and Subsequent Substance Use and Treatment Initiation in Probationers(2015-03) Spohr, Stephanie A.; Walters, Scott; Taxman, FayeObjective: The opportunities to influence behavior through the use of electronic goal reminders have not been examined in a criminal justice population. The purpose of this study was to assess probationer preferences for short-term goals from a web-based program and evaluate the role of voluntary electronic reminders (e.g., text messaging, email) in achieving early treatment and probation tasks. Methods: We used data from drug-involved offenders (n=76) participating in a clinical trial of a 2-session motivational computer program. As part of the program, participants could choose to receive text or email reminders about their probation and treatment goals for the next month. Poisson regression models were utilized to evaluate goal and reminder selection in relation to days of substance use and days of treatment attendance at two months. Results: The most common goals were related to treatment, probation, relationships, and reappraisal. Forty-five percent of probationers elected to receive electronic goal reminders at Visit 1 with a slight increase at Visit 2 (49%). Probationers who opted to receive electronic goal reminders at Visit 1 selected significantly more goals on average (M = 4.4, SD = 2.1) than probationers who did not want reminders (M = 3.4, SD = 1.8), (t = 2.41, p = .019). Reminder selection and total number of goals selected significantly predicted days of substance use and treatment attendance at two month follow-up. Probationers who opted not to receive electronic reminders and those who only selected to receive reminders at one visit had more days of substance use compared to those who received reminders at both visits, 1.66 and 2.31 times respectively. Probationers who chose not to receive electronic reminders attended 56% fewer days of treatment compared to those who received reminders at both visits. Conclusions: People’s choice of short-term goals and reminders can provide advance notification of the likelihood of substance use and treatment initiation. Probation systems might use such information to triage probationers to a higher level of service, before problems have emerged.Item FACTORS ASSOCIATED WITH INCREASED MOTIVATION FOR SUBSTANCE ABUSE TREATMENT AMONG PROBATIONERS(2014-03) Rodriguez, Mayra; Lerch, Jennifer; Walters, Scott; Taxman, FayePurpose (a): Study examines the individual factors associated with motivation for substance abuse treatment among probationers. Methods (b): Preliminary data (N=103) was collected from MAPIT, a multi-site, randomized controlled trial to increase substance abuse treatment (SAT) compliance. Criminal history, HIV testing, and social support were assessed as potential predictors of motivation. The CJ CEST-Intake was used to measure motivation, desire for help (alpha=.73) and problem recognition (.88). Results (c): Nearly 40% had a court condition to attend substance abuse treatment, with 41% having attended SAT sometime prior in their lifetime. 24.3% tested positive for any illicit drug. 87% had ever been tested for HIV in their lifetime, 69% were tested in the past 12 months. 32% had ever tested positive for any STD. Desire for help was marginally associated with at least one night of homelessness in the last 90 days (F(1, 101)=3.3, p=.07), lifetime prior SAT (F(1, 101) = 43.43, p=.00), having ever tested positive for an STD (F(1, 100) = 5.30, p=.02), and testing positive for amphetamines at baseline (F(1, 91)= 4.39, p=.04). Increased problem recognition was associated with lifetime prior SAT (F(1, 100)=7.70, p=.01) and testing positive for opiates F(1, 89)= 5.28, p=.02). Having ever had a prior SAT improved both desire for help (B= .50) and problem recognition (B= .52). Conclusions (d): Information may be helpful in increasing treatment initiation and engagement. Prior SAT, positive for STDs, and drug use were associated with increased motivation. Prior treatment may be considered to assess treatment readiness.Item Factors Associated with Medication Adherence Among Persons in Permanent Supportive Housing(2019-03-05) Nandy, Karabi; Nandy, Rajesh; Walters, Scott; Khan, MahbubaPurpose: Nonadherence to medication is associated with poor health outcomes, worsening of disease and frequent hospitalization. People living in permanent supportive housing (PSH) may be at greater risk of medication nonadherence because of a history of chronic homelessness, increased prevalence of mental disorders and other vulnerabilities. Understanding factors associated with medication nonadherence in this vulnerable population may help alleviate an important deficiency in their life and advance them towards stability. The objective of this study was to estimate the prevalence of medication adherence among PSH residents and to identify factors associated with low medication adherence. Methods: Adult PSH residents voluntarily participated in the mobile community health assistance for tenant (m.chat) project during 2014-2017 in Fort Worth, Texas. The Morisky medication adherence scale was used to classify participants as having low, medium or high adherence to medication. Self-reported data on demographic variables, alcohol consumption, quality of life, substance use, and depression were collected. Multinomial logistic regression was used to identify factors associated with participants’ levels of medication adherence. Results: A total of 598 participants were included in the sample. The prevalence of low, medium and high medication adherence were 54.5%, 29.9%, and 15.6%, respectively. In unadjusted analyses, binge drinking (p-value=0.001), quality of life (p-value Conclusion: A majority of PSH residents were in the low medication adherence category. To better address the issue of medication noncompliance, intervention programs may want to target PSH residents who have depression, binge drinking habit, and have a poor quality of life.Item Factors associated with the acceptability of Lopinavir/Ritonavir formulations among children living with HIV/AIDS attending care and treatment clinics in Mbeya and Mwanza, Tanzania(2024-03-21) Jiwa, Nadiya; Walters, ScottFACTORS ASSOCIATED WITH THE ACCEPTABILITY OF LOPINAVIR/RITONAVIR FORMULATIONS AMONG CHILDREN LIVING WITH HIV/AIDS ATTENDING CARE AND TREATMENT CLINICS IN MBEYA AND MWANZA, TANZANIA Authors: Jiwa NA[1],*, Ketang’enyi E1, Nganyanyuka K1, Mbwanji R1, Mwenisongole D1, Masuka E1, Brown M1, Charles M1, Mwasomola DL2 , Nyangalima T[2], Olomi W[3], Komba L1, Gwimile J1, Kasambala B1 and Mwita L1 *Corresponding author: Email addresses: njiwa@baylortanzania.or.tz [njiwa@baylortanzania.or.tz] (Nadiya Alnoor Jiwa- PI and Pharmacist) and lmwita@baylortanzania.or.tz [lmwita@baylortanzania.or.tz] (Dr Lumumba Mwita- Author and Executive Director). URL: https://www.texaschildrensglobalhealth.org/tanzania [https://www.texaschildrensglobalhealth.org/tanzania] and https://baylortanzania.or.tz/ [https://baylortanzania.or.tz/] [1] Baylor College of Medicine Children’s Foundation, Tanzania. [2] Mbeya Zonal Referral Hospital (MZRH) [3] National Institute of Medical Research (NIMR)- Mbeya Medical Research Center (MMRC) ABSTRACT INTRODUCTION Children living with chronic illnesses are offered formulations based on manufacturer and distributor research. The aim of this study is to better understand the perspectives of children and their caregivers in accepting Lopinavir/ritonavir (LPV/r) formulations. METHODS 362 participants were recruited from two pediatric HIV/AIDS clinics in Mbeya and Mwanza, Tanzania, from December 2021 to May 2022. A translated questionnaire was piloted and validated at both clinics, followed by the implementation of a cross-sectional study. RESULTS 169 participants (47.1%) reported general difficulties in swallowing, regardless of formulation, while 34.3% and 38.5% reported vomiting tablets and syrups, respectively. Statistical significance is shown to support that children can swallow medications if they can eat stiffened porridge (Ugali). This correlated with the lower incidence of younger children being able to swallow compared to older children (above six years of age). Children older than six years preferred taking tablets (independent of daily dosage) better than other formulations. Significantly, older children who attend school were associated with high odds of swallowing medicine (AOR = 3.06, 95%CI; 1.32–7.05); however, age was not found to be statistically related to ease of administration for Lopinavir/Ritonavir in this study. CONCLUSIONS Lopinavir/Ritonavir tablets remain the most accepted formulation among children and adolescents with HIV/AIDS. This study highlights the impact of various factors affecting the acceptability of pediatric formulation, suggesting that children younger than six years, unable to eat Ugali and not attending schools may be most vulnerable regarding their ability to accept Lopinavir/Ritonavir formulations. Further studies are needed to assess the acceptability of other medications in chronically ill children. Paper published on January 2nd, 2024 and available on: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0292424 [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0292424] Acknowledgement: Am grateful to Dr Scott Walters in his immense support for me to continue propagating this research from my previous work in my home, Tanzania Nadiya Alnoor Jiwa, Eunice Ketang’enyi, Kapongola Nganyanyuka, Ruth Mbwanji, Danistan Mwenisongole, Eutropia Masuka, Mary Brown, Mary Charles, Davance Leonard Mwasomola, Thomas Nyangalima, Willyhelmina Olomi, Lilian Komba, Judith Gwimile, Bertha Kasambala, Lumumba Mwita Published: January 2, 2024 https://doi.org/10.1371/journal.pone.0292424 [https://doi.org/10.1371/journal.pone.0292424]Item Factors Predicting Completion of Daily Phone Assessments(2017-03-14) Walters, Scott; Nandy, Rajesh; Li, TommyObjective: Participants in long-term studies often have varying rates of compliance with study activities, especially when those activities are required daily for extended periods of time. This study examined predictors of daily survey completion among a group of permanent supportive housing residents enrolled in m.Chat, a health coaching program. Methods: A subset of participants in the program received a prepaid cellphone with unlimited voice and text minutes, with the requirement that they complete a short automated assessment each morning. The phone recorded the number of days the participant was prompted to complete the assessment, the number of completed assessments, and the percentage completed each month. We examined age, sex, race, mental illnesses, reading ability, and alcohol use as predictors of percent completion. Results: Of the 109 participants who carried the phone for at least one month, three predictors impacted daily completion rate: a history of hallucinations, binge drinking, and baseline reading level. Of the three, having experienced hallucinations was the only statistically significant predictor. Subjects who had not experienced hallucinations in the past year had a completion rate approximately 10% higher than those who had experienced hallucinations. Conclusion: While some characteristics of a participant, namely their age, sex, race, and substance use, do not accurate predict the likelihood of completion rate of a daily assessment, other characteristics such as hallucinations may play a role. Additional research could help identify reliable predictors of compliance that would allow investigators to maximize response rates to long term assessment protocols. This may allow investigators to predict how reliable a participant will be when daily completion of an assessment is required on the phone.Item How are Incentives Spent? A Look at Gift Card Purchases Among Low-Income Research Participants(2017-03-14) Walters, Scott; Rendon, AlexisObjective: Incentives are frequently used to motivate volunteers to participate in research studies. This study examined the kinds of things that low-income study participants purchased with their incentive gift cards. Methods: For participating in a health coaching program, study participants received a $25 or $35 Walmart gift card every 6 months. During follow-up phone assessments, we asked participants what kinds of items they purchased with their most recent gift card. Results: Among 259 respondents, the most commonly reported purchased items were food (30.5%), household items (14.2%), clothing (12.6%), and personal hygiene items (11.9%). Less common items included cigarettes (1.6%), gifts for others (2.6%), pet food (2.6%), and reporting the gift card as unspent (2.6%). Additionally, we found that 73.4% of reported purchased items would have qualified as wellness items that could have been purchased using the study participant’s monthly $60 allowance. Conclusions: Most study participants reported spending their incentive gift cards on items that were congruent with health improvement goals of the health coaching program. This information may be useful in tailoring incentives in a way that helps participants reach their health and wellness goals.Item Improving Lives of Most Vulnerable: The Relationship between Diet, Physical Activity, and Quality of Life among Permanent Supportive Housing Residents(2016-03-23) Suzuki, Sumihiro; Spence-Almaguer, Emily; Walters, Scott; Chhetri, ShlesmaBackground: Chronic homelessness is a complex public health concern in the United States. People experiencing chronic homelessness are much more likely to suffer from mental illness and substance use, and to be overweight or obese (Tsai & Rosenheck, 2013; Tsemberis, Kent, & Respress, 2012). Housing First is an approach to place people who are chronically homeless into Permanent Supportive Housing (PSH) (Rog el at., 2014). There is clear evidence PSH programs increase housing retention and, reduce healthcare and criminal justice costs (Tsemberis & Eisenberg, 2014; McLaughlin, 2010). However, becoming housed does not necessarily improve a person’s overall quality of life (QOL) (Wolf et al., 2001). Improvement in diet and physical activity may be one way to improve QOL among vulnerable populations (Blissmer et al., 2006). However, this association has not been explored among PSH residents. The purpose of this study was to explore the patterns of change and relationship between diet, physical activity and QOL among PSH residents enrolled in a health coaching program. Method: We used data collected during baseline and follow up interviews from m.chat – a health coaching program for PSH residents in Fort Worth. The program utilizes motivational interviewing and wellness incentives to help people achieve health goals. Specifically, we examined demographic characteristics, diet, physical activity and overall QOL from 230 participants enrolled in the m.chat program. Paired t-test and mixed model analysis was performed utilizing SPSS software. Results: We found a significant improvement in the total QOL scores from baseline to follow-up. A random intercept model showed a positive association between change in diet and the improvement in QOL. Physical activity was not significantly related to improved QOL; however, there was large variation in the physical activity data. Conclusion: This study is the first to look at changes in QOL among PSH residents enrolled in a health coaching program. Interventions that encourage diet and physical activity may improve overall QOL among PSH residents.Item Longitudinal Associations of Social Support with Depression and Substance Use Problems among Permanent Supportive Housing Residents(2020) Walters, Scott; Mun, Eun-Young; Tan, ZhengqiPurpose: Social support is a well-known protective factor against depression and substance use problems, but very few studies have examined its protective effects among Permanent Supportive Housing (PSH) residents. We utilized unconditional latent growth curve (LGC) models and parallel process growth (PPG) models to describe trajectories of social support, depression, and substance use problems, and to examine their longitudinal associations in a large sample of adults residing in PSH. Methods: Participants were 653 adult PSH residents (56% female; 57% Black, 35% White, 8% others; mean age: 51 years). Health behaviors were assessed at baseline and every 6 months during a 2-year longitudinal study, which was conducted in Fort Worth, TX from 2014 to 2017. Results: Unconditional LGC models indicated that over time, social support increased whereas depressive symptoms and substance use problems decreased. However, their rate of change all slowed over time. Further, in PPG models, at baseline, greater social support was linked to less severe depression and substance use problems (coefficients: -0.21, p< 0.01; -0.06, p< 0.01, respectively). Linear slopes of social support and depression were negatively associated (coefficient: -0.01, p=0.01), indicating that faster rates of increase in social support were associated with steeper rates of reduction in depression. Linear slopes of social support and substance use problems were positively linked but statistically insignificant (coefficient: 0.01, p=0.63). Conclusions: This study suggests that increases in social support may positively impact depression and substance use problems among PSH residents, but when their positive trajectory slows, boosters may be needed.Item Project INTEGRATE: A Comprehensive and Systematic Meta-analysis Study of Brief Alcohol Interventions for Young Adults(2019-03-05) Li, Xiaoyin; Zhou, Zhengyang; Walters, Scott; Mun, Eun-YoungPurpose: Project INTEGRATE is a large synthesis study of alcohol intervention trials, which has been supported by the National Institute on Alcohol Abuse and Alcoholism since 2010. This multi-site, interdisciplinary project involves experts from a wide range of disciplinary fields (e.g., psychology, sociology, public health, statistics) who come together to help promote public health. Currently, we are conducting a comprehensive meta-analysis to examine the comparative effectiveness of brief alcohol interventions (BAI) for adolescents and young adults (aged 11-25). Through a previous systematic review and data request, we have compiled aggregate data (AD) from 189 studies and individual participant data (IPD) from 24 studies. We are currently reviewing full-text articles from 2013 through 2018 to update AD and IPD. Methods/Results: To examine the efficacy and mechanisms of BAIs on alcohol outcomes, our work has extended network meta-analysis models and multivariate random-effects meta-analysis models. Using a multilevel Bayesian hurdle model, we demonstrated how IPD from heterogeneous clinical trials with abundant structural and empirical zeros can be modeled in one step analysis. To validly compare individuals across time and studies, we have developed scoring approaches to harmonize and advance item response theory (IRT) models using Markov chain Monte Carlo studies. The goal of our methodological work is to develop tools to provide better clarity for the field by maximizing available data that are most granular and comprehensive. Thus far, we found that an in-person brief motivational intervention (BMI) is efficacious for reducing alcohol-related problems, and the benefit is sustained through 12 months post-intervention. We also found that the implementation and content of intervention makes a difference. When BMIs were highly personalized to participants, it was more beneficial to have a higher number of intervention components; conversely, when interventions have more general content, it was better to cover fewer components. Conclusions: Project INTEGRATE is developing innovative approaches to synthesizing information that will provide more robust, large-scale evidence of what works well, for whom, and how. The model-based inference derived from this complex synthesis of all available data will provide more contextualized and mechanism-based answers to major stakeholders.Item Protective behavioral strategies are more helpful for avoiding alcohol-related problems for college drinkers who drink less(2020) Li, Xiaoyin; Walters, Scott; Mun, Eun-YoungPurpose: Many health providers recommend that college students should use protective behavioral strategies (PBS) (e.g., setting drinking limits) to reduce negative consequences. This recommendation is derived from previous research showing that PBS can help reduce alcohol-related harm. However, more research is needed to determine whether PBS are equally protective across different demographic groups when college drinkers increase their alcohol consumption. This study examined race, gender, and alcohol use level as moderators of the association between PBS and alcohol-related problems among college students. Methods: A total of 12,011 participants (87.7% White, 61% Women) from 12 studies were selected from Project INTEGRATE that combined individual participant data from 24 intervention studies for college students. Complex samples hierarchical regressions were conducted using Mplus. Alcohol use, alcohol-related problems, and PBS use were continuous variables that were measured or estimated in latent variable modeling. Results: Moderation analyses suggested that the protective association between PBS and alcohol-related problems was greater for those who drank less. This moderated effect did not differ across men and women or across racial groups. Conclusions: Greater use of PBS may not always be beneficial for lowering alcohol problems, especially among heavier drinkers or during heavy drinking situations. College drinking prevention programs should ensure that students are aware of the limits of PBS as a harm reduction strategy for alcohol problems. Findings from this study provide evidence for public health efforts to reduce alcohol use "across the board" in addition to promoting PBS among student drinkers.Item Using Machine Learning Technique to Explore Factors Associated with Change in Quality of Life Among Permanent Supportive Housing Residents(2018-03-14) Nandy, Karabi; Nandy, Rajesh; Walters, Scott; Mamun, Md AbdullahPurpose: The purpose of this study was to identify predictors of change in the overall quality of life (QOL) at 6-months, compared to baseline, among permanent supportive housing residents with a history of chronic homelessness and mental illness. Methods: Data were collected at baseline and 6-month using 18 questionnaires, encompassing over 100 variables on 457 adults. The short version of the Quality of Life Enjoyment and Satisfaction Questionnaire was used to measure QOL. We used a machine learning technique for dimension reduction to achieve a final predictive model for QOL. We used a two-step approach: first, using a machine learning technique called random forest (RF) for dimension reduction by eliminating unimportant variables, and then using a model selection technique in multiple linear regression (MLR) framework with the reduced set obtained from RF to propose a final model. In the process, we highlighted the utility of RF as a means of exploring the fullness of a dataset in order to identify factors associated with improvement in QOL. We captured the linear relationships only in the final predictive model. Results: The mean improvement in QOL score at 6-months was 4.24 (SD=13.52, effect size=0.31). Significant predictors of the change in QOL were one’s baseline QOL (estimate=-0.32, p Conclusion: QOL is a multifaceted concept that encompasses various constructs ranging across physical health, psychological state of mind, social circumstances, environmental factors, etc. We hope that future interventions addressing QOL in this vulnerable population will benefit from our findings. Methodologically, we illustrate the benefit of using machine learning techniques in behavioral/social experiments to leverage “big data” and conduct comprehensive analyses.Item WHAT ARE THE NEEDS OF PERMANENT SUPPORTIVE HOUSING RESIDENTS? A SURVEY OF CASE MANAGERS IN TARRANT COUNTY(2014-03) Marshall, Brittany; Walters, Scott; Spence-Almaguer, Emily; Abraham, StacyThis research served as a pilot study to help us develop a program for homeless persons in Tarrant County to improve their quality of life. Purpose (a): Permanent Supportive Housing (PSH) is used as a method of reducing homelessness and its associated costs. The insight of case managers is integral to determine factors that may facilitate or inhibit the health and quality of life of PSH residents in Tarrant County. Methods (b): An online survey was conducted with PSH case managers (n=24) to assess the percentage of PSH residents affected by various health and wellness domains, barriers to improving health, and potential motivational levers. Data was analyzed using SPSS. Results (c): Case Managers reported that clients were most affected by poor mental health (74%), poor social support (69%) physical health (64%) and substance abuse (46%). Case managers identified furniture, transportation, and food as their clients’ top needs. Case managers believed clients were somewhat motivated to work on improving social support, physical and mental health, and poor nutrition. Approximately 60% of case managers believed their clients were not at all or a little motivated to work on improving medication adherence and substance abuse issues. Conclusions (d): Findings will guide the development of the Interactive Community Health Assistance for Tenants (iCHAT), which aims to reduce alcohol and drug use, reduce symptoms of depression, and improve quality of life amongst PSH residents.