Linda M Collins

• Ph.D.
• Pennsylvania State University

Objective Few individuals with eating disorders (EDs) receive treatment. Innovations are needed to identify individuals with EDs and address care barriers. We developed a chatbot for promoting services uptake that could be paired with online screening. However, it is not yet known which components drive effects. This study estimated individual and...

In the classical paradigm for intervention research, the components that are to make up an intervention are identified, pilot tested, and then immediately assembled into a treatment package and subjected to an evaluation randomized controlled trial (RCT) to assess the performance of the entire package. Intervention optimization, which adapts ideas...

Background Young adults from racial and ethnic minority (REM) groups are at greater risk of disengaging from vital mental health services than their majority group peers. Emerging research suggests developmentally tailored interventions that enable personalized exploration of cultural and structural contexts; encourage trust in relationships with s...

Advances in the multiphase optimization strategy (MOST) have suggested a new approach, decision analysis for intervention value efficiency (DAIVE), for selecting an optimized intervention based on the results of a factorial optimization trial. The new approach opens possibilities to select optimized interventions based on multiple valued outcomes....

We used results from an optimization randomized controlled trial which tested five behavioral intervention components to support HIV antiretroviral adherence/HIV viral suppression, grounded in the multiphase optimization strategy and using a fractional factorial design to identify intervention components with cost-effectiveness sufficiently favorab...

To build a coherent knowledge base about what psychological intervention strategies work, develop interventions that have positive societal impact, and maintain and increase this impact over time, it is necessary to replace the classical treatment package research paradigm. The multiphase optimization strategy (MOST) is an alternative paradigm that...

Interventions (including behavioral, biobehavioral, biomedical, and social-structural interventions) hold tremendous potential not only to improve public health overall but also to reduce health disparities and promote health equity. In this study, we introduce one way in which interventions can be optimized for health equity in a principled fashio...

Aim To compare effects of three post‐relapse interventions on smoking abstinence. Design Sequential three‐phase multiple assignment randomized trial (SMART). Setting Eighteen Wisconsin, USA, primary care clinics. Participants A total of 1154 primary care patients (53.6% women, 81.2% White) interested in quitting smoking enrolled from 2015 to 201...

Objective: Optimizing multicomponent behavioral and biobehavioral interventions presents a complex decision problem. To arrive at an intervention that is both effective and readily implementable, it may be necessary to weigh effectiveness against implementability when deciding which components to select for inclusion. Different components may have...

There is an urgent need for efficient behavioral interventions to increase rates of HIV viral suppression for populations with serious barriers to engagement along the HIV care continuum. We carried out an optimization trial to test the effects of five behavioral intervention components designed to address barriers to HIV care continuum engagement...

Intervention scientists applying the multiphase optimization strategy (MOST) to optimize a behavioral intervention (a) conduct an optimization trial and then (b) make decisions, based on the empirical results of the optimization trial, about which candidate intervention components merit inclusion in the optimized intervention. The current recommend...

Background The persistence of racial/ethnic inequities in rates of engagement along the HIV care continuum signals the need for novel approaches. We developed six behavioral intervention components for use in an optimization trial, grounded in a model that integrates critical race theory, harm reduction, and self-determination theory, designed to a...

Study objective: Tobacco dependence treatment initiated in the hospital emergency department (ED) is effective. However, trials typically use multicomponent interventions, making it difficult to distinguish specific components that are effective. In addition, interactions between components cannot be assessed. The Multiphase Optimization Strategy...

Background Rates of participation in HIV care, medication uptake, and viral suppression are improving among persons living with HIV (PLWH) in the United States. Yet, disparities among African American/Black and Latino PLWH are persistent, signaling the need for new conceptual approaches. To address gaps in services and research (e.g., insufficient...

Just-in-time adaptive interventions (JITAIs) are time-varying adaptive interventions that use frequent opportunities for the intervention to be adapted—weekly, daily, or even many times a day. The microrandomized trial (MRT) has emerged for use in informing the construction of JITAIs. MRTs can be used to address research questions about whether and...

Medical distrust is a potent barrier to participation in HIV care and medication use among African American/Black and Latino (AABL) persons living with HIV (PLWH). However, little is known about sociodemographic and risk factors associated with distrust. We recruited adult AABL PLWH from low socio-economic status backgrounds with insufficient engag...

The classical two-arm randomized clinical trial (RCT) is designed to test the efficacy or effectiveness of an intervention, which may consist of one or more components. However, this approach does not enable the investigator to obtain information that is important in intervention development, such as which individual components of the intervention...

As a new decade begins, we propose that the time is right to reexamine current methods and procedures and look for opportunities to accelerate progress in cancer prevention and control. In this article we offer our view of the next decade of research on behavioral and biobehavioral interventions for cancer prevention and control. We begin by discus...

Background The benefits of moderate to vigorous physical activity (MVPA) for breast cancer survivors are well established. However, most are insufficiently active. Fit2Thrive used the Multiphase Optimization Strategy methodology to determine the effect of 5 intervention components on MVPA in this population. Methods Two hundred sixty‐nine particip...

To improve understanding of how interventions work or why they do not work, there is need for methods of testing hypotheses about the causal mechanisms underlying the individual and combined effects of the components that make up interventions. Factorial mediation analysis, i.e., mediation analysis applied to data from a factorial optimization tria...

Each year hundreds of thousands of children and families receive behavioral interventions designed to prevent child maltreatment; yet rates of maltreatment have not declined in over a decade. To reduce the prevalence and prevent the life-long negative consequences of child maltreatment, behavioral interventions must not only be effective, but also...

This editorial introduces the multiphase optimization strategy (MOST), a principled framework for the development, optimization and evaluation of multicomponent interventions, to the field of implementation science. We suggest that MOST may be integrated with implementation science to advance the field, moving closer towards the ultimate goal of di...

Just-in-time adaptive interventions (JITAIs) are time-varying adaptive interventions that use frequent opportunities for the intervention to be adapted--weekly, daily, or even many times a day. The micro-randomized trial (MRT) has emerged for use in informing the construction of JITAIs. MRTs can be used to address research questions about whether a...

The COVID-19 pandemic has great potential to disrupt the lives of persons living with HIV (PLWH). The present convergent parallel design mixed-methods study explored the early effects of COVID-19 on African American/Black or Latino (AABL) long-term survivors of HIV in a pandemic epicenter, New York City. A total of 96 AABL PLWH were recruited from...

Aims: To assess the effectiveness of intervention components designed to increase quit attempts and promote abstinence in patients initially unwilling to quit smoking. Design: A 4-factor, randomized factorial experiment. Setting: 16 primary care clinics in southern Wisconsin. Participants: 577 adults who smoke (60% women, 80% White) recruite...

Background Using the multiphase optimization strategy (MOST), we previously developed and optimized an online behavioral intervention, itMatters, aimed at reducing the risk of sexually transmitted infections (STI) among first-year college students by targeting the intersection of alcohol use and sexual behaviors. Purpose We had two goals: (a) to e...

Substance use problems are highly prevalent among persons living with (PLWH) in the United States and serve as serious barriers to engagement in HIV care. Yet, in contrast to studies of single substances, little is known about patterns of polysubstance use in this population. Moreover, other risk factors (e.g., financial hardship, incarceration, ho...

Background Although periods of HIV antiretroviral therapy (ART) discontinuation have deleterious health effects, ART is not always sustained. Yet, little is known about factors that contribute to such ART non-persistence among long-term HIV survivors. The present study applied a convergent parallel mixed-methods design to explore the phenomena of s...

Background: Persons living with HIV (PLWH) are living longer, although racial/ethnic and socioeconomic status (SES) disparities persist. Yet, little is known about the experience of living with and managing HIV over decades. The present study took a qualitative approach and used the lens of symbolic violence, a type of internalized, non-physical v...

Objective To describe an iterative approach to developing an online intervention targeting the intersection of alcohol use and sexual behaviors among first year college students. Methods and Participants: Using the multiphase optimization strategy (MOST), we conducted two iterative optimization trials to: (1) identify candidate intervention compone...

Objective Intensive behavioral obesity treatments face scalability challenges, but evidence is lacking about which treatment components could be cut back without reducing weight loss. The Optimization of Remotely Delivered Intensive Lifestyle Treatment for Obesity (Opt‐IN) study applied the Multiphase Optimization Strategy to develop an entirely re...

Just-in-time adaptive interventions (JITAIs) are time-varying adaptive interventions that use frequent opportunities for the intervention to be adapted such as weekly, daily, or even many times a day. This high intensity of adaptation is facilitated by the ability of digital technology to continuously collect information about an individual's curre...

Introduction: Most people who smoke cigarettes are not willing (i.e., not ready) to make a quit attempt (QA) at any given time. Unfortunately, interventions intended to increase QAs and the success of QAs are only modestly effective. Identifying processes leading to QAs and quitting success could guide intervention development. Methods: This is...

Background Persons living with HIV (PLWH) are living longer, although racial/ethnic and socioeconomic status (SES) disparities persist. Yet, little is known about successful HIV management over decades. To address this gap, the present study took a qualitative approach and used the lens of symbolic violence, a type of internalized, non-physical vio...

Background Persons living with HIV (PLWH) are living longer, although racial/ethnic and socioeconomic status (SES) disparities persist. Yet, little is known about successful HIV management over decades. To address this gap, the present study took a qualitative approach and used the lens of symbolic violence, a type of internalized, non-physical vio...

Background: Smoking reduction treatment is a promising approach to increase abstinence amongst smokers initially unwilling to quit. However, little is known about which reduction treatment elements increase quit attempts and the uptake of cessation treatment amongst such smokers. Methods: This study is a secondary analysis of a 4-factor randomiz...

This chapter describes some aspects of an application of the multiphase optimization strategy (MOST) to optimize and evaluate itMatters, an online intervention that targets the intersection of alcohol use and sexual behaviors to reduce sexually transmitted infections (STIs) among college students. The chapter emphasizes two aspects of this applicat...

Background: High gestational weight gain is a major public health concern as it independently predicts adverse maternal and infant outcomes. Past interventions have had only limited success in effectively managing pregnancy weight gain, especially among women with overweight and obesity. Well-designed interventions are needed that take an individu...

Background The effectiveness of smoking cessation treatment is limited in real-world use, perhaps because we have not selected the components of such treatments optimally nor have treatments typically been developed for and evaluated in real-world clinical settings. Purpose To validate an optimized smoking cessation treatment package that comprise...

Fit2Thrive is a theory-guided physical activity promotion trial using the Multiphase Optimization Strategy (MOST) to test efficacy for improving physical activity of five technology-supported physical activity promotion intervention components among breast cancer survivors. This trial will recruit 256 inactive breast cancer survivors nationwide. Al...

Behavioral, biobehavioral, and biomedical interventions are programs with the objective of improving and maintaining human health and well-being, broadly defined, in individuals, families, schools, organizations, or communities. These interventions may be aimed at, for example, preventing or treating disease, promoting physical and mental health, p...

OBJECTIVES/SPECIFIC AIMS: The goal of this study is to develop an effective and efficient STI preventive intervention among college students following the principles and phases of MOST. METHODS/STUDY POPULATION As part of the preparation phase, an explicit conceptual model, drawing heavily on theory and prior research, was used to translate the exi...

Background More than half of persons living with HIV (PLWH) in the United States are insufficiently engaged in HIV primary care and not taking antiretroviral therapy (ART), mainly African Americans/Blacks and Hispanics. In the proposed project, a potent and innovative research methodology, the multiphase optimization strategy (MOST), will be employ...

Factorial experimental designs have many applications in the behavioral sciences. In the context of intervention development, factorial experiments play a critical role in building and optimizing high-quality, multicomponent behavioral interventions. One challenge in implementing factorial experiments in the behavioral sciences is that individuals...

Factorial experiments have rarely been used in the development or evaluation of clinical interventions. However, factorial designs offer advantages over randomized controlled trial designs, the latter being much more frequently used in such research. Factorial designs are highly efficient (permitting evaluation of multiple intervention components w...

To be suitable for informing digital behavior change interventions, theories and models of behavior change need to capture individual variation and changes over time. The aim of this paper is to provide recommendations for development of models and theories that are informed by, and can inform, digital behavior change interventions based on discuss...

Digital health interventions have enormous potential as scalable tools to improve health and healthcare delivery by improving effectiveness, efficiency, accessibility, safety, and personalization. Achieving these improvements requires a cumulative knowledge base to inform development and deployment of digital health interventions. However, evaluati...

Background: Understanding how smoking cessation treatments exert their effects can inform treatment development and use. Factorial designs allow researchers to examine whether multiple intervention components affect hypothesized change mechanisms, and whether the affected mechanisms are related to cessation. Methods: This is a secondary data ana...

Background: The development of tobacco use treatments that are effective for all smokers is critical to improving clinical and public health. The Multiphase Optimization Strategy (MOST) uses highly efficient factorial experiments to evaluate multiple intervention components for possible inclusion in an optimized tobacco use treatment. Factorial ex...

Digital health interventions have enormous potential as scalable tools to improve health and healthcare delivery by improving effectiveness, efficiency, accessibility, safety, and personalization. Achieving these improvements requires a cumulative knowledge base to inform development and deployment of digital health interventions. However, evaluati...

Background The just-in-time adaptive intervention (JITAI) is an intervention design aiming to provide the right type/amount of support, at the right time, by adapting to an individual?s changing internal and contextual state. The availability of increasingly powerful mobile and sensing technologies underpins the use of JITAIs to support health beha...

AimsTo identify promising intervention components that help smokers attain and maintain abstinence during a quit attempt. DesignA 2x2x2x2x2 randomized factorial experiment. SettingEleven primary care clinics in Wisconsin, USA. ParticipantsA total of 544 smokers (59% women, 86% white) recruited during primary care visits and motivated to quit. Inter...

Aim To identify promising intervention components intended to help smokers to attain and maintain abstinence in their quit smoking attempts. DesignA fully crossed, six-factor randomized fractional factorial experiment. SettingEleven primary care clinics in southern Wisconsin, USA. ParticipantsA total of 637 adult smokers (55% women, 88% white) moti...

AimsTo screen promising intervention components designed to reduce smoking and promote abstinence in smokers initially unwilling to quit. DesignA balanced, four-factor, randomized factorial experiment. SettingEleven primary care clinics in southern Wisconsin, USA. ParticipantsA total of 517 adult smokers (63.4% women, 91.1% white) recruited during...

Background and aims: A chronic care strategy could potentially enhance the reach and effectiveness of smoking treatment by providing effective interventions for all smokers, including those who are initially unwilling to quit. This paper describes the conceptual bases of a National Cancer Institute-funded research program designed to develop an op...

To move society toward an AIDS-free generation, behavioral interventions for prevention and treatment of HIV/AIDS must be not only effective, but also cost-effective, efficient, and readily scalable. The purpose of this article is to introduce to the HIV/AIDS research community the multiphase optimization strategy (MOST), a new methodological frame...

The multiphase optimization strategy (MOST) is a framework for not only evaluating but also optimizing behavioral interventions. A tool critical for MOST is the screening experiment, which enables efficient gathering of information for deciding which components to include in an optimized intervention. This article outlines a procedure for making de...

Given current pressures to increase the public health contributions of behavioral interventions, intervention scientists may wish to consider moving beyond the classical treatment package approach that focuses primarily on achieving statistical significance. They may wish also to focus on goals directly related to optimizing public health impact. T...

Background: An understanding of the individual and combined effects of a set of intervention components is important for moving the science of preventive medicine interventions forward. This understanding can often be achieved in an efficient and economical way via a factorial experiment, in which two or more independent variables are manipulated....

Background and purpose: A behavioral intervention is a program aimed at modifying behavior for the purpose of treating or preventing disease, promoting health, and/or enhancing well-being. Many behavioral interventions are dynamic treatment regimens, that is, sequential, individualized multicomponent interventions in which the intensity and/or typ...

The chronic, relapsing nature of tobacco use represents a major challenge in smoking cessation treatment. Recently, novel intervention paradigms have emerged that seek to adjust treatments over time in order to meet a patient's changing needs. This article demonstrates that Hybrid Model Predictive Control (HMPC) offers an appealing framework for de...

Excessive gestational weight gain (GWG) represents a major public health concern contributing to the obesity epidemic. Half of all pregnant women in the U.S. begin their pregnancies overweight or obese and 60% of these women exceed GWG guidelines. Despite focused prevention efforts, to date, behavioral intervention studies show little to no evidenc...

Introduction: It is vital to enhance the progress of smoking cessation treatment research. Using the Multiphase Optimization Strategy (MOST) we have attempted to identify effective smoking cessation intervention components that can be combined in an evidence-based manner to produce an optimized treatment package that significantly improves cessatio...

Introduction: College student-athletes are at increased risk of substance use compared to non-athletes. Currently there are no evidence-based programs that address their unique patterns and motivations for use. In response to this void, we developed myPlaybook, an online substance use intervention tailored to college student-athletes. After initial...

Adolescents who use methamphetamine (MA) are a vulnerable part of the South African population. In a study of ninth graders at 30 high schools in Cape Town (South Africa), those who had used MA in the last 30 days were significantly more likely to have had sex (vaginal, oral or anal) in the past month, been pregnant or made someone pregnant and to...

Background: Obesity-attributable medical expenditures remain high, and interventions that are both effective and cost-effective have not been adequately developed. The Opt-IN study is a theory-guided trial using the Multiphase Optimization Strategy (MOST) to develop an optimized, scalable version of a technology-supported weight loss intervention....

Cigarette smoking is a major global public health issue and the leading cause of preventable death in the United States. Toward a goal of designing better smoking cessation treatments, system identification techniques are applied to intervention data to describe smoking cessation as a process of behavior change. System identification problems that...

Efficient new technology has made it straightforward for behavioral scientists to collect anywhere from several dozen to several thousand dense, repeated measurements on one or more time-varying variables. These intensive longitudinal data (ILD) are ideal for examining complex change over time but present new challenges that illustrate the need for...

Self-regulation, a key component of the addiction process, has been challenging to model precisely in smoking cessation settings, largely due to the limitations of traditional methodological approaches in measuring behavior over time. However, increased availability of intensive longitudinal data (ILD) measured through ecological momentary assessme...

Almost 35 million U.S. smokers visit primary care clinics annually, creating a need and opportunity to identify such smokers and engage them in evidence-based smoking treatment. The purpose of this study is to examine the feasibility and effectiveness of a chronic care model of treating tobacco dependence when it is integrated into primary care sys...

Parental knowledge is a key protective factor for youths' risky behavior. Little is known about how longitudinal combinations of knowledge-related behaviors are associated with youths' substance use. This longitudinal study uses Latent Transition Analysis to identify latent patterns of parental knowledge-related behaviors occurring in mother-youth...

Excessive gestational weight gain (GWG) represents a major public health issue. In this paper, we pursue a control engineering approach to the problem by applying model predictive control (MPC) algorithms to act as decision policies in the intervention for assigning optimal intervention dosages. The intervention components consist of education, beh...

Cigarette smoking remains a major public health issue. Despite a variety of treatment options, existing intervention protocols intended to support attempts to quit smoking have low success rates. An emerging treatment framework, referred to as adaptive interventions in behavioral health, addresses the chronic, relapsing nature of behavioral health...

Methamphetamine (MA) use in Cape Town is steadily increasing. In 2009, nearly half of patients at Cape Town’s specialist substance abuse treatment centres received treatment for MA use, with 57% of MA patients aged 15-24 years. Only three previous studies examined the association between MA use and sexual risk behavior among youth in Cape Town. The...

Cigarette smoking remains a major public health issue. Despite a variety of treatment options, existing intervention protocols intended to support attempts to quit smoking have low success rates. An emerging treatment framework, referred to as adaptive interventions in behavioral health, addresses the chronic, relapsing nature of behavioral health...

Excessive gestational weight gain (GWG) represents a major public health issue. In this paper, we pursue a control engineering approach to the problem by applying model predictive control (MPC) algorithms to act as decision policies in the intervention for assigning optimal intervention dosages. The intervention components consist of education, beh...

Most studies isolate the effects of one knowledge-related behavior on youth outcomes. This study explores the relationship between subgroups of mother-youth dyads that use specific combinations of parental knowledge-related behaviors and youth risky behavior. Using a sample of 796 rural 6th graders (53 % female), we assessed mother and youth report...

Demonstrates the use of latent transition analysis (LTA), an extension of latent class models and similar to structural equation modeling (SEM), that provides a means of estimating and testing stage-sequential developmental models with longitudinal data. The model is tested on data examining gender differences in substance use onset in a sample of...

Discusses design, measurement, and analysis issues relevant to the study of growth and change in social psychological research. The authors view individual growth as a starting point, and argue that individual growth is a necessary prerequisite to the assessment of interindividual or group differences in growth. The age, cohort, and time perspectiv...

Often quantities of interest in psychology cannot be observed directly. These unobservable quantities, known as latent variables, tend to be complex, often multidimensional, constructs. In many cases these constructs are categorical, such that individuals belong to mutually exclusive and exhaustive unobservable subgroups. Latent class analysis (LCA...

Excessive gestational weight gain (GWG) represents a major public health concern. In this paper, we present a dynamical systems model that describes how a behavioral intervention can influence weight gain during pregnancy. The model relies on the integration of a mechanistic energy balance with a dynamical behavioral model. The behavioral model inc...

Missing data in a field experiment may arise from a number of sources. Participants may skip over questions inadvertently or refuse to answer them; they may offer an illegible response; they may fail to complete a questionnaire; or they may be absent from an entire measurement session in a longitudinal study. The last is often called wave nonrespon...

Background HealthWise South Africa: Life Skills for Adolescents (HW) is an evidence-based substance use and sexual risk prevention program that emphasizes the positive use of leisure time. Since 2000, this program has evolved from pilot testing through an efficacy trial involving over 7,000 youth in the Cape Town area. Beginning in 2011, through 20...

Factorial experimental designs have many potential advantages for behavioral scientists. For example, such designs may be useful in building more potent interventions by helping investigators to screen several candidate intervention components simultaneously and to decide which are likely to offer greater benefit before evaluating the intervention...

Background: Low levels of parental monitoring, the extent to which parents track youth activities, has been consistently associated with high rates of youth problem behavior (Crouter & Head, 2002). However, measurement issues have made it difficult to identify which specific combinations of parent and youth monitoring behaviors may be protective ag...

Excessive gestational weight gain (GWG) represents a major public health concern. In this paper, we present a dynamical systems model that describes how a behavioral intervention can influence weight gain during pregnancy. The model relies on the integration of a mechanistic energy balance with a dynamical behavioral model. The behavioral model inc...

Gestational weight gains (GWGs) that exceed the 2009 Institute of Medicine recommended ranges increase risk of long-term postpartum weight retention; conversely, GWGs within the recommended ranges are more likely to result in positive maternal and fetal outcomes. Despite this evidence, recent epidemiologic studies have shown that the majority of pr...

This paper examines how control engineering and risk management techniques can be applied in the field of behavioral health through their use in the design and implementation of adaptive behavioral interventions. Adaptive interventions are gaining increasing acceptance as a means to improve prevention and treatment of chronic, relapsing disorders,...

Replication research is essential for the advancement of any scientific field. In this paper, we argue that prevention science will be better positioned to help improve public health if (a) more replications are conducted; (b) those replications are systematic, thoughtful, and conducted with full knowledge of the trials that have preceded them; and...

Replication research is essential for the advancement of any scientific field. In this paper, we argue that prevention science will be better positioned to help improve public health if (a) more replications are conducted; (b) those replications are systematic, thoughtful, and conducted with full knowledge of the trials that have preceded them; and...