The past several decades have been characterized by anevolution of the public health problems facing society. Global obesity rates have doubled since the 1980s, with the United States experiencing the greatest gains in the developed world. Although total cancer deaths in the US have decreased since the 1990s, cancers of the skin, liver, and kidney have remained steady or increased, prompting an adjustment in prevention strategies. Increased opioid use has led to skyrocketing addiction and overdose levels. Recognition of global climate change has drawn attention to the effects of rising temperatures on air quality and communicable diseases such as Malaria and West Nile Virus. Increasing globalization has changed the speed and ways in which communicable diseases can be spread. Shifting political climates, nationally and abroad, have introduced new uncertainty about how healthcare will be delivered, particularly to the most vulnerable.
At the same time, the global community has experienced staggering developments in technology. In 1995, less than 1% of the global population had regular access to the Internet. By 2014, this proportion was almost 40%. Importantly, although Internet access in developed countries is nearing saturation, developing countries have also seen a dramatic increase in the number of individuals who have access to the Internet. Much of this increase, particularly in developing countries, has come from the introduction of smartphones. Following the rise of the Internet, social media platforms such as Facebook, Twitter, and Snapchat have changed the ways people around the world communicate. Developments in artificial intelligence and robotics are changing the ways human resources need to be allocated.
Although these technological trends have evolved concurrently, they have traditionally been viewed as unfolding in different worlds. Recently however, public health researchers have begun to explore the ways in which innovative technologies can be leveraged to address the public health issues facing today’s society. At the School of Public Health, technology is integrated into the ways we conduct research and educate about public health, as well as a bottom-up effort from individual faculty members to integrate technology into their programs of research.
Because of the interdisciplinary nature and breadth of expertise at Brown, technologies ranging from smartphone apps, to remote HIV testing kits, to methods of analyzing tumor images have been employed to address problems including alcohol use disorder, tobacco use, HIV treatment, cancer, and efficiency in the healthcare system.
Public health researchers have begun to explore the ways in which innovative technologies can be leveraged to address the public health issues facing today’s society.
For Nancy Barnett, Professor of Behavioral and Social Sciences, developments in how alcohol consumption can be monitored represent a change in the way contingency management can be used to motivate behavior change. Contingency management programs, which reward participants who engage in positive behaviors, have traditionally been used to incentivize those with alcohol use disorder to refrain from drinking alcohol. However, programs have generally relied upon breath alcohol tests, which only detect alcohol consumed within a relatively brief period. This measurement restriction can limit the accuracy with which nondrinkers and drinkers are identified, which has repercussions for who receives or does not receive rewards. Barnett and her colleagues at Brown, including Mark Celio, Jennifer Tidey, Suzanne Colby, and Robert Swift, have started to explore the potential for transdermal alcohol sensors to replace breath alcohol tests as a more comprehensive way of measuring alcohol consumption. Transdermal alcohol sensors are worn on the ankle or wrist, and measure alcohol content secreted through the skin, data which can be continuously uploaded to an online database. Although Professor Barnett is currently evaluating this technology integrated within a contingency management program, there are other ways in which this technology can address alcohol use. By integrating continuous monitoring with other technologies, such as global positioning systems, researchers can design just-in-time adaptive interventions, which deliver tailored intervention content to individuals through the web, based on their current alcohol levels or locations.
Just-in-time adaptive interventions represent one of the ways in which technologies can seamlessly collect data and push intervention content to deliver a holistic public health solution. Tyler Wray, Assistant Professor of Behavioral and Social Sciences, is currently investigating the ways in which real time monitoring of home-based self-HIV testing can promote increased linkage to care. Wray, with support from the National Institute of Mental Health, has proposed refining technology to monitor home-based tests in real time and then reaching individuals with immediate post-test counselling and linking them with care over the phone. For Wray, this type of approach is a game changer for how evidence-based strategies can be delivered to those who need them most: “As we’re understanding more and more about what the key elements of interventions are that tend to help people change to be healthier, the question is how we get interventions to people most in need and still make sure the important ‘ingredients’ are included. Using the Internet and technology to help provide these interventions, could be one way to make sure they maintain the key components most useful in helping patients change, while at the same time reaching more patients who need them.”
Providing care or support using technology is an approach shared by many researchers at Brown. Before the advancement of web-based technologies, public health interventionists struggled to design interventions that were both personalized and scalable. Now however, researchers can design programs tailored to individual-level characteristics, that can be more easily delivered to at-risk populations remotely. For example, researchers in the Department of Behavioral and Social Sciences have recently begun to explore how technology can address the challenges of providing alcohol counselling in the Emergency Department. Motivational interviewing, a form of counselling, is an effective approach to reduce drinking, but in the hectic Emergency Department environment, it can be difficult to provide this care to those admitted for alcohol use. For Mark Celio, Nancy Barnett, Suzanne Colby, and Chris Kahler, web-conferencing software may provide the solution to this problem. They are exploring the preliminary feasibility of delivering counselling using this platform to patients in the Emergency Department, and patients have responded quite positively to the experience. The researchers are enthusiastic about further evaluation of this exciting new approach.
As technology continues to impact all our lives, Public Health researchers are harnessing its power to provide targeted interventions, collect data in real time, and connect people with resources in new ways.
Faculty in the School of Public Health are also applying the power of technology to improvement of care in nursing homes. Vince Mor, Florence Pirce Grant University Professor and Professor of Health Services, Policy and Practice, has developed an innovative way of supporting advanced care planning for nursing home residents. As Professor Mor describes, “nursing homes have evolved into complex health care systems serving an increasingly sick patient population with advanced comorbid conditions. These patients often get aggressive and costly interventions that may be of little clinical benefit and inconsistent with their preferences.” Traditionally, advanced care planning has been a challenge for nursing home staff because it involves complex scenarios that are difficult to articulate, and can be compounded by language and literacy barriers. Professor Mor has developed a video-based decision support tool that uses graphics and scenarios to explain the process to patients in a clearer way. Importantly, this represents a scalable solution; Dr. Mor says this innovative model “offers a promising, scalable, and efficacious approach to promote more preference-based, higher quality, and cost-effective care among nursing home patients with advanced disease.”
Social media, which has unequivocally changed the way people communicate, is another vehicle faculty are using to connect populations to care. Dr. Jacob Vandenberg, Assistant Professor of Behavioral and Social Sciences, with support from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, is currently exploring the ways in which social media can be used to engage men who have sex with men, and link them to an existing interactive website, Men2MenRI.org, developed by Vandenberg and colleagues at the AIDS Project Rhode Island. In particular, Dr. Vandenberg is interested in the ways social media can be used to engage with African American and Latino men, populations that are historically difficult to reach.
The intersection between technology and public health also plays out in the growing field of medical image analysis. Radiological images are analyzed to identify signatures used to diagnose disease and predict patient outcomes. Radiogenomics analysis correlates radiomic signatures with the results of genomic analyses of specimens from the same patients. A research team led by Constantine Gatsonis, Chair of the Department of Biostatistics, focuses on cancer radiomics, with an emphasis on tumor heterogeneity. The team uses statistical machine learning tools to develop new measures of heterogeneity, which take into account the topology of tumors. This research analyzes imaging studies from trials conducted by the American College of Radiology Imaging Network and combines imaging and clinical data to predict the course of disease and patient response to therapy. This personalized medicine approach provides critical information for doctors as they determine treatment for their patients.
Finally, a discussion of technology would not be complete without including the rise of video games, a pastime for many students (and perhaps faculty) in the School of Public Health. Video games are not widely considered to be a public health tool, but Beth Bock, Professor of Behavioral and Social Sciences, is trying to change that. Bock has been evaluating the effect of ‘exercise video games’ on physical activity in adults to assess whether this approach can promote adequate levels of physical activity and reduce the risk of cardiovascular disease. In recent preliminary work, Bock has reported satisfaction with this platform as an exercise tool, as well as increased overall physical activity and reduced blood pressure. Although commonly associated with the Wii platform, exercise video games have become a popular subsegment of the video game market and have made their way onto other platforms including the Xbox and Playstation, suggesting this line of research will only become more important in the future.
As technology continues to impact all our lives, Public Health researchers are harnessing its power to provide targeted interventions, collect data in real time, and connect people with resources in new ways. Taken as a whole, the exciting research being done at Brown represents recognition that technology is, and will continue to be, an important component of the public health landscape. It will be exciting to watch how the School of Public Health, which has identified mobile health as an area of strategic growth, continues to respond to technology’s ever-evolving opportunities, challenges, and rewards.