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Pruitt SL, Leonard T, Murdoch J, Hughes A, McQueen A, Gupta S. Neighborhood effects in a behavioral randomized controlled trial. Health Place 2014; 30:293-300. [PMID: 25456014 DOI: 10.1016/j.healthplace.2014.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 09/29/2014] [Accepted: 10/02/2014] [Indexed: 10/24/2022]
Abstract
Randomized controlled trials (RCTs) of interventions intended to modify health behaviors may be influenced by neighborhood effects which can impede unbiased estimation of intervention effects. Examining a RCT designed to increase colorectal cancer (CRC) screening (N=5628), we found statistically significant neighborhood effects: average CRC test use among neighboring study participants was significantly and positively associated with individual patient's CRC test use. This potentially important spatially-varying covariate has not previously been considered in a RCT. Our results suggest that future RCTs of health behavior interventions should assess potential social interactions between participants, which may cause intervention arm contamination and may bias effect size estimation.
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Affiliation(s)
- Sandi L Pruitt
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9169, USA.
| | - Tammy Leonard
- Economics Department, University of Dallas, 1845 E. Northgate Dr., Irving, TX 75026, United States
| | - James Murdoch
- School of Economic, Political, and Policy Sciences, University of Texas-Dallas, 800W. Campbell Rd, GR31, Richardson, TX 75080, USA
| | - Amy Hughes
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; School of Economic, Political, and Policy Sciences, University of Texas-Dallas, 800W. Campbell Rd, GR31, Richardson, TX 75080, USA
| | - Amy McQueen
- Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue Campus, Box 8005, St. Louis, MO 63110, USA
| | - Samir Gupta
- Division of Gastroenterology, Department of Internal Medicine, Moores Cancer Center, University of California, San Diego, CA, USA; Department of Veterans Affairs, San Diego Healthcare System, 3350 La Jolla Village Dr MC 111D, San Diego, CA 92161, USA
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