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Purshouse RC, Buckley C, Brennan A. Commentary on Antosz et al. (2023): The role of macro-micro-macro frameworks and critical realism in agent-based modelling. ENVIRONMENTAL MODELLING & SOFTWARE : WITH ENVIRONMENT DATA NEWS 2024; 173:105959. [PMID: 38406209 PMCID: PMC10887422 DOI: 10.1016/j.envsoft.2024.105959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Antosz and colleagues' review of the role of theory in agent-based modelling (ABM) makes important recommendations for modelling practitioners. However, macro-micro-macro frameworks are not necessarily as reliant on existing theory as the review suggests. Adopting a critical realist perspective to ABM design would help to deliver the recommendations, within which macro-micro-macro frameworks can play an important enabling role.
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Affiliation(s)
- Robin C. Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, UK
| | - Charlotte Buckley
- Department of Automatic Control and Systems Engineering, University of Sheffield, UK
| | - Alan Brennan
- Sheffield Centre for Health and Related Research, University of Sheffield, UK
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Squires H, Kelly MP, Gilbert N, Sniehotta F, Purshouse RC. The long-term effectiveness and cost-effectiveness of public health interventions; how can we model behavior? A review. HEALTH ECONOMICS 2023; 32:2836-2854. [PMID: 37681282 PMCID: PMC10843043 DOI: 10.1002/hec.4754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 05/15/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
The effectiveness and cost of a public health intervention is dependent on complex human behaviors, yet health economic models typically make simplified assumptions about behavior, based on little theory or evidence. This paper reviews existing methods across disciplines for incorporating behavior within simulation models, to explore what methods could be used within health economic models and to highlight areas for further research. This may lead to better-informed model predictions. The most promising methods identified which could be used to improve modeling of the causal pathways of behavior-change interventions include econometric analyses, structural equation models, data mining and agent-based modeling; the latter of which has the advantage of being able to incorporate the non-linear, dynamic influences on behavior, including social and spatial networks. Twenty-two studies were identified which quantify behavioral theories within simulation models. These studies highlight the importance of combining individual decision making and interactions with the environment and demonstrate the importance of social norms in determining behavior. However, there are many theoretical and practical limitations of quantifying behavioral theory. Further research is needed about the use of agent-based models for health economic modeling, and the potential use of behavior maintenance theories and data mining.
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Affiliation(s)
- Hazel Squires
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nigel Gilbert
- Centre for Research in Social Simulation, University of Surrey, Guildford, UK
| | - Falko Sniehotta
- Faculty of Medicine Mannheim and Clinic Mannheim, Universität Heidelberg, Heidelberg, Germany
| | - Robin C Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
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Boyd J, Sexton O, Angus C, Meier P, Purshouse RC, Holmes J. Causal mechanisms proposed for the alcohol harm paradox-a systematic review. Addiction 2022; 117:33-56. [PMID: 33999487 PMCID: PMC8595457 DOI: 10.1111/add.15567] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/17/2020] [Accepted: 04/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS The alcohol harm paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol-related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another. METHODS This was a systematic review. We searched MEDLINE (1946-January 2021), EMBASE (1974-January 2021) and PsycINFO (1967-January 2021), supplemented with manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol-related harm and socio-economic position. Papers were set in Organization for Economic Cooperation and Development high-income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations. RESULTS Seventy-nine papers met the inclusion criteria and initial coding revealed that these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains: individual, life-style, contextual, disadvantage, upstream and artefactual. Explanations related to risk behaviours, which fitted within the life-style domain, were the most frequently proposed (n = 51) and analysed (n = 21). CONCLUSIONS While there are many potential explanations for the alcohol harm paradox, most research focuses on risk behaviours while other explanations lack empirical testing.
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Affiliation(s)
- Jennifer Boyd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Olivia Sexton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Robin C. Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Buckley C, Field M, Vu TM, Brennan A, Greenfield TK, Meier PS, Nielsen A, Probst C, Shuper PA, Purshouse RC. An integrated dual process simulation model of alcohol use behaviours in individuals, with application to US population-level consumption, 1984-2012. Addict Behav 2022; 124:107094. [PMID: 34530207 PMCID: PMC8529781 DOI: 10.1016/j.addbeh.2021.107094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/29/2021] [Accepted: 08/18/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The Theory of Planned Behaviour (TPB) describes how attitudes, norms and perceived behavioural control guide health behaviour, including alcohol consumption. Dual Process Theories (DPT) suggest that alongside these reasoned pathways, behaviour is influenced by automatic processes that are determined by the frequency of engagement in the health behaviour in the past. We present a computational model integrating TPB and DPT to determine drinking decisions for simulated individuals. We explore whether this model can reproduce historical patterns in US population alcohol use and simulate a hypothetical scenario, "Dry January", to demonstrate the utility of the model for appraising the impact of policy interventions on population alcohol use. METHOD Constructs from the TPB pathway were computed using equations from an existing individual-level dynamic simulation model of alcohol use. The DPT pathway was initialised by simulating individuals' past drinking using data from a large US survey. Individuals in the model were from a US population microsimulation that accounts for births, deaths and migration (1984-2015). On each modelled day, for each individual, we calculated standard drinks consumed using the TPB or DPT pathway. In each year we computed total population alcohol use prevalence, frequency and quantity. The model was calibrated to alcohol use data from the Behavioral Risk Factor Surveillance System (1984-2004). RESULTS The model was a good fit to prevalence and frequency but a poorer fit to quantity of alcohol consumption, particularly in males. Simulating Dry January in each year led to a small to moderate reduction in annual population drinking. CONCLUSION This study provides further evidence, at the whole population level, that a combination of reasoned and implicit processes are important for alcohol use. Alcohol misuse interventions should target both processes. The integrated TPB-DPT simulation model is a useful tool for estimating changes in alcohol consumption following hypothetical population interventions.
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Affiliation(s)
- Charlotte Buckley
- Department of Automatic Control and Systems Engineering, University of Sheffield, Mappin Street, Sheffield S1 3DA, UK.
| | - Matt Field
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, UK
| | - Tuong Manh Vu
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield S1 4DA, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield S1 4DA, UK
| | - Thomas K Greenfield
- Alcohol Research Group (ARG), Public Health Institute, 6001 Shellmound St, Emeryville, CA 94608, USA
| | - Petra S Meier
- MRC/CSO Social and Public Health Sciences Unit, Berkeley Square, 99 Berkeley Street, Glasgow G3 7HR, UK
| | - Alexandra Nielsen
- Alcohol Research Group (ARG), Public Health Institute, 6001 Shellmound St, Emeryville, CA 94608, USA
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, On M5S 2S1, Canada; Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld, 130.3 69120 Heidelberg, Germany
| | - Paul A Shuper
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, On M5S 2S1, Canada
| | - Robin C Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Mappin Street, Sheffield S1 3DA, UK
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Implementations, interpretative malleability, value-laden-ness and the moral significance of agent-based social simulations. AI & SOCIETY 2021. [DOI: 10.1007/s00146-021-01304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Purshouse RC, Buckley C, Brennan A, Holmes J. Commentary on Robinson et al. (2021): Evaluating theories of change for public health policies using computer model discovery methods. Addiction 2021; 116:2709-2711. [PMID: 34184346 PMCID: PMC9365023 DOI: 10.1111/add.15595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022]
Abstract
Recent developments in computer modelling—known as model discovery—could help to confirm the mechanisms underpinning Robinson and colleagues’ important early findings for the effectiveness of minimum unit pricing, and to test the complete theory of change underpinning this crucial evaluation.
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Affiliation(s)
- Robin C. Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield
| | - Charlotte Buckley
- Department of Automatic Control and Systems Engineering, University of Sheffield
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield
| | - John Holmes
- School of Health and Related Research, University of Sheffield
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McGill E, Petticrew M, Marks D, McGrath M, Rinaldi C, Egan M. Applying a complex systems perspective to alcohol consumption and the prevention of alcohol-related harms in the 21st century: a scoping review. Addiction 2021; 116:2260-2288. [PMID: 33220118 DOI: 10.1111/add.15341] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/09/2020] [Accepted: 11/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS A complex systems perspective has been advocated to explore multi-faceted factors influencing public health issues, including alcohol consumption and associated harms. This scoping review aimed to identify studies that applied a complex systems perspective to alcohol consumption and the prevention of alcohol-related harms in order to summarize their characteristics and identify evidence gaps. METHODS Studies published between January 2000 and September 2020 in English were located by searching for terms synonymous with 'complex systems' and 'alcohol' in the Scopus, MEDLINE, Web of Science and Embase databases, and through handsearching and reference screening of included studies. Data were extracted on each study's aim, country, population, alcohol topic, system levels, funding, theory, methods, data sources, time-frames, system modifications and type of findings produced. RESULTS Eighty-seven individual studies and three systematic reviews were identified, the majority of which were conducted in the United States or Australia in the general population, university students or adolescents. Studies explored types and patterns of consumption behaviour and the local environments in which alcohol is consumed. Most studies focused on individual and local interactions and influences, with fewer examples exploring the relationships between these and regional, national and international subsystems. The body of literature is methodologically diverse and includes theory-led approaches, dynamic simulation models and social network analyses. The systematic reviews focused on primary network studies. CONCLUSIONS The use of a complex systems perspective has provided a variety of ways of conceptualizing and analyzing alcohol use and harm prevention efforts, but its focus ultimately has remained on predominantly individual- and/or local-level systems. A complex systems perspective represents an opportunity to address this gap by also considering the vertical dimensions that constrain, shape and influence alcohol consumption and related harms, but the literature to date has not fully captured this potential.
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Affiliation(s)
- Elizabeth McGill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Dalya Marks
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael McGrath
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Chiara Rinaldi
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Rehm J, Purshouse RC. Causality and initiation of alcohol control policy. A response to Allamani. Drug Alcohol Rev 2021; 40:1389-1391. [PMID: 34347331 DOI: 10.1111/dar.13371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/27/2022]
Abstract
In a recent commentary, Allamani asked how one can establish causality in epidemiological research, and specifically about causality as it relates to alcohol control policy. Epidemiology customarily uses a sufficient-component cause model, where a sufficient cause for an outcome is determined by a set of minimal conditions and events that inevitably produce the stated outcome. While this model is theoretically clear, its operationalisation often involves probabilistic elements. Recent advances in agent-based modelling may improve operationalisation. The implications for alcohol control policy from this model are straightforward: the so-called alcohol-attributable fraction denotes the cases of morbidity or mortality which would not have happened in the absence of alcohol use.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.,Agència de Salut Pública de Catalunya, Barcelona, Spain.,Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robin C Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
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Boyd J, Bambra C, Purshouse RC, Holmes J. Beyond Behaviour: How Health Inequality Theory Can Enhance Our Understanding of the 'Alcohol-Harm Paradox'. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6025. [PMID: 34205125 PMCID: PMC8199939 DOI: 10.3390/ijerph18116025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022]
Abstract
There are large socioeconomic inequalities in alcohol-related harm. The alcohol harm paradox (AHP) is the consistent finding that lower socioeconomic groups consume the same or less as higher socioeconomic groups yet experience greater rates of harm. To date, alcohol researchers have predominantly taken an individualised behavioural approach to understand the AHP. This paper calls for a new approach which draws on theories of health inequality, specifically the social determinants of health, fundamental cause theory, political economy of health and eco-social models. These theories consist of several interwoven causal mechanisms, including genetic inheritance, the role of social networks, the unequal availability of wealth and other resources, the psychosocial experience of lower socioeconomic position, and the accumulation of these experiences over time. To date, research exploring the causes of the AHP has often lacked clear theoretical underpinning. Drawing on these theoretical approaches in alcohol research would not only address this gap but would also result in a structured effort to identify the causes of the AHP. Given the present lack of clear evidence in favour of any specific theory, it is difficult to conclude whether one theory should take primacy in future research efforts. However, drawing on any of these theories would shift how we think about the causes of the paradox, from health behaviour in isolation to the wider context of complex interacting mechanisms between individuals and their environment. Meanwhile, computer simulations have the potential to test the competing theoretical perspectives, both in the abstract and empirically via synthesis of the disparate existing evidence base. Overall, making greater use of existing theoretical frameworks in alcohol epidemiology would offer novel insights into the AHP and generate knowledge of how to intervene to mitigate inequalities in alcohol-related harm.
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Affiliation(s)
- Jennifer Boyd
- School of Health and Related Research, The University of Sheffield, S1 4DA Sheffield, UK;
| | - Clare Bambra
- Population Heath Sciences Institute, Faculty of Medical Sciences, Newcastle University, NE2 4HH Newcastle upon Tyne, UK;
| | - Robin C. Purshouse
- Department of Automatic Control and Systems Engineering, The University of Sheffield, S1 3JD Sheffield, UK;
| | - John Holmes
- School of Health and Related Research, The University of Sheffield, S1 4DA Sheffield, UK;
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Using Multi-objective Grammar-based Genetic Programming to Integrate Multiple Social Theories in Agent-based Modeling. EVOLUTIONARY MULTI-CRITERION OPTIMIZATION : ... INTERNATIONAL CONFERENCE, EMO ... : PROCEEDINGS. EMO (CONFERENCE) 2021; 12654:721-733. [PMID: 33959730 DOI: 10.1007/978-3-030-72062-9_57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Different theoretical mechanisms have been proposed for explaining complex social phenomena. For example, explanations for observed trends in population alcohol use have been postulated based on norm theory, role theory, and others. Many mechanism-based models of phenomena attempt to translate a single theory into a simulation model. However, single theories often only represent a partial explanation for the phenomenon. The potential of integrating theories together, computationally, represents a promising way of improving the explanatory capability of generative social science. This paper presents a framework for such integrative model discovery, based on multi-objective grammar-based genetic programming (MOGGP). The framework is demonstrated using two separate theory-driven models of alcohol use dynamics based on norm theory and role theory. The proposed integration considers how the sequence of decisions to consume the next drink in a drinking occasion may be influenced by factors from the different theories. A new grammar is constructed based on this integration. Results of the MOGGP model discovery process find new hybrid models that outperform the existing single-theory models and the baseline hybrid model. Future work should consider and further refine the role of domain experts in defining the meaningfulness of models identified by MOGGP.
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Brennan A, Buckley C, Vu TM, Probst C, Nielsen A, Bai H, Broomhead T, Greenfield T, Kerr W, Meier PS, Rehm J, Shuper P, Strong M, Purshouse RC. Introducing CASCADEPOP: an open-source sociodemographic simulation platform for us health policy appraisal. INTERNATIONAL JOURNAL OF MICROSIMULATION 2020; 13:21-60. [PMID: 33884027 DOI: 10.34196/ijm.00217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Largescale individual-level and agent-based models are gaining importance in health policy appraisal and evaluation. Such models require the accurate depiction of the jurisdiction's population over extended time periods to enable modeling of the development of non-communicable diseases under consideration of historical, sociodemographic developments. We developed CASCADEPOP to provide a readily available sociodemographic micro-synthesis and microsimulation platform for US populations. The micro-synthesis method used iterative proportional fitting to integrate data from the US Census, the American Community Survey, the Panel Study of Income Dynamics, Multiple Cause of Death Files, and several national surveys to produce a synthetic population aged 12 to 80 years on 01/01/1980 for five states (California, Minnesota, New York, Tennessee, and Texas) and the US. Characteristics include individuals' age, sex, race/ethnicity, marital/employment/parental status, education, income and patterns of alcohol use as an exemplar health behavior. The microsimulation simulates individuals' sociodemographic life trajectories over 35 years to 31/12/2015 accounting for population developments including births, deaths, and migration. Results comparing the 1980 micro-synthesis against observed data shows a successful depiction of state and US population characteristics and of drinking. Comparing the microsimulation over 30 years with Census data also showed the successful simulation of sociodemographic developments. The CASCADEPOP platform enables modelling of health behaviors across individuals' life courses and at a population level. As it contains a large number of relevant sociodemographic characteristics it can be further developed by researchers to build US agent-based models and microsimulations to examine health behaviors, interventions, and policies.
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Affiliation(s)
- Alan Brennan
- School of Health and Related Research, University of Sheffield (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - Charlotte Buckley
- Department of Automatic Control and Systems Engineering, University of Sheffield, Mappin Street, Sheffield, S1 3JD, UK
| | - Tuong Manh Vu
- School of Health and Related Research, University of Sheffield (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, On M5S 2S1, Canada
| | - Alexandra Nielsen
- Alcohol Research Group (ARG), Public Health Institute, 6001 Shellmound St, Emeryville, CA, 94608, USA
| | - Hao Bai
- Department of Automatic Control and Systems Engineering, University of Sheffield, Mappin Street, Sheffield, S1 3JD, UK
| | - Thomas Broomhead
- School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK
| | - Thomas Greenfield
- Alcohol Research Group (ARG), Public Health Institute, 6001 Shellmound St, Emeryville, CA, 94608, USA
| | - William Kerr
- Alcohol Research Group (ARG), Public Health Institute, 6001 Shellmound St, Emeryville, CA, 94608, USA
| | - Petra S Meier
- School of Health and Related Research; University of Sheffield (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - JüRgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Paul Shuper
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Mark Strong
- School of Health and Related Research; University of Sheffield (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - Robin C Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Mappin Street, Sheffield, S1 3JD, UK
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