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Estimating the Effects of a Complex, Multidimensional Moderator: An Example of Latent Class Moderation to Examine Differential Intervention Effects of Substance Use Services

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Abstract

Improvements in substance use disorder recovery may be achieved by recognizing that effective interventions do not work equally well for all individuals. Heterogeneity of intervention effects is traditionally examined as a function of a single variable, such as gender or baseline severity. However, responsiveness to an intervention is likely a result of multiple, intersecting factors. Latent class moderation enables the examination of heterogeneity in intervention effects across subgroups characterized by profiles of characteristics. This study analyzed data from adolescents (aged 13 to 18 years old) who needed treatment for cannabis use (n = 14,854) and participated in the Global Appraisal of Individual Needs to evaluate differential effects of substance use services on cannabis use outcomes. We demonstrate an adjusted three-step approach using weights that account for measurement error; sample codes in Mplus and Latent Gold are provided and data are publicly available. Indicators of the latent class moderator comprised six contextual (e.g., recovery environment risk) and individual (e.g., internal mental distress) risk factors. The latent class moderator comprised four subgroups: low risk (21.1%), social risk (21.1%), environmental risk (12.5%), and mixed risk (45.2%). Limited moderation of associations between level of care and any past 90-day cannabis use were observed. In predicting number of cannabis use-days, compared to individuals with low risk, those with environmental risk showed improved outcomes from intensive outpatient care whereas individuals with social risk and mixed risk showed improved outcomes from residential care (all compared to early intervention/outpatient care). Latent class moderation holds potential to elucidate heterogeneity in intervention effectiveness that otherwise may go undetected.

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Acknowledgements

The authors wish to thank Loren D. Masters who assisted in the acquisition and management of the Global Appraisal of Individual Needs (GAIN) data. The authors also wish to thank Michael L. Dennis, Christy K. Scott, and Chestnut Health System for the collection, management, and dissemination of GAIN data and early discussions that helped inform our thinking about our latent class moderator.

Funding

This research was conducted at The University of Illinois at Chicago, Yale University, and The Pennsylvania State University and was supported by awards P50-DA039838 and R01-DA037902 from the National Institute on Drug Abuse (NIDA), T32-MH020031 from the National Institute of Mental Health (NIMH), and DGE1255832 from the National Science Foundation (NSF) Graduate Research Fellowship Program.

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Authors and Affiliations

  1. Institute for Health Research and Policy, University of Illinois Chicago, 1747 W Roosevelt Rd., IL, 60608, Chicago, USA

    Bethany C. Bray

  2. Department of Human Development and Family Sciences, University of Delaware, 111 Alison Hall West, Newark, DE, 19716, USA

    Eric K. Layland

  3. Edna Bennett Pierce Prevention Research Center, The Pennsylvania State Univerity, 314 Biobehavioral Health Bldg., PA, 16802, University Park, USA

    Samuel W. Stull & Stephanie T. Lanza

  4. Department of Biobehavioral Health, The Pennsylvania State University, 314 Biobehavioral Health Bldg, University Park, PA, 16802, USA

    Samuel W. Stull & Stephanie T. Lanza

  5. Department of Human Development and Family Science, Syracuse University, 144 White Hall, Syracuse, NY, 13244, USA

    Sara A. Vasilenko

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  1. Bethany C. Bray
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  5. Stephanie T. Lanza
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Correspondence to Bethany C. Bray.

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Data collection protocols for the Global Appraisal of Individual Needs (GAIN) were approved by the Institutional Review Board of Chestnut Health Systems; determinations for secondary use of GAIN data were provided by The University of Illinois at Chicago and The Pennsylvania State University. All the procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Where appropriate, informed consent and assent were obtained from all individual participants included in this study.

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The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), or National Science Foundation (NSF). The authors declare that they have no conflicts or competing interests.

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Bray, B.C., Layland, E.K., Stull, S.W. et al. Estimating the Effects of a Complex, Multidimensional Moderator: An Example of Latent Class Moderation to Examine Differential Intervention Effects of Substance Use Services. Prev Sci 24, 493–504 (2023). https://doi.org/10.1007/s11121-022-01448-3

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