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.”
