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The focus of precision medicine is on decision support, often in the form of dynamic treatment regimes (DTRs), which are sequences of decision rules. At each decision point, the decision rules determine the next treatment according to the patient's baseline characteristics, the information on treatments and responses accrued by that point, and the patient's current health status, including symptom severity and other measures. However, DTR estimation with ordinal outcomes is rarely studied, and rarer still in the context of interference - where one patient's treatment may affect another's outcome. In this paper, we introduce the weighted proportional odds model (WPOM): a regression-based, approximate doubly-robust approach to single-stage DTR estimation for ordinal outcomes. This method also accounts for the possibility of interference between individuals sharing a household through the use of covariate balancing weights derived from joint propensity scores. Examining different types of balancing weights, we verify the approximate double robustness of WPOM with our adjusted weights via simulation studies. We further extend WPOM to multi-stage DTR estimation with household interference, namely dWPOM (dynamic WPOM). Lastly, we demonstrate our proposed methodology in the analysis of longitudinal survey data from the Population Assessment of Tobacco and Health study, which motivates this work. Furthermore, considering interference, we provide optimal treatment strategies for households to achieve smoking cessation of the pair in the household.

In precision medicine, Dynamic Treatment Regimes (DTRs) are treatment protocols that adapt over time in response to a patient's observed characteristics. A DTR is a set of decision functions that takes an individual patient's information as arguments and outputs an action to be taken. Building on observed data, the aim is to identify the DTR that optimizes expected patient outcomes. Multiple methods have been proposed for optimal DTR estimation with continuous outcomes. However, optimal DTR estimation with binary outcomes is more complicated and has received comparatively little attention. Solving a system of weighted generalized estimating equations, we propose a new balancing weight criterion to overcome the misspecification of generalized linear models' nuisance components. We construct binary pseudo-outcomes, and develop a doubly-robust and easy-to-use method to estimate an optimal DTR with binary outcomes. We also outline the underlying theory, which relies on the balancing property of the weights; provide simulation studies that verify the double-robustness of our method; and illustrate the method in studying the effects of e-cigarette usage on smoking cessation, using observational data from the Population Assessment of Tobacco and Health (PATH) study.

The R software has become popular among researchers due to its flexibility and open-source nature. However, researchers in the fields of public health and epidemiological studies are more customary to commercial statistical softwares such as SAS, SPSS and Stata. This paper provides a comprehensive comparison on analysis of health survey data using the R survey package, SAS, SPSS and Stata. We describe detailed R codes and procedures for other software packages on commonly encountered statistical analyses, such as estimation of population means and regression analysis, using datasets from the Canadian Longitudinal Study on Aging (CLSA). It is hoped that the paper stimulates interest among health science researchers to carry data analysis using R and also serves as a cookbook for statistical analysis using different software packages., Comment: There is a data usage issue with the paper and it is requested by the data owner (CLSA) to withdraw the paper at this time