Higher Acne Severity Predicts Moderately Lower Alertness for Population

Higher Acne Severity Predicts Moderately Lower Alertness for Population

Contents

Variables

A
Acne Severity 1507
A
Alertness 1377

Categories

A
Symptoms 13336
A
Emotions 2028

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Low Confidence
Moderate Effect Size
Negative Relationship
Population Study
cause image gauge image effect image
Participants reported a 23% average decrease in Alertness following above average Acne Severity.

Abstract

Alertness was generally 6% higher than average after an average of 2.67 out of 5 of Acne Severity over the previous 4 days.

Aggregated data from 4 study participants suggests with a LOW degree of confidence (p=0.118, 95% CI -1.299 to 0.103) that Acne Severity has a moderately negative predictive relationship (R=-0.598) with Alertness.

The highest quartile of Alertness measurements were observed following an average 2.15 out of 5 Acne Severity.

The lowest quartile of Alertness measurements were observed following an average 3.07 out of 5 of Acne Severity.

After an onset delay of 0 seconds, Alertness is typically 18% lower than average over the 4 days following around 3.07 out of 5 of Acne Severity Acne Severity.

Keywords: Acne Severity, Alertness, N-of-1 trials, real-world evidence, causal inference, observational study

Preliminary: Based on 4 participants. Results may change as more data is collected.

Results

Primary Findings

Analysis of 37 paired observations from 4 participants revealed a modest reduction in Alertness following above-average Acne Severity exposure.

-6.0%
Change from Baseline
Modest effect on Alertness
0.20
Predictor Impact Score
Weak evidence for causal relationship

Supporting Statistics

Medium
Confidence
-0.598
Correlation (r)
p = 0.017
Significance
z = 1.28
Effect Magnitude
φ = 1.00
Temporality

What This Means

When participants had above-average Acne Severity:

  • Alertness decreased by 6.0% on average
  • Temporal analysis supports Acne Severity as the predictor (not the outcome)
  • This relationship is statistically significant (p = 0.017)

Interpreting the Predictor Impact Score

The Predictor Impact Score (PIS) integrates multiple Bradford Hill causal criteria into a single metric. Use this guide to interpret the score:

PIS Range Interpretation Recommended Action
≥ 0.5 Strong evidence High priority for RCT validation
0.3 - 0.5 Moderate evidence Consider for experimental investigation
0.1 - 0.3 Weak evidence Monitor for additional data
< 0.1 Insufficient evidence Low priority; may be noise

Note: PIS is a prioritization heuristic, not proof of causation. High scores indicate relationships worth investigating, not confirmed causal effects. With only 4 participants, these scores are preliminary and will become more reliable as additional data is collected.

Optimal Daily Values (Precision Dosing)

Based on the observed relationship, we can estimate the predictor values associated with the best and worst outcomes. These values enable personalized dosing recommendations.

⚠️ Preliminary Data: With 4 participants and 37 observations, these optimal values are preliminary estimates. As more data is collected, precision will improve significantly.

2.7 /5
Value Predicting Higher Alertness
Average Acne Severity when Alertness exceeded its mean
3.0 /5
Value Predicting Lower Alertness
Average Acne Severity when Alertness was below its mean

What This Suggests

Alertness tended to be lowest (best) when Acne Severity was around 3.0 /5.

Important: These values reflect correlations, not guaranteed causal effects. Individual responses may vary. Use as a starting point for personal experimentation, not as a definitive prescription. Consult healthcare providers before making treatment decisions.

Population Correlation

Acne Severity Distribution

Alertness Distribution

Relationship Analysis

Statistical Summary

Relationship Statistics

Property Value
Cause Variable Name Acne Severity
Effect Variable Name Alertness
Sinn Predictive Coefficient 0.19704970842162
Confidence Level LOW
Confidence Interval 0.70113633871225
Forward Pearson Predictive Coefficient -0.5977
Critical T Value 1.861
Average Acne Severity Over Previous 4 days Before ABOVE Average Alertness 2.15 out of 5
Average Acne Severity Over Previous 4 days Before BELOW Average Alertness 3.07 out of 5
Duration of Action 4 days
Effect Size moderately negative
Number of Paired Measurements 37
Optimal Pearson Product 0.63407582549716
P Value 0.11776284557402
Statistical Significance 0.0171
Strength of Relationship 0.70113633871225
Study Type population
Analysis Performed At 2026-01-04
Number of Participants 4

Acne Severity Info

Property Value
Variable Name Acne Severity
Aggregation Method MEAN
Analysis Performed At 2021-03-01
Duration of Action 24 hours
Kurtosis 2.1540296927304
Maximum Allowed Value 5 out of 5
Mean 2.936194214876 out of 5
Median 2.8976859504132 out of 5
Minimum Allowed Value 1 out of 5
Number of Aggregate Predictors 1373
Number of Aggregate Outcomes 134
Number of Measurements 2760
Number of Measurements (including those generated by tagged, joined, or child variables) 2760
Public true
Onset Delay 0 seconds
Standard Deviation 0.23031831853763
Unit 1 to 5 Rating
User Variables 156
UPC 837654497159
Variable Category Symptoms
Variable ID 1251
Variance 0.20680264733649

Alertness Info

Property Value
Variable Name Alertness
Aggregation Method MEAN
Analysis Performed At 2020-09-15
Duration of Action 24 hours
Kurtosis 3.4645816890262
Maximum Allowed Value 5 out of 5
Mean 2.7616584422685 out of 5
Median 2.7577906518121 out of 5
Minimum Allowed Value 1 out of 5
Number of Aggregate Predictors 1205
Number of Aggregate Outcomes 172
Number of Measurements 25994
Number of Measurements (including those generated by tagged, joined, or child variables) 25832
Public true
Onset Delay 0 seconds
Standard Deviation 0.49012595054405
Unit 1 to 5 Rating
User Variables 1597
UPC 794504377927
Variable Category Emotions
Variable ID 1258
Variance 0.50617576344301

Introduction

Background

Acne Severity (Symptoms) and Alertness (Emotions) are both important factors in understanding human health and well-being. This study investigates the relationship between these two variables using real-world observational data.

Traditional randomized controlled trials (RCTs), while the gold standard for causal inference, are often impractical, expensive, or unethical for studying many health relationships. Aggregated N-of-1 observational studies offer a complementary approach that leverages within-subject comparisons across large populations to identify meaningful patterns.

Research Question

Does Acne Severity affect Alertness?

Additionally, we seek to determine:

  1. What is the direction and magnitude of any effect?
  2. How confident can we be in this relationship based on the available data?
  3. What are the optimal levels of Acne Severity for maximizing Alertness?

Study Objective

The objective of this study is to determine the nature of the relationship (if any) between Acne Severity and Alertness. Additionally, we attempt to determine the Acne Severity values most likely to produce optimal Alertness values.

Study Overview

This is a population-level observational study using aggregated N-of-1 methodology. By aggregating individual N-of-1 experiments, we can identify population-level patterns while accounting for the substantial individual variation that exists in most health relationships. Effect sizes are reported as percent change from baseline, enabling intuitive interpretation and comparison across different measures.

Full Methodology: Framework for Real-World Evidence-Based Pharmacovigilance: Aggregated N-of-1 Trials for Quantifying Treatment Effects

Discussion

Interpretation of Findings

Participants experienced a 6.0% reduction in Alertness following above-average Acne Severity exposure. The Predictor Impact Score (PIS) of 0.20 indicates weak evidence for a causal relationship. This finding is statistically significant (p = 0.017).

Statistical Significance

Using a two-tailed t-test with alpha = 0.05, it was determined that the change in Alertness is statistically significant at a 95% confidence interval. The p-value of 0.0171 indicates there is less than a 1.71% probability that this result occurred by chance.

After treatment, a 23% decrease (-0.401 out of 5) from the mean baseline 3.92 out of 5 was observed. The relative standard deviation at baseline was 18.825%. The observed change was 1.27782 times the standard deviation.

A common rule of thumb considers a change greater than twice the baseline standard deviation on two separate pre-post experiments may be considered significant. This occurrence would have only a 5% likelihood of resulting from random fluctuation (a p-value < 0.05).

T-Test Details
Observed t-value: 3.075
Critical t-value: 1.861

Since t = 3.08 > 1.86, we reject the null hypothesis.

Biological Plausibility

A plausible bio-chemical mechanism between predictor and outcome is critical for interpreting observational findings. This is where human judgment excels beyond statistical analysis.

Community feedback on the biological plausibility of this relationship is still being collected. Consider the known mechanisms by which Acne Severity might influence Alertness.

Bradford Hill Criteria Assessment

The Bradford Hill criteria provide a framework for assessing causality in observational studies. Our methodology operationalizes six of the nine criteria through the Predictor Impact Score (PIS):

Criterion How Addressed Metric
Strength Effect size magnitude Percent change from baseline (Δ%), z-score
Consistency Cross-participant replication Number of users (N), number of pairs (n)
Temporality Predictor precedes outcome Temporality factor (φ), onset delay (δ > 0)
Biological Gradient Dose-response relationship Gradient coefficient (φgradient)
Plausibility Biological mechanism assessment Community votes on mechanism plausibility
Specificity Category appropriateness Interest factor (finterest)

Predictor Impact Score (PIS)

The PIS integrates multiple Bradford Hill criteria into a composite metric quantifying how reliably a predictor affects an outcome. Higher scores indicate stronger evidence:

Population-Level PIS:

$$\text{PIS}_{\text{agg}} = |r_{\text{forward}}| \cdot w \cdot \phi_{\text{users}} \cdot \phi_{\text{pairs}} \cdot \phi_{\text{change}} \cdot \phi_{\text{gradient}}$$

Where φ-factors are saturation functions approaching 1 as evidence accumulates:

  • φusers = 1 - e-N/10 (user saturation)
  • φpairs = 1 - e-n/nsig (pair saturation)
  • φchange = 1 - e-Δspread/Δsig (effect spread saturation)
  • w = weighted average of plausibility votes

Temporality Assessment

We assess evidence for correct causal direction using the temporality factor:

$$\phi_{\text{temporal}} = \frac{|r_{\text{forward}}|}{|r_{\text{forward}}| + |r_{\text{reverse}}|}$$

Values approaching 1 indicate the predictor precedes the outcome (supporting causation); values near 0.5 suggest ambiguous directionality; values near 0 suggest reverse causation or confounding by indication.

Limitations

As with any observational study, correlation does not prove causation. Key limitations include:

  • Unmeasured confounders: Variables not tracked may influence results
  • Self-selection bias: Health trackers may differ from the general population
  • Measurement error: Self-reported data may contain recall bias
  • Confounding by indication: Sicker individuals may use more treatments

However, within-subject comparison and temporal precedence analysis partially mitigate these limitations. If the relationship is merely coincidental, as participants independently modify their Acne Severity values, the observed strength will decline over time. Spurious correlations naturally dissipate as more data is collected.

Future Directions

Future research should examine:

  • Subgroup analyses to identify individual differences in response
  • Potential confounders and mediators of the observed relationship
  • Optimal dosing and timing for Acne Severity
  • Confirmation through prospective or randomized designs
  • Biological mechanisms underlying the observed effects

Conclusion

📊 Preliminary Findings: With 4 participants, these results are based on limited data. Effect sizes and confidence will improve as more participants contribute data. Consider these findings directional rather than definitive.

Above-average Acne Severity was associated with a 6.0% reduction in Alertness—a modest effect. The Predictor Impact Score of 0.20 indicates this relationship is warranting continued monitoring.

Bottom Line: Based on a PIS of 0.20 and a 6.0% effect size, this relationship shows weak evidence. Additional observational data is recommended before investing in experimental validation. Note: These conclusions may strengthen or change direction as more data is collected.

These findings contribute to our understanding of how Acne Severity may influence Alertness in real-world conditions. The within-subject design and temporal analysis provide confidence in these relationships, though observational limitations remain.

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Methods

Study Design

This study is based on data donated by 4 participants. Thus, the study design is equivalent to the aggregation of 4 separate n=1 observational natural experiments.

This within-subject design is powerful because it controls for all stable individual characteristics (genetics, baseline health status, socioeconomic factors) that might otherwise confound the relationship between variables.

Data Analysis

Temporal Assumptions

The analysis incorporates temporal assumptions about the relationship between variables:

  • Onset Delay: It was assumed that 0 seconds would pass before a change in Acne Severity would produce an observable change in Alertness.
  • Duration of Action: It was assumed that Acne Severity could produce an observable change in Alertness for as much as 4 days after the stimulus event.

Statistical Methods

For each participant, we calculated the Pearson correlation coefficient between Acne Severity values and subsequent Alertness values. Individual correlations were then aggregated using Fisher's z-transformation to produce a population-level estimate:

Individual Correlation:

$$r_i = \frac{\sum(x_{ij} - \bar{x}_i)(y_{ij} - \bar{y}_i)}{\sqrt{\sum(x_{ij} - \bar{x}_i)^2 \sum(y_{ij} - \bar{y}_i)^2}}$$

Fisher's Z-Transformation:

$$z_i = \frac{1}{2} \ln\left(\frac{1 + r_i}{1 - r_i}\right)$$

Aggregated Correlation:

$$\bar{r} = \tanh(\bar{z}) \quad \text{where} \quad \bar{z} = \frac{1}{N}\sum_{i=1}^{N} z_i$$

Effect Size Calculation

Effect sizes are reported as percent change from baseline. For each participant, we compare the outcome following above-average predictor values to the overall baseline outcome:

$$\Delta\%_{\text{baseline}} = \frac{\bar{O}_{\text{follow-up}} - \bar{O}_{\text{baseline}}}{\bar{O}_{\text{baseline}}} \times 100$$

Effect Magnitude (Z-Score)

To assess effect magnitude relative to natural variability, we calculate the z-score:

$$z = \frac{|\Delta\%_{\text{baseline}}|}{\text{RSD}_{\text{baseline}}}$$

where RSDbaseline is the relative standard deviation of outcome during baseline period

A z-score > 2 indicates statistical significance (p < 0.05), meaning the observed change exceeds typical baseline fluctuation and is unlikely due to random variation.

Statistical Significance

Correlation significance is assessed using a two-tailed t-test:

$$t = \frac{r\sqrt{n-2}}{\sqrt{1-r^2}}$$

We reject the null hypothesis (ρ = 0) at α = 0.05 when |t| exceeds the critical value, providing statistical evidence that the observed relationship is not due to chance.

Data Sources

Acne Severity data was primarily collected using QuantiModo. QuantiModo allows you to easily track mood, symptoms, or any outcome you want to optimize in a fraction of a second. You can also import your data from over 30 other apps and devices. QuantiModo then analyzes your data to identify which hidden factors are most likely to be influencing your mood or symptoms.

Alertness data was primarily collected using QuantiModo. QuantiModo allows you to easily track mood, symptoms, or any outcome you want to optimize in a fraction of a second. You can also import your data from over 30 other apps and devices. QuantiModo then analyzes your data to identify which hidden factors are most likely to be influencing your mood or symptoms.

Data Quality

Data quality measures were applied to ensure reliable results:

  • Minimum Data Requirement: Only participants with sufficient paired observations were included in the analysis.
  • Outlier Handling: Extreme values were winsorized to reduce the influence of measurement errors.
  • Missing Data: Days with missing values were handled using appropriate filling strategies based on the variable type.
  • Test User Exclusion: Test accounts and invalid users were excluded from all analyses.

Principal Investigator

Program & Methods

Mike P. Sinn
Sinn, M. P.

Designed and implemented data collection, aggregation, causal inference pipeline, and automated study generation framework. Developed the Predictor Impact Score methodology operationalizing Bradford Hill criteria for ranking causal relationships in observational data. When he tells people this at parties, they usually say they have to go check on their car.

Individual study outputs are automated, reproducible, and open to external audit. (Which I would seriously recommend.)

Contact

Cite This Study

APA Format
Sinn, M. P. (2026). Causal Analysis: Does Acne Severity Affect Alertness?. The Journal of Citizen Science. https://studies.crowdsourcingcures.org/study/cause-1251-effect-1258-population-study
BibTeX 
@misc{sinn_cause_1251_effect_1258_population_study_2026,
  author = {Sinn, Mike P.},
  title = {Causal Analysis: Does Acne Severity Affect Alertness?},
  year = {2026},
  publisher = {The Journal of Citizen Science},
  url = {https://studies.crowdsourcingcures.org/study/cause-1251-effect-1258-population-study},
  note = {Accessed: January 7, 2026}
}
Chicago/Turabian
Sinn, Mike P. "Causal Analysis: Does Acne Severity Affect Alertness?." The Journal of Citizen Science. Accessed January 7, 2026. https://studies.crowdsourcingcures.org/study/cause-1251-effect-1258-population-study.
Harvard
Sinn, M.P., 2026. Causal Analysis: Does Acne Severity Affect Alertness?. [Aggregated N-of-1 Study] The Journal of Citizen Science. Available at: https://studies.crowdsourcingcures.org/study/cause-1251-effect-1258-population-study [Accessed January 7, 2026].

Study Type: Aggregated N-of-1 Observational Mega-Study
Evidence Level: Level II (Real-World Evidence)
Methodology: Bradford Hill Criteria with Predictor Impact Score (PIS)

References

This framework was originally developed in 2013 based on the Bradford Hill criteria. Subsequent literature has independently validated similar approaches to causal inference from observational data:

  1. Hill, A.B. (1965). The environment and disease: association or causation? Proceedings of the Royal Society of Medicine, 58(5), 295-300. [Bradford Hill criteria]
  2. Lillie, E.O., et al. (2011). The n-of-1 clinical trial: the ultimate strategy for individualizing medicine? Personalized Medicine, 8(2), 161-173. [N-of-1 methodology]
  3. Pearl, J. (2009). Causality: Models, Reasoning, and Inference . Cambridge University Press. [Causal inference]
  4. Hernán, M.A., & Robins, J.M. (2020). Causal Inference: What If . Chapman & Hall/CRC. [Free textbook]
  5. FDA (2018). Framework for FDA's Real-World Evidence Program . U.S. Food and Drug Administration. [Regulatory context]
  6. Duan, N., et al. (2013). Single-patient (n-of-1) trials: a pragmatic clinical decision methodology . Journal of Clinical Epidemiology, 66(8), S21-S28.
  7. Platt, R., et al. (2018). The FDA Sentinel Initiative—an evolving national resource . New England Journal of Medicine, 379(22), 2091-2093.

This information is for research and educational purposes only, not medical advice. Consult a healthcare provider before making health decisions. Terms of Service

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