Evaluation of a Combined Motivational Interviewing and Ecological Momentary Intervention to Reduce Risky Alcohol Use among Sexual Minority Males and Transgender Individuals

摘要 性和性别少数群体更有可能报告危险饮酒和饮酒 与顺性别者和异性恋者相比，新兴成人（18-34岁）的性和 与老年人相比，少数性别人群的AUD风险尤其高，高达44%的人患有AUD 的搜索.这些趋势令人担忧，因为研究发现，饮酒会增加艾滋病毒风险行为， 艾滋病毒不成比例地影响新出现的成年性少数男性和变性人（SMMT）。因此，在本发明中， 有必要测试干预措施，以减少SMMT个体的酒精使用， 艾滋病毒在这一弱势群体中的传播。一个潜在的减少酒精使用的循证方法是 动机访谈，其中包括一个目标导向的方法来改变行为，并已 在先前的文献和研究人员的试点研究中，在各种人群中显示出有效性。 然而，也有机会利用技术扩大这一方法的影响， 用于真实的防止风险行为的消息传送（即，在干预会议之外）。拟定的研究将 进行一项3组随机对照试验，评估两种干预措施的疗效， 对照组：1）通过手机远程进行为期8周的动机访谈干预（TRAC），2） TRAC与生态瞬时干预相结合，旨在传递强化饮酒的信息 在TRAC会议期间讨论个人访问危险地点时的减少战略（GeoTRAC）。所有 参与者还将通过完成每日调查来完成对酒精使用和性行为的监测， 每天两次的移动的呼气测醉器读数。GeoTRAC将使用调查人员开发的现有应用程序， 正在进行的研究，使用GPS跟踪，以确定当个人访问“危险”的位置。参与者将 在到达这些地点时接收消息，提醒他们应对饮酒触发因素的策略， 并将完成移动的调查和呼气测醉读数时，他们离开这些地点，以确定 他们有哪些酗酒和/或危险行为。如果他们报告饮酒，他们将获得伤害减轻 消息传递以鼓励他们避免随后的风险行为（例如，无保护的性行为）。呼气测醉器结果 每日自我报告将用于评估饮酒日的主要和次要结果， 饮酒/饮酒日、狂饮事件和HIV风险行为，以及基线时的额外评估， 8周、6个月和12个月将评价探索性长期结局。参与者将被招募 从肯塔基州和康涅狄格州通过以社区为基础的招聘和健康诊所，服务SMMT 个体总的来说，迫切需要确定减少酒精使用的最佳方法， 新兴的成年SMMT个体，因为它与增加的艾滋病毒风险行为有关。拟议的工作将 通过使用移动的电话，利用新兴成年人的高技术素养，并将测试一种创新的 精准医疗方法，为减少危险酒精消费提供全面支持。

ABSTRACT Sexual and gender minority individuals are more likely to report hazardous drinking and have alcohol use disorders (AUDs) compared to cisgender and heterosexual people. Emerging adult (aged 18-34) sexual and gender minorities are at especially high risk for AUDs compared to older adults, with up to 44% meeting AUD criteria. These trends are concerning, as studies have found that alcohol use increases HIV risk behaviors, and HIV disproportionately affects emerging adult sexual minority male and transgender (SMMT) individuals. Thus, it is essential to test interventions for reducing alcohol use among SMMT individuals as a means of preventing HIV among this vulnerable population. One potential evidence-based method of reducing alcohol use is motivational interviewing, which incorporates a goal-oriented approach for changing behavior and has been shown to be effective among various populations in prior literature and the investigators’ pilot research. However, there are opportunities to use technology to extend the impact of this approach by delivering messaging to prevent risk behaviors in real time (i.e., outside of intervention sessions). The proposed study will conduct a 3-arm randomized controlled trial that assesses the efficacy of two interventions as compared to a control: 1) An 8-week motivational interviewing intervention (TRAC) delivered remotely via cell phones and 2) TRAC combined with an ecological momentary intervention designed to deliver messages reinforcing drinking reduction strategies discussed during TRAC sessions when individuals visit risky locations (GeoTRAC). All participants will also complete monitoring of alcohol use and sexual behavior by completing daily surveys and twice-daily mobile breathalyzer readings. GeoTRAC will use an existing app developed in the investigators’ ongoing research that uses GPS tracking to determine when individuals visit “risky” locations. Participants will receive messages upon arrival at these locations reminding them of strategies to address triggers for drinking, and will also complete mobile surveys and breathalyzer readings when they leave these locations to determine what alcohol and/or risk behaviors they engaged in. If they reported drinking, they will receive harm reduction messaging to encourage them to avoid subsequent risk behavior (e.g., unprotected sex). Breathalyzer results and daily self-reports will be used to assess the primary and secondary outcomes of drinking days, drinks/drinking day, binge drinking episodes, and HIV risk behaviors, and additional assessments at baseline, 8 weeks, 6 months, and 12 months will evaluate exploratory long-term outcomes. Participants will be recruited from Kentucky and Connecticut through community-based recruitment and health clinics that serve SMMT individuals. Overall, there is a strong need to determine optimal methods of reducing alcohol use among emerging adult SMMT individuals given its relationship to increased HIV risk behaviors. The proposed work will draw upon the high technological literacy of emerging adults by using mobile phones and will test an innovative precision medicine approach that offers comprehensive support in reducing hazardous alcohol consumption.