Subpopulation Differences in Intervention Efficacy for College Drinkers

描述（由申请人提供）：大学饮酒者干预效果的亚群差异。尽管采取了预防措施，但大学狂饮仍然造成了无数与酒精有关的负面个人和社会后果。简短的动机干预（BMI）已被证明在减少大学酒精消费方面是有效的;然而，平均在人群中，报告的干预效果往往是小的和短暂的。通常更感兴趣的是了解谁对干预措施作出反应，而不是确定不同亚群的平均效果。本研究的目的不是描述“典型”大学饮酒者的干预效果，而是描述不同亚群或类型饮酒者的干预效果。适度分析测试可能影响干预效果的假设因素。与传统的适度分析相比，增长混合模型（GMM）经验性地探索数据，以确定均匀的纵向模式，在酒精消费，而不需要预先确定的预测。使用甘精胰岛素，过去的研究已经确定了多达五种类型的饮酒者随着时间的推移自然发生的酒精消费轨迹;然而，拟议的项目采取了一种新的方法，通过探索干预后的饮酒模式。拟议的项目包括3项随机临床试验的次要数据分析，共有1，384名大学生饮酒者（509名志愿者，875名因饮酒违规而被强制），他们的饮酒行为在基线时进行评估，并在干预后1，6和12个月进行评估。参与者被随机分为BMI（n = 602），2种计算机干预之一（酒精101，n = 271;酒精EDU，n = 167）或无干预对照条件（n = 344）。这四个具体目标是：a）确定有多少不同的大学饮酒者亚群存在对酒精BMI的短期和长期反应; B）表征BMI相对于计算机干预的功效，并对每种类型的饮酒者进行控制; c）使用人口统计学和心理学解释变量来表征每个饮酒者亚群;以及d）确定饮酒者亚群与高风险酒精后果之间的关系。不连续甘精胰岛素将用于确定不同类型的饮酒者在干预后从基线到1个月（短期效应）和从1个月到12个月（长期效应）的独特反应，以及确定受制裁个人和志愿者中饮酒者亚群的相关心理预测因素。这项研究的结果可用于了解谁最容易接受BMI干预，指导筛查工作以可靠地检测高风险个体，并使用有关最耐药亚群的信息为未来的干预开发提供信息。 公共卫生相关性：该研究将使用创新和先进的统计模型来确定对旨在减少大学饮酒者饮酒量的干预措施有反应和无反应的个体的亚群特征。这项研究的结果可用于了解谁最容易接受简短的动机干预，指导筛查工作以可靠地检测高风险个体，并使用有关最具抵抗力的亚群的信息为未来的干预开发提供信息。改进的筛查和干预方法对于减少大学生中与酒精相关的个人和社会后果至关重要。

DESCRIPTION (provided by applicant): Subpopulation Differences in Intervention Efficacy for College Drinkers. Despite prevention efforts, college binge drinking continues to account for a myriad of negative personal and social alcohol-related consequences. Brief motivational interventions (BMIs) have proved efficacious in reducing college alcohol consumption; however, averaging across people, reported intervention effects tend to be small and short-lived. It is often of more interest to understand who responds to an intervention rather than determine the average effect across different subpopulations. Instead of characterizing intervention efficacy for a "typical" college drinker, the purpose of this research is to characterize intervention effects across different subpopulations, or types, of drinkers. Moderation analyses test hypothesized factors that may influence intervention efficacy. In contrast to traditional moderation analyses, growth mixture modeling (GMM) empirically explores the data to identify homogenous longitudinal patterns in alcohol consumption without need of pre-identified predictors. Using GMMs, past research has identified up to five types of drinkers regarding naturally-occurring trajectories of alcohol consumption over time; however, the proposed project takes a novel approach by exploring drinking patterns following intervention. The proposed project includes secondary data analysis of 3 randomized clinical trials with a combined total of 1,384 college-student drinkers (509 volunteers, 875 mandated as a result of alcohol violations), whose drinking behaviors were assessed at baseline, and at 1, 6, and 12 months post-intervention. Participants were randomized into a BMI (n = 602), 1 of 2 computerized interventions (Alcohol 101, n = 271; Alcohol EDU, n = 167), or a no-intervention control condition (n = 344). The four specific aims are a) to identify how many different subpopulations of college drinkers exist regarding short- and long-term response to an alcohol BMI; b) to characterize BMI efficacy relative to computerized intervention and a control for each type of drinker; c) to use demographic and psychological explanatory variables to characterize each drinker subpopulation; and d) ascertain how drinker subpopulations relate to high-risk alcohol consequences. Discontinuous GMMs will be used to ascertain how different types of drinkers uniquely respond following intervention from baseline to 1-month (short-term effect) and from 1-month to 12- months (long-term effect), as well as to identify relevant psychological predictors of drinker subpopulations among both sanctioned individuals and volunteers. Results of this research can be used to understand who is most receptive to BMI intervention, to guide screening efforts to reliably detect high-risk individuals, and to use the information about the most resistant subpopulation(s) to inform future intervention development. PUBLIC HEALTH RELEVANCE: Subpopulation Differences in Intervention Efficacy for College Drinkers The proposed research will use innovative and advanced statistical modeling to identify subpopulation characteristics of individuals who respond and do not respond to interventions designed to reduce alcohol consumption among college drinkers. The results of this research can be used to understand who is most receptive to brief motivational intervention, to guide screening efforts to reliably detect high-risk individuals, and to use the information about the most resistant subpopulation(s) to inform future intervention development. Improved screening and intervention methods are critical to reducing personal and social alcohol-related consequences among college populations.