Cherokee Nation Prevention Trial: Interactive Effects of Environment & SBIRT

描述（由申请人提供）：拟议的项目是预防科学家和切罗基民族行为健康服务之间的伙伴关系，以创建，实施和评估一个新的，综合的社区一级干预措施，旨在防止未成年人饮酒和相关的负面影响美国印第安人和白色青年生活在农村高风险的服务不足的社区。这项试验将在俄克拉荷马州东北部进行，该地区贫困率高，健康状况参差不齐。建议的干预措施直接建立在多个先前的实验结果与两种不同的方法-社区环境变化和简短的干预和单独和组合使用析因设计的评估。直接行动的社区组织，记录为有效的多个先前的随机试验，将用于解决社区问题有关的酒精使用和商业和社会获得酒精的青少年。我们的设计和实现的简短干预不同的典型的实现方式在根本上。我们将设计一个社区范围的SBIRT干预，而不是在有限数量的诊所、急诊室或学校实施SBIRT。人口一级的简短干预措施将包括五个关键组成部分：（1）简短的一对一筛选和动机访谈会议，（2）看门人培训，（3）同侪领导培训，（4）家庭明信片运动，（5）社区范围的媒体运动。五个关键的研究设计要素优化了因果推理和干预效果的实验评估：（1）受控中断时间序列设计，（2）随机选择城镇，（3）随机分配研究条件，（4）析因设计，（5）多个比较组。本随机试验的主要设计特征是对照中断时间序列设计。大量的重复测量（时间序列）大大增加了内部有效性（即，因果推断的强度）以及相对于常规的前/后社区试验设计的统计功效。重复评估将衡量每个干预措施组成部分的执行情况，并通过调查、观察和档案来源衡量关键的近期和主要的最终成果。主要研究样本将包括研究城镇内的所有高中学生。每周和每月的测量将产生一个时间序列设计，在四年的时间内对城镇内的青年进行观察。除了重复的横断面样本，我们还将使用参与者标识符来跟踪四年内的嵌入式队列。这一创新项目涉及到既定的预防科学家和切罗基国家行为健康服务领导人之间的强有力的伙伴关系，有可能改变酒精预防研究和实践。尽管近几十年来在预防科学和实践方面取得了进展，但美国仍在努力应对与酒精有关的重大风险和后果。拟议的项目将对一项新的、综合的社区一级预防性干预措施进行严格的评价。

DESCRIPTION (provided by applicant): The proposed project is a partnership between prevention scientists and the Cherokee Nation Behavioral Health Services to create, implement and evaluate a new, integrated community-level intervention designed to prevent underage drinking and associated negative consequences among American Indian and white youth living in rural high-risk underserved communities. This trial will take place in northeastern Oklahoma, an area suffering from high rates of poverty and substantial health disparities. The proposed intervention builds directly on the results of multiple previous experiments with two distinct approaches-community environmental change and brief intervention and referral-evaluated alone and in combination using a factorial design. Direct- action community organizing, documented as effective in multiple previous randomized trials, will be used to address community issues related to alcohol use and commercial and social access to alcohol among adolescents. Our design and implementation of brief interventions differs in a fundamental way from typical implementations. Instead of SBIRT implemented in select limited numbers of clinics, emergency departments or schools, we will design a community-wide SBIRT intervention. The population-level brief interventions will include five key components: (1) brief one-on-one screening and motivational interviewing sessions, (2) gatekeeper training, (3) peer leader training, (4) family postcard campaign, and (5) community-wide media campaign. Five key research design elements optimize causal inference and experimental evaluation of the intervention effects: (1) a controlled interrupted time-series design, (2) random selection of towns, (3) random assignment to study condition, (4) a factorial design, and (5) multiple comparison groups. The primary design feature of this randomized trial is a controlled interrupted time-series design. The large number of repeated measures (a time-series) substantially increases internal validity (i.e., strength of causal inference) as well as statistical power over conventional pre/post community trial designs. Repeated assessments will measure implementation fidelity for each intervention component, and measure key proximal as well as the primary ultimate outcomes through survey, observation and archival sources. The primary study sample will include all high-school students within study towns. Weekly and monthly measurements will produce a time-series design with observations of youth nested within town over the four-year period. In addition to repeated cross-sectional samples, we will use participant identifiers to track the embedded cohorts over the four years. This innovative project, involving a strong partnership between established prevention scientists and leaders of the Cherokee Nation Behavioral Health Services, has the potential to transform alcohol prevention research and practice. Despite advances in prevention science and practices in recent decades, the U.S. continues to struggle with significant alcohol-related risks and consequences among youth. The proposed project will provide a rigorous evaluation of a new, integrated community-level preventive intervention.