Towards Optimal treatment matching for brief motivational interventions

描述(由申请人提供)：研究表明，短暂的动机干预(BMI)可能有效地减少大学生中的高危饮酒(Larmer&Cronce，2007)。另一方面，关于不同类型的BMI对不同群体的高危大学生饮酒者的有效性，文献显示出混合的结果。此外，理论和实证研究已经提供了初步证据，表明BMI可能与某些动机水平更匹配(Collins&Carey，2005；Collins等人，2005)；然而，在大学生群体中，动机措施并不总是被证明在心理测量学上是健全的。考虑到这些混合的发现，这项研究将澄清和建立关于BMI在高危大学饮酒者中的有效性和潜在机制的文献。首先，它将测试两种基于网络的BMI的有效性，即决策平衡练习(DBE)和个性化规范反馈(PNF)，并与仅限评估的对照(AO)进行比较。据推测，在12个月的随访中，PNF和DBE将与酒精使用和酒精相关问题的更大减少相关。目前的研究还将测试决策平衡比例(DBP)，即参与者产生的减少饮酒的利弊与总体决策平衡的比例，以作为改变动机的创新衡量标准。假设舒张压变化(基线后)和基线舒张压得分将分别作为体重指数效应的中介和调节变量。最终目标是试行一个方案，该方案可用于后续的先验客户治疗匹配，以根据大学饮酒者的基线动机水平将他们与体重指数进行最佳匹配。这一模式的初步验证将使用广义生长混合建模和顺序过程进行，以测试基线水平动机是否足以预测参与者在BMI之后的纵向轨迹。长期目标是考察DBP作为衡量改变动机的指标，以及针对高危大学饮酒者的网络BMI的最佳治疗匹配变量。未来的研究可能会改进这一治疗匹配方案，并最终推广它，以适应不同人群的需求，以增加BMI对酒精使用的整体疗效。 公共卫生相关性：本研究旨在提高高校高危饮酒二级预防的有效性。在开发和测试由参与者生成的新的改变动机测量、基于网络的干预和治疗匹配技术时，这项研究将解决NIAAA的战略计划：它将使用创新的研究技术来加强简短的动机干预，并将开发和测试新的方法，向青少年和初出茅庐的成年人提供阶梯式和动机适当的干预。

DESCRIPTION (provided by applicant): Research has indicated that brief motivational interventions (BMIs) may be efficacious in reducing at-risk drinking among college students (Larimer & Cronce, 2007). On the other hand, the literature has shown mixed findings regarding the efficacy of different types of BMIs for different groups of at-risk college drinkers. Further, theory and empirical research have provided preliminary evidence that BMIs may be more optimally matched to certain levels of motivation (Collins & Carey, 2005; Collins et al., 2005); however, motivational measures have not always been shown to be psychometrically sound in the college population. Considering these mixed findings, this study will clarify and build on the literature regarding the efficacy and underlying mechanisms of BMIs among at-risk college drinkers. First, it will test the efficacy of 2 web-based BMIs, decisional balance exercises (DBE) and personalized normative feedback (PNF), compared to assessment- only control (AO). It is hypothesized that PNF and DBE will be associated with greater reductions in alcohol use and alcohol-related problems over the 12-month follow-up. The current study will also test the decisional balance proportion (DBP), or the proportion of participant-generated pros of reducing drinking and cons of current drinking to the total decisional balance, to serve as an innovative measure of motivation to change. It is hypothesized that DBP change (post-baseline) and baseline DBP scores will serve as mediators and moderators of the BMI effects, respectively. The final aim is to pilot a schema that may be used for subsequent a priori client-treatment matching to optimally match college drinkers to BMIs on the basis of their baseline motivational level. Preliminary validation of this schema will be conducted using generalized growth mixture modeling and sequential processes to test whether baseline levels motivation are adequate to predict participants' longitudinal trajectories following a BMI. The long-term goal is to examine the DBP as a measure of motivation to change and an optimal treatment-matching variable for web-based BMIs for at- risk college drinkers. Future studies may refine this treatment-matching schema and eventually generalize it to fit the needs of diverse populations to increase the overall efficacy of BMIs for alcohol use. PUBLIC HEALTH RELEVANCE: This study aims to increase the efficacy of secondary prevention for at-risk college drinking. In developing and testing a new participant-generated measure of motivation to change, web-based interventions and treatment matching technology, this study will address the strategic plan of the NIAAA: it will use innovative research technology to enhance brief motivational interventions and will develop and test new ways to deliver stepped and motivationally appropriate interventions to adolescents and emerging adults.