Efficacy and Mechanisms of Technology-Based Behavioral Interventions

 描述（由申请人提供）：大学生饮酒是一个主要的公共卫生问题（NIAAA，2002 b）。大规模调查表明，大约68%的大学生每月饮酒（约翰斯顿等人，2006年）和40%的大学生从事重度间歇性饮酒（NIAAA，2004年）。尽管采取了预防/干预措施，但大学生中有问题的酒精消费每年仍导致约1，800人死亡和600，000人受伤（Hingson，Zha和Weitzman，2009），流行病学研究表明，大学生中的风险没有明显降低（例如，约翰斯顿等人，2006年）。建议的研究的目的是改善现存的大学饮酒干预，通过推进传播方法和干预内容（具体目标1）。作为方法上的改进，移动的计算的快速发展使得生态瞬时干预（EMI）变得越来越可行（Heron等人，2012年）。环境管理信息指的是可以多次和“即时”提供的干预措施。EMI可以优化干预的时间和位置，同时还可以增加干预的剂量。为了改善干预 内容，我们把我们的研究重点放在保护性行为策略（PBS），以减少酒精问题，而不仅仅是酒精使用。PBS是一个人可以在饮酒之前、饮酒期间和饮酒之后立即参与的行为，这些行为限制了饮酒、酒精中毒和/或酒精相关的伤害（Pearson，2013）。在多项研究和调查中，研究表明PBS的使用可以保护个体免受酒精问题的影响，而不仅仅是减少酒精使用的影响（Martens等人，2005，2007，2009，2011; Pearson，Kite，& Henson，2012 a; Pearson，Kite，& Henson，2012 b; Pearson，Kite，&Henson; 2013）.本研究的主要目的是通过使用基于技术的干预方法（即，EMI）。受试者将按性别随机分配至完全交叉的3（标准BMI、含PBS组分的BMI、对照）× 2（基于PBS的EMI，仅生态学评估[EMA]）设计。我们选择这6个条件来回答几个至关重要的研究问题（具体目标2）：a）PBS组分的添加是否改善了标准BMI的功效，B）基于PBS的EMI是否相对于标准的单次治疗BMI改善了功效，c）基于动机的干预（BMI）与基于技能的干预（EMI）的组合是否产生了更大的后果降低（即，适度）。本研究的最终目的是确定行为改变的机制，以优化干预开发。具体来说，我们将检查PBS规范，PBS感知的有效性，以及改变PBS作为改进干预措施的新介质的动机。研究结果可用于传播更有效的大学饮酒干预措施，这些干预措施更便宜，更有效地减少酒精问题，而不仅仅是使用。

 DESCRIPTION (provided by applicant): College student alcohol use is a major public health concern (NIAAA, 2002b). Large scale surveys indicate that approximately 68% of college students drink alcohol every month (Johnston et al., 2006) and 40% of college students engage in heavy episodic drinking (NIAAA, 2004). Despite prevention/intervention efforts, problematic alcohol consumption among college students continues to result in an estimated 1,800 deaths and 600,000 injuries annually (Hingson, Zha, & Weitzman, 2009), and epidemiological studies demonstrate no appreciable decrease in risk among college students (e.g., Johnston et al., 2006). The purpose of the proposed research is to improve extant college-drinking interventions by advancing the dissemination methodology and the intervention content (Specific Aim 1). As a methodological improvement, rapid advances in mobile computing makes ecological momentary interventions (EMIs) increasingly feasible (Heron et al., 2012). EMIs refer to interventions that can be delivered multiple times and "in the moment". EMIs can optimize the timing and location of the intervention while also increasing the dose of the intervention. To improve the intervention content, we focus our research on protective behavioral strategies (PBS) to reduce alcohol problems, not just alcohol use. PBS are behaviors that one can engage in immediately prior to, during, and immediately following alcohol use that limit alcohol use, alcohol intoxication, and/or alcohol-related harm (Pearson, 2013). Across multiple studies and investigators, research suggests that PBS use can protect individuals from alcohol problems above and beyond its effect on reducing alcohol use (Martens et al., 2005, 2007, 2009, 2011; Pearson, Kite, & Henson, 2012a; Pearson, Kite, & Henson, 2012b; Pearson, Kite, & Henson; 2013). The primary purpose of this research is to provide a more powerful test of a PBS intervention's effects on alcohol- related consequences by using a technology-based intervention methodology (i.e., EMI). Participants will be randomized by gender into to a fully crossed, 3 (Standard BMI, BMI with a PBS component, control) X 2 (PBS- based EMI, Ecological Assessment Only [EMA]) design. We selected these 6 conditions to answer several critically important research questions (Specific Aim 2): a) does the addition of a PBS component improve the efficacy of a standard BMI, b) does a PBS-based EMI improve efficacy over the standard, single session BMI, c) does the combination of motivation-based intervention (BMI) with a skills-based intervention (EMI) yield even greater decreases in consequences (i.e., moderation). A final purpose of this research is to identify mechanisms of behavior change to optimize intervention development. Specifically, we will be examining PBS norms, PBS perceived effectiveness, and motivation to change PBS use as novel mediators of the improved interventions. Results can be used to disseminate more effective college drinking interventions that are cheaper and more efficacious at reducing alcohol problems, not just use.