Targeting High Risk Drinking Days with Mobile Treatment for Spanish-Speaking Patients

项目摘要 每年在美国，数百万讲西班牙语的西班牙裔人经历了 有害的酒精使用。西班牙裔患有酒精使用障碍（AUD）和酒精相关肝脏疾病的比例很高 与非西班牙裔白人相似。然而，患有AUD的西班牙裔人接受治疗的可能性低于非西班牙裔人。 西班牙白人拉美裔人在接受AUD治疗时也面临着更大的社会经济、文化和语言障碍 非西班牙裔白人。这些障碍包括获得讲西班牙语的提供者的机会有限， 适应循证治疗。计算机化治疗和移动的技术具有巨大的潜力 以具有成本效益的方式为讲西班牙语的人提供更多的循证治疗。一个文化 为讲西班牙语的西班牙裔物质使用障碍患者提供的适应性计算机化治疗， 在一项随机临床试验中， 认知行为疗法培训;西班牙语CBT 4CBT）。其他几项临床试验也支持 CBT 4CBT英文版的有效性和成本效益。快速、移动的提供CBT技能将 在日常生活中饮酒的危险时期（例如周末晚上），促进治疗的可行性。但是，CBT 4CBT 每个模块都需要35-40分钟的持续关注才能完成，并且在高 喝酒的危险期该项目建议开发一个浓缩的移动的西班牙语版本， CBT 4CBT在高危饮酒日快速提供治疗内容：目标1）识别西班牙语 CBT 4CBT模块主题与日常饮酒和精神症状的进一步减少相关。目的 2)开发西班牙语CBT 4CBT的浓缩版本，包括当前内容的子集 模块。目标3）测试使用智能手机提供浓缩版的 西班牙语CBT 4CBT在高风险饮酒日。 为了实现这些目标，我的职业发展计划包括以下领域的指导培训： 1)进行AUD治疗的临床试验; 2）为西班牙裔设计适应文化的治疗方法; 3） 通过智能手机提供治疗成分; 4）使用混合方法探索利益相关者的 对AUD治疗的看法; 5）通过赠款写作，出版， 领导力和网络。该奖项将为我提供正在进行的临床试验的实践经验， 为使用AUD的西班牙语人士提供电脑化治疗。我将参加国家卫生研究院的数字化培训项目 技术，少数民族健康和专业发展，包括MOSAIC UE 5领导论坛。我 将完成耶鲁大学的临床试验方法，定性研究和拨款写作课程。这些 活动将建立在我以前的专业知识与使用移动的技术和先进的统计研究， 饮酒动机和社会过程的时间动态。这个奖项将支持我过渡到一个 独立的研究事业，为西班牙裔开发移动的治疗方法，以实时瞄准饮酒。

Project Abstract Each year in the U.S., millions of Spanish-speaking Hispanics experience negative consequences from harmful alcohol use. Hispanics suffer from alcohol use disorder (AUD) and alcohol-related liver disease at rates similar to non-Hispanic Whites. However, Hispanics with AUD are less likely to receive treatment than non- Hispanic Whites. Hispanics also face greater socioeconomic, cultural, and linguistic barriers to treatment for AUD than non-Hispanic Whites. These barriers include limited access to Spanish-speaking providers and culturally adapted evidence-based treatments. Computerized treatments and mobile technology have significant potential to increase access to evidence-based treatments in a cost-effective manner for Spanish speakers. A culturally adapted computerized treatment for Spanish-speaking Hispanics with substance use disorders has demonstrated efficacy at reducing rates of alcohol and drug use in a randomized clinical trial (Computer-Based Training for Cognitive Behavioral Therapy; Spanish CBT4CBT). Several other clinical trials have supported the efficacy and cost-effectiveness of English versions of CBT4CBT. Rapid, mobile delivery of CBT skills would facilitate treatment feasibility during risky periods for drinking in daily life (e.g. weekend evenings). But, CBT4CBT modules each require 35-40 minutes of sustained attention to complete and cannot be used quickly during high- risk drinking periods. This project proposes to develop a concentrated mobile version of Spanish CBT4CBT to rapidly deliver treatment content on high-risk drinking days: Aim 1) Identify Spanish CBT4CBT module topics associated with greater reductions in daily alcohol use and psychiatric symptoms. Aim 2) Develop a concentrated version of Spanish CBT4CBT consisting of a subset of content from the current modules. Aim 3) Test the feasibility and acceptability of using smartphones to deliver a concentrated version of Spanish CBT4CBT on high-risk drinking days. To complete these aims, my career development plan includes mentored training in the following domains: 1) conducting clinical trials of treatments for AUD; 2) designing culturally adapted treatments for Hispanics; 3) delivering treatment components through smartphones; 4) using mixed methods to explore stakeholders’ perspectives on treatments for AUD; 5) fostering professional development through grant writing, publishing, leadership, and networking. This award will provide me with hands-on experience in ongoing clinical trials of computerized treatments for Spanish speakers with AUD. I will participate in NIH training programs on digital technologies, minority health, and professional development, including the MOSAIC UE5 leadership forums. I will complete Yale University courses on clinical trial methods, qualitative research, and grant writing. These activities will build on my prior expertise with using mobile technology and advanced statistics to study the temporal dynamics of motivation for drinking and social processes. This award will support my transition to an independent research career developing mobile treatments for Hispanics to target drinking in real-time.