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

项目摘要 在美国，每年数百万说西班牙语的拉美裔美国人都会经历 有害的酒精使用。拉美裔美国人患有酒精使用障碍(AUD)和与酒精相关的肝病的比率 类似于非西班牙裔白人。然而，患有AUD的西班牙裔患者接受治疗的可能性低于非AUD患者 西班牙裔白人。拉美裔美国人也面临着更大的社会经济、文化和语言障碍来治疗澳州大学。 而不是非西班牙裔白人。这些障碍包括接触西班牙语提供者的机会有限，以及文化上的障碍 采用循证治疗。计算机化治疗和移动技术具有巨大的潜力 以符合成本效益的方式增加讲西班牙语的人获得循证治疗的机会。一种文化上的 对西班牙语拉美裔药物使用障碍患者进行了经过调整的计算机化治疗 在一项随机临床试验中证明了降低酒精和药物使用率的有效性(基于计算机 认知行为疗法培训；西班牙CBT4CBT)。其他几项临床试验也支持 CBT4CBT英文版的疗效和成本效益。快速、移动地交付CBT技能将 在日常生活中饮酒的危险时期(如周末晚上)促进治疗的可行性。但是，CBT4CBT 每个模块都需要持续关注35-40分钟才能完成，并且不能在高峰期快速使用 冒着饮酒的风险。该项目建议开发一个集中的西班牙语移动版本 CBT4CBT在高风险饮酒日快速提供治疗内容：目标1)识别西班牙语 CBT4CBT模块主题与日常饮酒和精神症状的大幅减少有关。目标 2)开发西班牙CBT4CBT的集中版本，包括当前内容的子集 模块。目标3)测试使用智能手机提供集中版本的 西班牙CBT4CBT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性培训： 1)进行AUD治疗的临床试验；2)为拉美裔设计适应文化的治疗方法；3) 通过智能手机提供治疗组件；4)使用混合方法探索利益相关者的 对澳元治疗的看法；5)通过撰写赠款、出版、 领导力和人脉。这一奖项将为我提供正在进行的临床试验的实践经验 对说西班牙语的澳大利亚人进行计算机治疗。我将参加美国国立卫生研究院的数字培训计划 技术、少数民族健康和专业发展，包括马赛克UE5领导人论坛。我 将完成耶鲁大学有关临床试验方法、定性研究和拨款撰写的课程。这些 活动将以我以前使用移动技术和高级统计数据的专业知识为基础，研究 饮酒动机和社交过程的时间动力学。这个奖项将支持我过渡到 独立研究生涯为拉美裔开发移动治疗，以实时饮酒为目标。

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.