An Adaptive Preventive Intervention to Optimize the Transition from Universal to Indicated Resources for College Student Alcohol Use

大学生饮酒及其相关的负面后果是公共卫生问题。特别是， 一年级学生过渡到大学的风险增加。稀缺的干预资源必须被用作 尽可能明智地解决这些关切。解决酗酒问题同时节约资源的一种方法 首先利用普遍的干预措施，识别反应不佳的高危学生，然后 激励他们进行有针对性的干预。这种预防方法是“适应性的”，因为 关于干预过程中的学生的信息(例如，响应状态)被用来确定 是否应该投入更多的资源来激励学生过渡到指定的服务。这个 拟议项目的目的是实施适应性预防干预(API)，利用成本- 有效的、以技术为基础的简短干预措施可以做到以下几点。第一，提供通用的个性化 规范反馈(PNF)干预，然后是学生自我监控(SM)。第二，激励学生 继续大量饮酒的人(即，女性/男性2份报告四分之四饮酒，或1份报告8/10饮酒 妇女/男子)过渡到额外的干预资源。为了优化这一干预措施的效果，我们 将调查提供初始通用PNFSM干预(即接种)的最佳时机 在他们进入大学之前与他们在第一学期经历大学环境时的情况相比)。 此外，我们将研究如何最好地激励酗酒学生采取有针对性的干预措施。 (即，通过自动电子邮件与使用mBridge的个人健康教练的在线交互)。按顺序排列 将使用多分配随机试验(SMART)设计(N=700)来解决这些问题。 大学生将被随机安排在大学开始前(开课前两周)接受PNF 或在第一学期开始(大约在他们进入校园后的3周内)，然后是SM 在第一学期每两周进行一次；这些SM评估将被用来识别酗酒者 仍然处于危险之中的学生。一旦确定大量饮酒，学生将被重新随机分配到 自动发送电子邮件或mBridge指导，以提供指定的干预资源。具体目标是审查： (1)与仅评估对照相比，API的有效性；(2)API是否可以通过以下方式进行优化 改变普遍干预的时间和/或消息的类型以激励所指示的寻求 干预，以及(3)这些影响的调节因素(例如，大学前饮酒意图，高强度[比较 在大学开始时酗酒)。大量饮酒的频率、与酒精相关的后果以及 将在课程开始之前和每个后续行动点(#年结束时)评估卫生服务利用情况 学期、年终和次年秋季)。透过这个项目精炼的原料药将会提供一个 减轻急性负面健康后果(如伤害、酒精中毒)和 青少年饮酒的长期健康后果(如酒精使用障碍)。

College student alcohol use and associated negative consequences are public health problems. In particular, first-year students transitioning to college are at increased risk. Scarce intervention resources must be used as wisely as possible to address these concerns. One way to address heavy drinking while conserving resources is to first utilize universal interventions, identify students at high risk who do not respond well, and then motivate them to engage in indicated intervention. This approach to prevention is `adaptive' because information about the student in the course of the intervention (e.g., response status) is used to determine whether more resources should be invested to motivate the student to transition to indicated services. The purpose of the proposed project is to implement adaptive preventive intervention (API) that employs cost- effective, technology-based brief interventions to do the following. First, provide a universal personalized normative feedback (PNF) intervention followed by student self-monitoring (SM). Second, motivate students who continue to drink heavily (i.e., 2+ reports of 4/5+ drinks for women/men, or 1 report of 8/10+ drinks for women/men) to transition to additional intervention resources. To optimize the efficacy of this intervention, we will investigate the best timing for delivering the initial universal PNF+SM intervention (i.e., as an inoculation before moving to college vs. once they are experiencing the college context during their first semester). Additionally, we will examine how best to motivate heavy-drinking students to pursue indicated intervention (i.e., via automated emails vs. online interaction with a personal health coach using mBridge). A sequential multiple assignment randomized trial (SMART) design (N=700) will be used to address these questions. College students will be randomized to receive PNF either before college begins (2 weeks before classes start) or during the beginning of the first semester (about 3 weeks after they arrive on campus), followed by SM every two weeks during the first semester; these SM assessments will be used to identify heavy-drinking students who remain at risk. Once heavy drinking is identified, the student will be re-randomized to either an automated email or mBridge coach to offer indicated intervention resources. The specific aims are to examine: (1) the efficacy of the API compared to an assessment-only control, (2) whether the API can be optimized by altering the timing of the universal intervention and/or the type of message to motivate seeking indicated intervention, and (3) moderators of these effects (e.g., pre-college drinking intentions, high-intensity [compared to binge] drinking during the start of college). Frequency of heavy drinking, alcohol-related consequences, and health services utilization will be assessed prior to the start of classes, and at each follow-up point (the end of the semester, the end of the year, and the following fall). The API to be refined through this project will offer a novel strategy for mitigating both the acute negative health consequences (e.g., injury, alcohol poisoning) and long-term health consequences (e.g., alcohol use disorders) of young adult alcohol use.