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， 过渡到大学的一年级学生面临的风险更大。必须将稀缺的干预资源用作 尽可能明智地解决这些问题。解决酗酒问题同时节约资源的一种方法 首先是利用普遍干预，确定那些反应不好的高危学生，然后 鼓励他们参与指定的干预。这种预防方法是“适应性的”，因为 在干预过程中关于学生的信息（例如，响应状态）用于确定 是否应该投入更多的资源来激励学生过渡到指定的服务。的 拟议项目的目的是实施适应性预防干预（API），采用成本- 有效的、基于技术的简短干预，以实现以下目标。第一，提供通用的个性化 规范性反馈（PNF）干预，其次是学生自我监控（SM）。第二，激励学生 他们继续大量饮酒（即，女性/男性中有2例以上报告4/5+饮酒，或1例报告8/10+饮酒， 妇女/男子）过渡到额外的干预资源。为了优化这种干预的效果，我们 将研究提供初始通用PNF+SM干预的最佳时机（即，作为预防接种 在进入大学之前与一旦他们在第一学期经历了大学环境）。 此外，我们将研究如何最好地激励酗酒学生追求指示干预 (i.e.,通过自动电子邮件与使用MBridge的个人健康教练在线互动）。顺序 将使用多分配随机试验（SMART）设计（N=700）来解决这些问题。 大学生将随机接受PNF或在大学开始前（上课前2周） 或在第一学期开始时（大约3周后，他们到达校园），其次是SM 第一学期每两周进行一次;这些SM评估将用于识别重度饮酒 仍处于危险中的学生。一旦确定重度饮酒，学生将被重新随机分配到 自动电子邮件或mBridge教练提供指示的干预资源。具体目标是审查： (1)与仅评估对照相比，API的功效，（2）API是否可以通过以下方式优化 改变通用干预的定时和/或消息的类型以激励所指示的寻求 干预，以及（3）这些效应的调节剂（例如，大学前饮酒意向，高强度[比较 在大学开始的时候喝酒）。酗酒的频率，酒精相关的后果，以及 将在开课前和每个随访点（期末）评估卫生服务利用情况。 学期，年底，和下一个秋天）。通过本项目改进的API将提供 用于减轻急性负面健康后果（例如，酒精中毒）和 长期健康后果（例如，酒精使用障碍（alcohol use disorders）指的是年轻的成年人饮酒。

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.