A digital intervention to prevent the initiation of opioid misuse in adolescents in school-based health centers

大多数阿片类药物滥用始于青春期和青年期。青春期是干预的时候 在学校健康中心（HC）等环境中进行预防干预，但很少有预防措施 阿片类药物滥用“严肃的电子游戏”干预可以改善健康行为。他们遇到青少年 与标准干预措施相比，它们可以覆盖大量人群， 忠诚，对人员/资源的要求有限，促进快速可持续的分配，所有这些都在一个 潜在的低成本。该提案利用了视频游戏干预的力量， 有效的物质使用预防计划的组成部分，以制定循证干预措施， 防止青少年开始滥用阿片类药物。基于我们开发视频游戏的经验 干预措施，并与国家校本健康联盟（SBHA）合作，我们将制定和 测试一种新的视频游戏干预，PlaySmart。PlaySmart将基于我们的PlayForward视频游戏 干预平台，已证明在改善与风险有关的态度和知识方面有效 行为。通过严格的形成性工作和青少年的投入，以及我们的SBHA和游戏 开发合作伙伴，我们将创建PlaySmart视频游戏干预。PlaySmart将被设计为 通过重复和引人入胜的视频游戏，为玩家提供行为技能和知识， 青少年对开始滥用阿片类药物的危害风险的认识。这项建议的具体目标是： 1)第1阶段（UG 3）：开发和试点测试PlaySmart游戏，并与SBHA利益相关者合作开发 实施策略和合作伙伴; 2）第2阶段（UH 3）：进行随机对照试验（RCT） 与532高风险的16-19岁的青少年，在10个当地的学校为基础的（HC），比较PlaySmart游戏 注意力/时间控制游戏，并与SBHA合作，研究实施PlaySmart的策略， 全国性的学校HCs。随机对照试验的主要结果将是报告 认为滥用阿片类药物有很大的伤害风险，滥用阿片类药物的意图，拒绝的自我效能 阿片类药物和阿片类药物滥用的开始。我们假设玩智能组的参与者， 对照组在第6周（完成游戏）以及第3周、第6周和第12周时的结果将有所改善。 个月在试验期间，我们会向参加者、校本协调员及 电子游戏软件（如Dose）。我们将使用一个实施框架来检查障碍， 促进者在全国范围内的学校卫生中心实施PlaySmart，并评估成本效益 干预和实施战略的成本。这项研究由一位经验丰富的 视频游戏干预研究人员和国家SBHA的团队，承诺创造一个有效的， 参与和量身定制的干预措施，以防止阿片类药物滥用的开始。这项工作有相当大的 通过以学校为基础的人道主义协调，广泛实施、覆盖和影响高危青少年的潜力。

Most opioid misuse begins during adolescence and young adulthood. Adolescence is the time to intervene with prevention interventions in settings like school-based health centers (HCs), yet few exist that prevent initiation of opioid misuse. “Serious videogame” interventions can improve health behaviors. They meet adolescents “where they are,” and compared to standard interventions, they can reach large populations, with consistent fidelity, place limited demands on personnel/resources, facilitate rapid sustainable distribution, all at a potentially lower cost. This proposal harnesses the power of videogame interventions and incorporates components of effective substance use prevention programs to develop an evidence-informed intervention to prevent the initiation of opioid misuse in adolescents. Building on our experience developing videogame interventions and in partnership with the national School-Based Health Alliance (SBHA), we will develop and test a new videogame intervention, PlaySmart. PlaySmart will build upon our PlayForward videogame intervention platform that has demonstrated efficacy in improving attitudes and knowledge related to risk behaviors. Through rigorous formative work and with input from adolescents, and our SBHA and game development partners, we will create the PlaySmart videogame intervention. PlaySmart will be designed to provide players with behavioral skills and knowledge through repetitive and engaging videogame play to target adolescent perception of risk of harm from initiating opioid misuse. The specific aims of this proposal are to: 1) Phase 1 (UG3): Develop and pilot-test the PlaySmart game and, working with SBHA stakeholders, develop implementation strategies and partners; and 2) Phase 2 (UH3): Conduct a randomized controlled trial (RCT) with 532 high-risk 16-19 year old adolescents, in 10 local school-based (HCs), comparing the PlaySmart game to attention/time control games, and work with the SBHA to examine strategies for implementing PlaySmart in school-based HCs nationally. The main outcomes for the RCT will be the proportion of participants who report a perception of great risk of harm from misuse of opioids, intentions to misuse opioids, self-efficacy for refusing opioids, and initiation of opioid misuse. We hypothesize that participants in the PlaySmart group, compared to the control group, will have improved outcomes at 6 weeks (completion of gameplay), and at 3, 6 and 12 months. During the trial, we will collect implementation data from participants and school-based HCs and from the videogame software (e.g. dose). We will use an implementation framework to examine barriers and facilitators to implementing PlaySmart in school-based HCs nationally, and evaluate the cost-effectiveness of the intervention and the cost of the implementation strategies. This research, conducted by an experienced team of videogame intervention researchers and the national SBHA, holds the promise of creating an effective, engaging, and tailored intervention for preventing initiation of opioid misuse. This work has considerable potential for wide implementation, reach, and impact on high-risk adolescents through school-based HCs.