Cross-Tailoring Integrative Alcohol and Risky Sex Feedback for College Students: A Hybrid Type 1 Effectiveness-Implementation Trial

项目总结/摘要 酒精滥用和相关的危险性行为（RSB）是大学生中重要的公共卫生问题 学生三分之二的学生目前是饮酒者，至少三分之一的学生报告上个月酗酒（5杯以上 每10人中就有1人报告高强度饮酒（连续饮酒10次以上）。学生饮酒量增加 并且在给定的一天大量饮酒与增加的性活动和RSB（例如，无保护的性行为， 计划外的连接）。这使学生面临负面健康结果的风险（例如，性传播感染），是一种途径， 性侵害和酗酒大学的前几周，或“红区”，呈现出一个关键的 干预酒精使用升级和相关风险的机会窗口，这可能导致潜在的 对公众健康和临床影响很大。然而，针对大学生的个人层面的预防策略往往 更广泛地关注学生的酒精使用模式和后果，很少或根本没有整合内容 关于酒精使用和RSB之间的关系，这是文献中的一个重要空白，也是NIAAA的优先领域。 我们的团队先前建立了个性化反馈干预（PFI）的短期疗效，这是一种黄金疗法。 标准的干预方法，包括关于酒精和RSB的综合内容。我们建议延长我们的 集成的PFI包括一个交叉定制的动态反馈（CDF）组件，该组件利用技术 整合学生行为的日常评估，并为用户提供超过12周的动态每周反馈 几周的时间来扩大综合PFI的有效性，并在大学校园中轻松实施。的 该项目采用多站点混合1型有效性-实施研究设计，以（1）评估 CDF为有风险的大学一年级学生和（2）确定其成功的关键实施因素，以促进 未来在校园环境中扩大规模。第一个目标是进行多层次的知识产权参与的适应， 通过制定和纳入CDF，将酒精和危险性行为纳入PFI。第二个目标是 在600名第一次- 报告最近酗酒和性活跃的一年大学生。我们的主要假设是 接受PFI+CDF干预的参与者将报告较少的酒精使用，较少的危险性行为， 与接受补充了一般健康信息的PFI的患者相比， 向上（1、2、3、6和13个月）。我们的第三个目标是确定在以下方面实施PFI+CDF的关键因素： 通过与RCT的一部分学生以及当地和 国家系统一级的利益攸关方。干预措施具有广泛传播的巨大潜力， 针对酒精滥用和RSB的高风险群体。

PROJECT SUMMARY/ABSTRACT Alcohol misuse and related risky sexual behavior (RSB) are significant public health concerns among college students. Two-thirds of students are current drinkers, at least 1 in 3 report past month binge drinking (5+ drinks in a row), and 1 in 10 report high intensity drinking (10+ drinks in a row). Greater student alcohol consumption and heavy drinking on a given day is linked to increased sexual activity and RSB (e.g., unprotected sex, unplanned hook-ups). This puts students at risk for negative health outcomes (e.g., STIs) and is a pathway to sexual victimization and escalated drinking. The first few weeks of college, or the ‘red zone,’ present a critical window of opportunity to intervene for escalated alcohol use and associated risks, which can result in a potentially high public health and clinical impact. However, individual-level prevention strategies for college students tend to focus on students’ alcohol use patterns and consequences more broadly, with little to no integration of content on the relationship between alcohol use and RSB, an important gap in the literature and a priority area for NIAAA. Our team previously established the short-term efficacy of a personalized feedback intervention (PFI), a gold standard intervention approach, with integrated content on alcohol and RSB. We propose to extend our integrated PFI to include a cross-tailored dynamic feedback (CDF) component, which leverages technology to incorporate daily assessments of student behavior and provide users with dynamic weekly feedback over 12 weeks to amplify the effectiveness of the integrated PFI and to be easily implemented on college campuses. The project utilizes a multisite, hybrid type 1 effectiveness-implementation study design to (1) evaluate the impact of CDF for at-risk first-year college students and (2) identify implementation factors critical to its success to facilitate future scale-up in campus settings. The first aim is to conduct a multi-level stakeholder-engaged adaptation of the integrated alcohol and risky sex PFI through the development and inclusion of CDF. The second aim is to conduct a randomized controlled trial (RCT) of the enhanced intervention (PFI+CDF) in a sample of 600 first- year college students who report recent binge drinking and are sexually active. Our primary hypothesis is that participants who receive the PFI+CDF intervention will report less alcohol use, fewer risky sexual behaviors, and fewer consequences relative to those who receive a PFI supplemented with generic health information at follow- up (1, 2, 3, 6, and 13 months). Our third aim seeks to identify factors critical to PFI+CDF implementation in campus settings through conducting focus groups with a subset of students from the RCT and with local and national systems-level stakeholders. The intervention has strong potential for widespread dissemination and targets a group at high risk for alcohol misuse and RSB.