A Randomized Controlled Trial of a Game-Based Intervention to Reduce Alcohol Use among Sexual and Gender Minority Youth

项目摘要/摘要 性和性别少数民族青年(例如，女同性恋者、男同性恋者、双性恋者、变性人和非双性恋者) 年)在饮酒方面经历了严重的不平等，从而使SGMY面临与酒精相关的更大风险 整个生命过程中的发病率和死亡率。尽管在识别决定因素方面取得了很大进展(例如， 少数族裔压力和歧视)在过去的25年里，对这些不平等的循证干预 减少SGMY的酒精使用是不够的。我们这个应用程序的主要目标是严格测试 奇点的功效，一种基于理论、SGMY信息、基于游戏的干预措施，用于预防和 减少SGMY狂饮。这个游戏是在我们之前的资助中开发和试点测试的 (R21HD083561；PI：EGAN)，这表明游戏对SGMY的接受度很高，并有初步的 降低SGMY狂饮频率的功效。我们提议的全功率药效试验将是下一个 确认我们以游戏为基础的干预措施对公众健康的影响。在目标1a中，我们将进行 以游戏为基础的随机对照试验测试短期、中期和长期疗效 预防和减少SGMY狂饮的干预措施(n=2,298)。我们假设在3，6， 而在干预交付12个月后，SGMY在基于游戏的干预臂相对于控制臂将有 更大程度地减少酗酒(主要结果)和其他健康危险行为(次要结果)。 在目标1b中，我们将探索干预摄取和参与在非随机非 激励SGMY子样本(n=60)，以阐明在真实世界条件下的干预实施。在……里面 目标2，我们将定量地探索RCT参与者的基线少数民族应激源(跨越多个远端和 近端领域)和人口统计(例如，种族/民族)与干预相互作用以预测 酗酒和其他结果(即干预效果因亚组而异)。在《目标3》中，我们将 定性地探索(通过随机对照试验后访谈)干预参与者酗酒、 少数民族压力源，以及他们对基于游戏的技能的使用。在成功完成这项研究后， 预期的结果是有一个基于证据的干预措施，显著减少SGMY酗酒。 此外，我们的研究将提供混合的方法结果，确定少数民族压力和人口统计 适中我们循证干预的有效性，这将向现场提供有关SGMY- 积极的干预措施是最有益的，并阐明了谁需要更多的干预措施。 这些结果将产生积极影响，因为我们的干预措施有可能通过在线方式广泛推广 传播，并可帮助联邦机构实现其目标(例如，2030年健康人)，以减少 人群层面的酒精使用中的SGMY不平等。

PROJECT SUMMARY/ABSTRACT Sexual and gender minority youth (SGMY; e.g., lesbian, gay, bisexual, transgender, and nonbinary people <18 years) experience substantial inequities in alcohol use, thus placing SGMY at greater risk for alcohol-related morbidity and mortality across the life-course. Despite making great strides in identifying determinants (e.g., minority stress and discrimination) of these inequities over the last 25 years, evidence-based interventions for reducing SGMY alcohol use are lacking. Our primary objective for this application is to rigorously test the efficacy of Singularities, a theory-based, SGMY-informed, game-based intervention for preventing and reducing SGMY binge drinking. This game was developed and pilot tested in our previous grant (R21HD083561; PI: Egan), which showed that the game was highly acceptable to SGMY and had preliminary efficacy for reducing SGMY’s binge drinking frequency. Our proposed fully-powered efficacy trial is the next step to confirm the public health impacts of our game-based intervention. In Aim 1a, we will conduct a randomized controlled trial to test the short-term, mid-term, and long-term efficacy of a game-based intervention for preventing and reducing binge drinking among SGMY (n=2,298). We hypothesize that at 3, 6, and 12 months after intervention delivery, SGMY in the game-based intervention arm vs. control arm will have greater reductions in binge drinking (primary outcome) and other health risk behaviors (secondary outcomes). In Aim 1b, we will explore the feasibility of intervention uptake and engagement in a non-randomized non- incentivized SGMY subsample (n=60) to elucidate intervention implementation under real world conditions. In Aim 2, we will quantitatively explore if RCT participants’ baseline minority stressors (across multiple distal and proximal domains) and demographics (e.g., race/ethnicity) interact with the intervention to predict changes in binge drinking and other outcomes (i.e., how intervention efficacy differs by subgroups). In Aim 3, we will qualitatively explore (via post-RCT interviews) the interplay between intervention participants’ binge drinking, minority stressors, and their use of game-based skills. Upon successful completion of this research, the expected outcome is to have an evidence-based intervention for significantly reducing SGMY binge drinking. Further, our study will provide mixed methods results identifying how minority stress and demographics moderate the efficacy of our evidence-based intervention, which will inform the field about for whom SGMY- affirmative interventions are most beneficial and illuminate for whom additional interventions are needed. These results will have positive impacts because our intervention has potential to be widely scaled via online dissemination and can help federal agencies meet their goals (e.g., Healthy People 2030) of reducing population-level SGMY inequities in alcohol use.