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

项目总结/摘要 性和性别少数青年（SGMY;例如，女同性恋、男同性恋、双性恋、跨性别者和非二元人群<18 在酒精使用方面经历了很大的不平等，因此使SGMY处于酒精相关的更大风险中。 发病率和死亡率。尽管在确定决定因素方面取得了很大进展（例如， 少数民族的压力和歧视）的这些不平等在过去的25年里， 减少SGMY酒精的使用。我们的主要目标是对这个应用程序进行严格的测试， 奇点的有效性，一种基于理论的，SGMY-informed，基于游戏的干预措施，用于预防和 减少SGMY酗酒。这款游戏是在我们之前的资助中开发和测试的 （R21 HD 083561; PI：埃根），这表明游戏对SGMY的接受度很高， 降低SGMY酗酒频率的功效。我们提出的完全有效性试验是下一个 确认我们基于游戏的干预措施对公共卫生的影响。在目标1a中，我们将进行 随机对照试验，以测试基于游戏的短期，中期和长期疗效 SGMY（n= 2，298）中预防和减少酗酒的干预措施。我们假设在3，6， 干预实施后12个月，基于游戏的干预组与对照组的SGMY将具有 酗酒（主要结局）和其他健康风险行为（次要结局）的减少。 在目标1b中，我们将探讨在非随机非随机的情况下， 激励SGMY子样本（n=60），以阐明在真实的世界条件下的干预实施。在 目标2，我们将定量探索RCT参与者的基线少数压力源（跨多个远端和远端） 邻近域）和人口统计（例如，种族/民族）与干预措施相互作用，以预测 酗酒和其他结果（即，干预效果如何因亚组而异）。在目标3中，我们 定性探索（通过RCT后访谈）干预参与者的酗酒之间的相互作用， 少数民族的压力源，以及他们对游戏技能的使用。在成功完成这项研究后， 预期的结果是有一个以证据为基础的干预措施，显着减少SGMY狂饮。 此外，我们的研究将提供混合方法的结果，以确定少数民族的压力和人口统计学 缓和我们的循证干预的有效性，这将告知该领域关于谁SGMY- 扶持性干预措施最为有益，并阐明了哪些人需要额外干预。 这些结果将产生积极的影响，因为我们的干预有可能通过在线广泛推广 并且可以帮助联邦机构实现它们的目标（例如，2030年健康人口减少 SGMY在酒精使用方面的不平等。

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.