Project THRIVE: Testing an app-based early intervention to reduce alcohol use and PTSD after sexual assault

项目总结 性侵犯在大学生中非常普遍，并与酗酒的高风险有关 以及所有性别幸存者的创伤后应激障碍。这些情况与 对校园服务系统造成巨大压力，并对学生产生重大的短期和长期后果。 虽然有效的预防性干预措施(即在接触创伤后的几个月内实施) 在这些情况下，大学生幸存者往往不寻求或成功获得面对面的护理， 特别是在男子和种族/族裔少数群体中。移动健康(即，移动健康)干预措施前景看好 在大学生中增加获得预防性干预的低障碍的战略。我们开发了 飞行员测试了一种多组分的mHealth预防性干预原型Thrive，以减少 新近性侵犯幸存者的创伤后应激和酒精滥用。欣欣向荣在 减少创伤后应激和酒精滥用，使其成为首个创伤后mHealth干预措施 有证据表明在减少酒精滥用方面是有效的。在目前的研究中，我们建议进行一项 优化试验，以确定最有效、高效和低负担的大学版Thrive 学生们。在进行试验之前，我们将使用在 试点试验(目标1)。修订版将保留Thrive的核心元素，同时增加可用性。修订将 通过审查应用程序并与用户体验/界面合作试用用户反馈来选择 设计师，我们的干预文化适应专家顾问委员会，以及我们的顾问委员会 大学生幸存者。这将最大限度地提高可用性，同时关注不同学生幸存者的需求。 使用修订后的APP，我们将进行2x2x2析因随机试验，以测试3种 核心Thrive组件(即应用内活动计划、应用内认知重组、电话培训) 酒精滥用和创伤后应激(目标2)，以及活动指导的额外好处 时间安排和认知重组(目标3)。N=464名在过去12周内遭受性侵的大学生， 酗酒和创伤后应激障碍将被登记。所有参与者都将收到入职呼叫和非核心应用程序 要素(即自我监测、鼓励性声明横幅、推荐)，并将随机分配到 此外，还会收到3个核心要素的组合。参与者将在以下位置完成自我报告评估 基线、干预期间的每日、干预后以及3、6、9和12个月。结果将用于 选择Thrive的优化版本。我们的设计将确保未来的测试和传播蓬勃发展 反映最大限度的包容性、高效和有效的干预要素。如果有效，Thrive将代表 可由校园服务系统直接实施的高度可扩展的战略，以减少 创伤后应激障碍和酗酒给学生带来了沉重的负担。

PROJECT SUMMARY Sexual assault is highly prevalent among college students and is associated with high risk for alcohol misuse and co-occurring posttraumatic stress in survivors of all genders. These conditions are associated with significant strain on campus service systems and substantial short- and long-term consequences for students. Although effective preventative interventions (i.e., implemented within the months following trauma exposure) exist for these conditions, college student survivors often do not seek or successfully access in-person care, especially among men and racial/ethnic minorities. Mobile health (i.e., mHealth) interventions are a promising strategy to increase low-barrier access to preventative interventions among college students. We developed and pilot tested a multi-component mHealth preventative intervention prototype, THRIVE, to reduce posttraumatic stress and alcohol misuse in recent survivors of sexual assault. THRIVE was effective in reducing both posttraumatic stress and alcohol misuse, making it the first post-trauma mHealth intervention with evidence of efficacy in reducing alcohol misuse. In the current study, we propose to conduct an optimization trial to identify the most effective, efficient, and low-burden version of THRIVE for college students. Prior to conducting the trial, we will revise THRIVE using the real-time user feedback collected in the pilot trial (Aim 1). Revisions will maintain the core elements of THRIVE while increasing usability. Revisions will be selected by reviewing the app and pilot user feedback in partnership with user experience/interface designers, our advisory board of experts in cultural adaptations of interventions, and our advisory board of college student survivors. This will maximize usability with attention to the needs of diverse student survivors. Using the revised app, we will then conduct a 2x2x2 factorial randomized trial to test the unique effects of the 3 core THRIVE components (i.e., in-app activity scheduling, in-app cognitive restructuring, phone coaching) on alcohol misuse and posttraumatic stress (Aim 2), as well as the added benefit of coaching to activity scheduling and cognitive restructuring (Aim 3). N=464 college students with past-12-week sexual assault, elevated drinking, and PTSD will be enrolled. All participants will receive an onboarding call and non-core app elements (i.e., self-monitoring, encouraging statements banner, referrals), and will be randomized to additionally receive combinations of the 3 core elements. Participants will complete self-report assessments at baseline, daily during the intervention, post-intervention, and 3, 6, 9, and 12 months. Results will be used to select an optimized version of THRIVE. Our design will ensure that future testing and dissemination of THRIVE reflects maximally inclusive, efficient, and effective intervention elements. If effective, THRIVE would represent a highly-scalable strategy that could be directly implemented by campus service systems to reduce the substantial burden of PTSD and alcohol misuse on students.