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

项目摘要 性侵犯在大学生中非常普遍，并且与酒精滥用的高风险有关 和创伤后应激障碍并存。这些条件与 对校园服务系统造成巨大压力，并对学生造成严重的短期和长期后果。 虽然有效的预防措施（即，在创伤暴露后的几个月内实施） 存在这些条件，大学生幸存者往往不寻求或成功地获得亲自照顾， 特别是在男性和少数种族/族裔中。移动的健康（即，mHealth）干预措施是一种有前途的 提高大学生获得预防性干预措施的低障碍战略。我们开发 并试点测试了一个多组件的mHealth预防干预原型，繁荣，以减少 性侵犯幸存者的创伤后压力和酒精滥用。THRIVE有效地 减少创伤后压力和酒精滥用，使其成为第一个创伤后移动健康干预措施 有证据表明其在减少酒精滥用方面的功效。在目前的研究中，我们建议进行一项 优化试验，以确定最有效的，高效的，低负担的版本，繁荣的大学 学生在进行试验之前，我们将使用收集的实时用户反馈对THRIVE进行修订， 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 通过审查应用程序和试点用户反馈与用户体验/界面合作进行选择 设计师，我们的咨询委员会的专家在文化适应的干预措施，和我们的咨询委员会， 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。 使用修改后的应用程序，我们将进行一项2x2 x2析因随机试验，以测试3种药物的独特效果。 核心THRIVE组件（即，应用内活动安排、应用内认知重构、电话辅导） 酒精滥用和创伤后压力（目标2），以及活动指导的额外好处 调度和认知重构（目标3）。N=464名在过去12周内遭受性侵犯的大学生， 酗酒和创伤后应激障碍都会被纳入所有参与者都将收到一个入职电话和非核心应用程序 元件（即，自我监测，鼓励声明横幅，转介），并将被随机分配到 另外接收3个核心元件的组合。参与者将在以下地点完成自我报告评估： 基线、干预期间每日、干预后以及3、6、9和12个月。结果将用于 选择一个优化版本的THRIVE。我们的设计将确保未来的测试和传播的繁荣 最大限度地体现包容、高效、有效的干预要素。如果有效，蓬勃发展将代表 一个高度可扩展的策略，可以直接由校园服务系统实施，以减少 创伤后应激障碍和酒精滥用对学生的巨大负担。

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.