Informing treatment adaptation based on the interplay between behavioral undercontrol and context: an event-level study

项目摘要 在美国，未成年人饮酒是一个严重的健康问题，其病因是多方面的， 包括危险情况（机动车事故，危险性行为和暴力）和酒精的影响 使用障碍（青少年酒精使用障碍发病率最高）。环境和 青少年饮酒行为的发展与个人特征有关。在 环境水平，社会，地点和情境背景特征影响青少年的模式， 喝酒在个人层面上，未成年人饮酒的最强预测因素之一是行为 控制不足（BU;例如冲动，感觉寻求）。成功针对BU差异的干预措施 延迟发病和减少未成年饮酒者的饮酒量。然而，研究表明， 背景特征和BU的差异有意义地改变了饮酒行为。因此，有一个 有机会调查背景效应如何因性别而异，并由BU调节，以产生重 在事件层面上的偶发性饮酒;通过进行时间敏感的研究，调查BU如何预测自我， 选择到饮酒环境，以及如何BU随后缓和这些背景的影响。K01 一项名为“在青少年饮酒中使用细粒度背景数据指导治疗适应”的提案 建议收集细粒度数据，通过告知何时， 干预的地点和对象，沿着适应性或具体情况。人数相等 报告至少有一次重度饮酒事件的男性和女性青少年（N = 120，年龄15-17岁）， 在过去的两周里，将被招募参加为期17天的生态瞬时评估（EMA）调查， 一个实验室会议。实验室会议将包括自我报告和行为评估， 以及环境因素。EMA将包括随机用户提示以及自启动 报告评估酒精使用，社会，地点和情境背景特征，沿着 在饮酒之前和之后评估BU。本项目有三个具体的研究目标：1）考察 背景是否介导BU对青少年饮酒的影响。2)检查BU是否调节角色 在预测青少年饮酒方面的作用。3)研究饮酒如何影响冲动，以及这种影响 预测酒精的后果。通过根据调查结果提供对背景敏感的干预措施，我们将 利用技术，允许上下文适当的提示（“即时”干预）。的 相关的培训计划将为候选人提供独立进行EMA调查的能力 在青少年中开展活动，并帮助确保未来的资金，成为事件层面背景的实质性专家 使用细粒度评估工具，并告知治疗适应性 基于个体差异的干预措施。因此，该项目在多个层面上与NIAAA的 未成年人饮酒研究倡议，以调查因素，推动有害的青少年饮酒。

PROJECT SUMMARY Underage drinking in the United States is a serious health concern, with a multifaceted etiology and wide- ranging implications including risky situations (motor vehicle accidents, risky sex, and violence) and alcohol use disorder (adolescents have the highest rate of alcohol use disorder onset). Both environmental and individual characteristics are implicated in the development of adolescent drinking behavior. At the environmental level, social, locational, and situational context characteristics influence adolescent patterns of drinking. At the individual level, one of the strongest individual predictors of underage drinking is behavioral undercontrol (BU; e.g. impulsivity, sensation seeking). Interventions that target differences in BU successfully delay onset and reduce quantity of alcohol use in underage drinkers. However, research has shown that context characteristics, and differences in BU, meaningfully change drinking behavior. Hence, there is an opportunity to investigate how context effects differ by sex and are moderated by BU to produce heavy episodic drinking at the event level; by conducting time-sensitive research investigating how BU predicts self- selection into drinking contexts, and how BU subsequently moderates the impact of those contexts. This K01 proposal, titled “Informing treatment adaptation using fine-grained context data in adolescent alcohol use” proposes to collect fine-grained data that could inform context-sensitive interventions, by informing when, where, and with whom to intervene, along with adaptation to sex- or context-specific situations. Equal numbers of male and female adolescents (N = 120, ages 15-17 years) who report at least one heavy drinking episode in the past two weeks, will be recruited for a 17-day ecological momentary assessment (EMA) survey preceded by a single laboratory session. The laboratory session will include self-report and behavioral assessments of BU as well as environmental factors. The EMA will include random user prompts as well as self-initiated reports assessing alcohol use, social, locational, and situational context characteristics, along with assessments of BU prior to, and after, alcohol use. The project has three specific research aims: 1) Examine whether context mediates the effect of BU on adolescent drinking. 2) Examine whether BU moderates the role of context in predicting adolescent drinking. 3) Examine how drinking impacts impulsivity, and how this impact predicts alcohol consequences. By informing context-sensitive interventions based on findings, we will capitalize on technology that allows for context-appropriate prompts (“Just-in-time” interventions). The associated training plan will provide the candidate with the ability to independently conduct EMA surveys among adolescents and aid in securing future funding, becoming a substantive expert on event-level context characteristics and individual traits using fine-grained assessment tools, and informing treatment adaptations for individual-differences-based interventions. Thus, the project is aligned at multiple levels with NIAAA’s underage drinking research initiative into investigating factors that drive harmful adolescent alcohol use.