Integrative Data Analysis of Gender and Ethnic Differences in MDFT RCTs

描述（由申请人提供）：尽管少数族裔青年面临着充分记录的健康差异，但药物滥用治疗领域只解决了有关少数族裔青年循证治疗（EBTs）有效性的最基本问题。同样，随机对照试验测试的ebt对滥用药物的青少年（从数字上讲）是由男性主导的。虽然最近的一些评论表明，一些EBTs对药物滥用、少年司法、少数民族、青少年人群有效，但许多重要问题仍未得到解答。从根本上说，标准的ebt是否对少数民族和欧洲裔美国人，以及男性和女性，年轻人同样有益的问题仍然没有答案，因为大多数研究缺乏足够的统计能力来检测调节效应（治疗相互作用的种族）。此外，我们对ebt如何在女孩和少数民族人群中发挥作用的了解更少，这主要是因为研究人员刚刚开始使用复杂的方法来检查治疗效果的介质，而不考虑性别/种族，并且还没有开始解决不同的治疗机制是否在不同的种族和性别中起作用。Curran等人（2008）介绍了一种整合大量纵向研究数据的有前途的方法，即综合数据分析（integrated data Analysis， IDA），即使在不同研究中对一个结构的观察结果测量有所不同。我们建议使用IDA方法，从10个纵向随机对照试验中，将物质使用、犯罪和家庭功能的测量联系起来，这些试验测试了多维家庭治疗（MDFT）的有效性，MDFT是一种经验支持的治疗药物滥用、少年司法问题青少年的方法（Liddle, 2009），并解决以下具体目标：干预效果-将MDFT的临床结果与10个随机对照试验中比较治疗的临床结果进行比较。目的2：调节效应-检查种族和性别调节干预结果的程度。目标3：作用机制-确定MDFT在不同种族背景的男女青年中发挥作用的机制。从10个随机对照试验中收集的1532名青少年的药物使用、犯罪和家庭功能的测量将被分析。最先进的统计技术，包括潜在增长曲线模型（LGM）和使用渐近自举置信区间方法的中介检验，将用于检验研究假设。

DESCRIPTION (provided by applicant): Despite the well-documented health disparities faced by minority youth, the field of substance abuse treatment has only addressed the most elementary questions regarding the effectiveness of evidence-based treatments (EBTs) with minority youth. Similarly, randomized controlled trials testing EBTs for substance-abusing youth are dominated (numerically speaking) by males. While several recent reviews have indicated that a number of EBTs are effective with substance abusing, juvenile justice-involved, ethnic minority, adolescent populations, many important questions remain unanswered. Fundamentally, the question of whether standard EBTs are equally beneficial for ethnic minority and European American, as well as male and female, youth remains unanswered because most studies lack adequate statistical power to detect moderator effects (ethnicity by treatment interaction). Further, we know even less about how EBTs achieve their effects among girls and minority populations-largely because researchers have only begun using sophisticated methods to examine mediators of treatment effects irrespective of gender/ethnicity-and have not begun to address whether different treatment mechanisms operate in different ethnicities and genders. Curran et al. (2008) introduced a promising method for integrating data from numerous longitudinal studies, even when the observed outcome measures for a construct vary across studies, Integrative Data Analysis (IDA). We propose to use IDA methods to link measures of substance use, delinquency, and family functioning from 10 longitudinal randomized controlled trials testing the effectiveness of Multidimensional Family Therapy (MDFT), an empirically-supported treatment for substance abusing, juvenile-justice- involved youth (Liddle, 2009) and address the following specific aims: Aim 1: Intervention Effectiveness - To compare the clinical outcomes of MDFT to those achieved by comparison treatments across 10 randomized controlled trials. Aim 2: Moderating Effects - To examine the extent to which ethnicity and gender moderate intervention outcomes. Aim 3: Mechanisms of Action - To identify the mechanisms through which MDFT achieves its effects in male and female youth from diverse ethnic backgrounds. Measures of substance use, delinquency, and family functioning from a total of 1532 youth collected across 10 RCTs will be analyzed. State-of-the-art statistical techniques, including latent growth curve modeling (LGM) and mediation tests using the asymptotic bootstrap confidence interval method, will be used to examine study hypotheses. PUBLIC HEALTH RELEVANCE: The proposed study uses an innovative data analytic methodology, Integrative Data Analysis (IDA; Curran et al., 2008), to combine data from 10 randomized controlled trials examining the effectiveness of Multidimensional Family Therapy (MDFT) as an evidence-based treatment for adolescent substance abuse and delinquency. Although MDFT developers have been concerned with gender and cultural issues as they pertain to treatment effectiveness (Dakof, 2000; Jackson-Gilfort et al., 2001; Rodriguez et al., 2007), previous single-study MDFT trials have been limited in the statistical power they have to test meaningful research questions regarding MDFT's comparative effectiveness with minority and White, non-Latino, as well as male and female, youth. The study has the potential to yield new knowledge about MDFTs effectiveness with female and ethnic minority youth and extend IDA methodology for clinical research.