Optimizing a Drug Abuse Prevention Program for Dissemination

描述(由申请人提供)：该项目是Bridges计划简化版本的混合功效/有效性试验，这是一种旨在预防药物滥用和精神健康障碍的循证干预(EBI)。Bridge是一项综合的父母-青年干预措施，在一项针对墨西哥裔美国人(移民和美国出生)的随机对照试验(RCT)中进行了评估，该试验显示了对多种结果的长期影响：青春期早期的药物使用开始和升级、外化和内化症状、异常同伴交往和平均成绩(GPA)；青春期后期的酒精滥用障碍、酗酒、大麻使用、高风险性行为、确诊的精神障碍和辍学。基于核心干预内容的证据和为现实世界重新设计EBI的战略，我们将与低收入、多民族学校合作，将计划调整为简短的四节制(Bridges Short Program，BSP)，并优化参与、交付、培训和实施监控系统，以促进传播和可持续性。建议的随机对照研究亦会研究，当神经生物系统迅速改变时，亲子-青年EBI是否可以影响青少年在青春期的多种自我调节渠道(例如，生物、行为、情绪)，以及先前存在的自我调节方面的个体差异是否会缓和计划的效果。本RCT的具体目的是：1)检验BSP与对照组在测试后对目标家庭和青少年能力的影响，6个月随访的多种青少年自我调节系统，以及1年随访的多个青少年结果：物质使用、外化和内化症状、变态同伴交往、危险性行为和GPA；2)检验影响是否通过项目诱导的对目标父母和青少年能力的改善以及对青少年自我调节的多个指标的改变而中介；3)检查计划语言(英语和西班牙语)、基线青少年风险(包括生物风险)和基线家庭风险，作为BSP对青少年结果和调解人影响的调节因素；4)检查实施的可变性是否解释了调解者和结果的差异；以及5)对BSP和最初的桥梁计划进行成本分析，并估计BSP和对照组在延迟SU启动以及SU的数量和频率方面的成本效益。在拟议的试验中，500名7年级学生和他们的家长将被随机分配到每所学校接受BSP或控制组。试验将包括4个评估点：7年级的前测(W1)和即刻后测(W2)、6个月(W3)和8年级(W4)的一年随访(W4)。对自律的多个层面的评估将解决预防方面的创新问题。由此产生的干预方案和随机试验的结果将为传播战略规划编制工作奠定基础。

DESCRIPTION (provided by applicant): This project is a hybrid efficacy/effectiveness trial of a streamlined version of the Bridges program, an evidence-based intervention (EBI) to prevent substance abuse and mental health disorders. Bridges is an integrated parent-youth intervention evaluated in a randomized controlled trial (RCT) with Mexican Americans (immigrant and U.S. born) that showed long-term effects on multiple outcomes: substance use initiation and escalation, externalizing and internalizing symptoms, deviant peer association, and grade point average (GPA) in early adolescence; alcohol abuse disorder, binge drinking, marijuana use, risky sexual behavior, diagnosed mental disorder, and school dropout in late adolescence. Building on evidence of core intervention components and strategies for redesigning EBIs for the real-world, we will partner with low-income, multiethnic schools to adapt the program to a brief, 4-session format (Bridges short program, BSP), and optimize engagement, delivery, training, and implementation monitoring systems to facilitate dissemination and sustainability. The proposed RCT will also examine whether a parent-youth EBI can impact multiple channels of youth self- regulation (e.g., biological, behavioral, emotional) during adolescence when neurobiological systems are changing rapidly, and whether preexisting individual differences in self-regulation moderate program effects. The specific aims of this RCT are to: 1) examine the effects of the BSP vs. a control group on targeted family and youth competencies at post-test, multiple systems of youth self-regulation at 6-month follow-up, and multiple youth outcomes at 1-year follow-up: substance use, externalizing and internalizing symptoms, deviant peer association, risky sexual behaviors, and GPA; 2) examine whether effects are mediated by program- induced improvements on targeted parent and youth competencies and by changes on multiple indicators of youth self-regulation; 3) examine program language (English vs. Spanish), baseline youth risk (including biological risk), and baseline family risk as moderators of BSP effects on youth outcomes and mediators; 4) examine whether variability in implementation accounts for variability in mediators and outcomes; and 5) conduct a cost analysis of the BSP vs. the original Bridges program, as well as estimate the cost-effectiveness of the BSP vs. the control group on delayed SU initiation and quantity and frequency of SU at 1-year follow-up. In the proposed trial, 500 7th grade students and their parents will be randomized to receive the BSP or the control group within each school. The trial will include 4 assessment points: pretest (W1) and immediate posttest in 7th grade (W2), 6-month (W3) and one-year follow-up in 8th grade (W4). Assessment of multiple dimensions of self-regulation will address innovative questions for prevention. The resulting intervention package and findings from the randomized trial will lay the foundation for dissemination of the BSP.