Optimizing a Drug Abuse Prevention Program for Dissemination

描述（由申请人提供）：该项目是桥梁项目精简版的混合功效/有效性试验，这是一种基于证据的干预（EBI），旨在预防药物滥用和精神健康障碍。桥梁是一种综合的父母-青少年干预，在一项随机对照试验（RCT）中对墨西哥裔美国人（移民和美国出生）进行了评估，显示出对多种结果的长期影响：物质使用的开始和升级，外化和内化症状，异常同伴关联和青春期早期的平均绩点（GPA）；酒精滥用障碍，酗酒，大麻使用，危险的性行为，被诊断为精神障碍，青春期晚期辍学。基于核心干预要素的证据和为现实世界重新设计ebi的战略，我们将与低收入的多民族学校合作，将项目调整为简短的四节课形式（桥梁短期项目，BSP），并优化参与、交付、培训和实施监测系统，以促进传播和可持续性。该RCT还将研究亲子EBI是否会影响青春期神经生物系统快速变化时青少年自我调节的多个渠道（如生物、行为、情绪），以及先前存在的自我调节的个体差异是否会调节程序的效果。本随机对照试验的具体目的是：1)检查BSP与对照组在测试后对目标家庭和青少年能力的影响，6个月随访时青年自我调节的多个系统，以及1年随访时青年的多个结果：物质使用，外化和内化症状，异常同伴交往，危险性行为和GPA；2)研究项目诱导的目标父母和青少年能力的改善以及青少年自我调节的多项指标的变化是否介导了效果；3)检验项目语言（英语vs.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对青少年结局影响的调节因子和中介因子；4)检查执行的可变性是否解释了中介和结果的可变性；5)对BSP与原来的桥梁计划进行成本分析，并在1年随访中评估BSP与对照组在延迟SU启动和SU数量和频率方面的成本效益。在拟议的试验中，500名七年级学生及其家长将在每所学校随机接受BSP或对照组。试验将包括4个评估点：7年级前测（W1）和立即后测（W2）， 6个月（W3）和8年级随访1年（W4）。对自我监管的多个维度进行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BSP的传播奠定基础。

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.