Evaluation of a Combined Motivational Interviewing and Ecological Momentary Intervention to Reduce Risky Alcohol Use among Sexual Minority Males and Transgender Individuals

摘要 性和性别少数群体更有可能报告危险饮酒和饮酒 精神障碍(AUD)与顺性和异性恋者相比。新兴成人(18-34岁)性行为和 与老年人相比，性别少数群体患AUD的风险特别高，高达44%的人患有AUD 标准。这些趋势令人担忧，因为研究发现，饮酒会增加艾滋病毒危险行为，而且 艾滋病毒对新出现的成年人、性少数群体、男性和变性人(SMMT)的影响不成比例。因此， 必须测试减少SMMT患者饮酒的干预措施，以此作为预防 艾滋病病毒在这一弱势群体中的传播。减少酒精使用的一个潜在的循证方法是 激励性访谈，它结合了一种以目标为导向的方法来改变行为，并已 先前的文献和研究人员的初步研究表明，该药在不同人群中有效。 然而，有机会使用技术来通过提供 用于实时(即，在干预会话之外)防止危险行为的消息传送。拟议的研究将 进行一项三组随机对照试验，评估两种干预措施的疗效。 对照：1)为期8周的动机访谈干预(TRAC)，通过手机远程提供；2) TRAC与生态瞬时干预相结合，旨在传递强化饮酒的信息 当个人访问高风险地点时，在TRAC会议期间讨论的减少战略(GeoTRAC)。全 参与者还将完成对酒精使用和性行为的监测，方法是完成每日调查和 每天两次的移动酒精测定仪读数。GeoTRAC将使用调查人员开发的现有应用程序 正在进行的研究使用GPS跟踪来确定个人何时访问“危险”地点。参与者将 在到达这些位置时接收提醒他们解决饮酒诱因的策略的消息， 当他们离开这些地点时，还将完成流动调查和呼气测定仪读数，以确定 他们有哪些酗酒和/或危险行为。如果他们报告饮酒，他们将得到伤害减少 鼓励他们避免随后的危险行为(例如，无保护措施的性行为)的信息。呼气测试结果 每天的自我报告将用于评估饮酒日的主要和次要结果， 饮酒/饮酒日、酗酒事件和艾滋病毒危险行为，以及基线的额外评估， 8周、6个月和12个月将评估探索性长期结果。参与者将被招募 来自肯塔基州和康涅狄格州，通过社区招聘和为SMMT提供服务的医疗诊所 个人。总体而言，迫切需要确定减少酒精使用的最佳方法 新出现的成年SMMT患者与增加的艾滋病毒危险行为有关。拟议的工作将 利用新兴成年人的高技术素养通过使用手机，并将测试一个创新的 在减少有害酒精消费方面提供全面支持的精准医学方法。

ABSTRACT Sexual and gender minority individuals are more likely to report hazardous drinking and have alcohol use disorders (AUDs) compared to cisgender and heterosexual people. Emerging adult (aged 18-34) sexual and gender minorities are at especially high risk for AUDs compared to older adults, with up to 44% meeting AUD criteria. These trends are concerning, as studies have found that alcohol use increases HIV risk behaviors, and HIV disproportionately affects emerging adult sexual minority male and transgender (SMMT) individuals. Thus, it is essential to test interventions for reducing alcohol use among SMMT individuals as a means of preventing HIV among this vulnerable population. One potential evidence-based method of reducing alcohol use is motivational interviewing, which incorporates a goal-oriented approach for changing behavior and has been shown to be effective among various populations in prior literature and the investigators’ pilot research. However, there are opportunities to use technology to extend the impact of this approach by delivering messaging to prevent risk behaviors in real time (i.e., outside of intervention sessions). The proposed study will conduct a 3-arm randomized controlled trial that assesses the efficacy of two interventions as compared to a control: 1) An 8-week motivational interviewing intervention (TRAC) delivered remotely via cell phones and 2) TRAC combined with an ecological momentary intervention designed to deliver messages reinforcing drinking reduction strategies discussed during TRAC sessions when individuals visit risky locations (GeoTRAC). All participants will also complete monitoring of alcohol use and sexual behavior by completing daily surveys and twice-daily mobile breathalyzer readings. GeoTRAC will use an existing app developed in the investigators’ ongoing research that uses GPS tracking to determine when individuals visit “risky” locations. Participants will receive messages upon arrival at these locations reminding them of strategies to address triggers for drinking, and will also complete mobile surveys and breathalyzer readings when they leave these locations to determine what alcohol and/or risk behaviors they engaged in. If they reported drinking, they will receive harm reduction messaging to encourage them to avoid subsequent risk behavior (e.g., unprotected sex). Breathalyzer results and daily self-reports will be used to assess the primary and secondary outcomes of drinking days, drinks/drinking day, binge drinking episodes, and HIV risk behaviors, and additional assessments at baseline, 8 weeks, 6 months, and 12 months will evaluate exploratory long-term outcomes. Participants will be recruited from Kentucky and Connecticut through community-based recruitment and health clinics that serve SMMT individuals. Overall, there is a strong need to determine optimal methods of reducing alcohol use among emerging adult SMMT individuals given its relationship to increased HIV risk behaviors. The proposed work will draw upon the high technological literacy of emerging adults by using mobile phones and will test an innovative precision medicine approach that offers comprehensive support in reducing hazardous alcohol consumption.