Towards Optimal treatment matching for brief motivational interventions

描述（由申请人提供）：研究表明，简短的动机干预（bmi）可能有效地减少大学生的饮酒风险（Larimer & Cronce, 2007）。另一方面，关于不同类型的身体质量指数对不同高危大学饮酒者群体的功效，文献显示了不同的发现。此外，理论和实证研究已经提供了初步证据，表明bmi可能与某些动机水平更理想地匹配（Collins & Carey, 2005; Collins et al., 2005）；然而，在大学生群体中，动机测量并不总是被证明是心理测量学上合理的。考虑到这些混杂的发现，本研究将澄清和建立有关bmi在高危大学饮酒者中的功效和潜在机制的文献。首先，它将测试两种基于网络的bmi，决策平衡练习（DBE）和个性化规范反馈（PNF）的有效性，与仅评估控制（AO）相比。假设在12个月的随访中，PNF和DBE将与酒精使用和酒精相关问题的更大减少有关。本研究还将测试决策平衡比例（DBP），或参与者产生的减少饮酒的赞成和当前饮酒的反对占总决策平衡的比例，以作为改变动机的创新措施。假设DBP变化（基线后）和基线DBP评分将分别作为BMI效应的中介和调节因子。最终目的是试点一个模式，该模式可用于随后的先验客户-治疗匹配，以最优匹配大学饮酒者的基线动机水平为基础的bmi。该模式的初步验证将使用广义生长混合模型和顺序过程进行，以测试基线水平的动机是否足以预测参与者在BMI后的纵向轨迹。长期目标是检验DBP作为改变动机的衡量标准，并为高危大学饮酒者的基于网络的bmi提供最佳的治疗匹配变量。未来的研究可能会完善这种治疗匹配模式，并最终将其推广，以适应不同人群的需求，从而提高bmi对酒精使用的总体功效。

DESCRIPTION (provided by applicant): Research has indicated that brief motivational interventions (BMIs) may be efficacious in reducing at-risk drinking among college students (Larimer & Cronce, 2007). On the other hand, the literature has shown mixed findings regarding the efficacy of different types of BMIs for different groups of at-risk college drinkers. Further, theory and empirical research have provided preliminary evidence that BMIs may be more optimally matched to certain levels of motivation (Collins & Carey, 2005; Collins et al., 2005); however, motivational measures have not always been shown to be psychometrically sound in the college population. Considering these mixed findings, this study will clarify and build on the literature regarding the efficacy and underlying mechanisms of BMIs among at-risk college drinkers. First, it will test the efficacy of 2 web-based BMIs, decisional balance exercises (DBE) and personalized normative feedback (PNF), compared to assessment- only control (AO). It is hypothesized that PNF and DBE will be associated with greater reductions in alcohol use and alcohol-related problems over the 12-month follow-up. The current study will also test the decisional balance proportion (DBP), or the proportion of participant-generated pros of reducing drinking and cons of current drinking to the total decisional balance, to serve as an innovative measure of motivation to change. It is hypothesized that DBP change (post-baseline) and baseline DBP scores will serve as mediators and moderators of the BMI effects, respectively. The final aim is to pilot a schema that may be used for subsequent a priori client-treatment matching to optimally match college drinkers to BMIs on the basis of their baseline motivational level. Preliminary validation of this schema will be conducted using generalized growth mixture modeling and sequential processes to test whether baseline levels motivation are adequate to predict participants' longitudinal trajectories following a BMI. The long-term goal is to examine the DBP as a measure of motivation to change and an optimal treatment-matching variable for web-based BMIs for at- risk college drinkers. Future studies may refine this treatment-matching schema and eventually generalize it to fit the needs of diverse populations to increase the overall efficacy of BMIs for alcohol use. PUBLIC HEALTH RELEVANCE: This study aims to increase the efficacy of secondary prevention for at-risk college drinking. In developing and testing a new participant-generated measure of motivation to change, web-based interventions and treatment matching technology, this study will address the strategic plan of the NIAAA: it will use innovative research technology to enhance brief motivational interventions and will develop and test new ways to deliver stepped and motivationally appropriate interventions to adolescents and emerging adults.