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中的危险饮酒（Larimer & Cronce，2007）。另一方面，文献显示不同类型的BMI对不同风险大学饮酒者群体的疗效好坏参半。此外，理论和实证研究提供了初步证据，表明BMI可能与某些水平的动机更佳匹配（柯林斯和凯里，2005年;柯林斯等人，2005年）;然而，激励措施并不总是被证明是在大学人口的心理健康。考虑到这些混合的结果，本研究将澄清和建立在文献中的疗效和潜在机制的BMI在高危大学饮酒者。首先，它将测试2种基于网络的BMI的功效，决策平衡练习（DBE）和个性化规范反馈（PNF），与仅评估对照（AO）相比。据推测，PNF和DBE将与12个月随访期间酒精使用和酒精相关问题的减少有关。目前的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优点和当前饮酒的缺点占总决策平衡的比例，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效应的介导因子和调节因子。最后的目标是试点的架构，可用于随后的先验客户端治疗匹配，以最佳匹配的基础上，他们的基线动机水平的大学饮酒者的BMI。将使用广义增长混合模型和序贯过程对该模式进行初步验证，以测试基线水平动机是否足以预测参与者在BMI后的纵向轨迹。长期目标是检查DBP作为改变动机的量度和基于网络的BMI的最佳治疗匹配变量，用于有风险的大学饮酒者。未来的研究可能会完善这种治疗匹配方案，并最终将其推广到适应不同人群的需求，以提高BMI对酒精使用的整体疗效。 公共卫生相关性：这项研究旨在提高二级预防的有效性，为风险大学饮酒。在开发和测试一个新的参与者产生的动机改变，基于网络的干预措施和治疗匹配技术的措施，这项研究将解决NIAAA的战略计划：它将使用创新的研究技术，以加强简短的动机干预，并将开发和测试新的方法，提供阶梯式和动机适当的干预青少年和新兴的成年人。

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.