A Text-Message Intervention to Reduce Alcohol Use Among Young Adult ED Patients

描述(由申请人提供)：这项K23指导型患者导向职业发展奖的目的是加速候选人发展为一名独立调查员，具有在行为干预研究方面的专业知识，以减少青少年在急诊科(ED)接受护理时的酒精使用和与酒精相关的后果。在这个为期5年的奖项中，重点培训将致力于获得以下方面的专业知识：1)酒精使用和行为改变的心理学理论；2)防止危险酒精使用的行为干预；3)提供行为干预的计算机方法；以及4)混合方法分析。候选人将在获奖过程中进行三项研究，以应用这些已获得的技能，并优化交互式、计算机化、短信(SMS)提供的行为干预，以防止年轻人有害饮酒。这一干预建立在候选人开发和测试短信传递的行为干预措施的经验基础上，并纳入了一些策略，以增加年轻人在计划好的饮酒场合之前设定饮酒限制的动机，在饮酒期间加强目标限制，并在饮酒后帮助反思。沟通将在每周的周四至周日进行，将根据基线数据进行量身定做，并适应酒精认知和使用模式的生态瞬时评估(EMA)。在研究1中，候选人将对40名有危险饮酒的年轻人进行焦点小组研究，以确定对包含这些特征的短信干预的接受度和偏好。在第二项研究中，候选人将在为期12周的时间里测试用户告知的短信干预的可行性，对象是40名在ED中被确认为危险饮酒的年轻人。评估将在基线、通过环境评估报告完成，并在第12周通过基于网络的后续行动完成。主要结果包括12个周末对EMA的忠诚度(包括饮酒内对话)和研究结束时对程序可用性的评级。在第三项研究中，候选人将对90名在ED中被确认为有危险饮酒的年轻人进行三臂随机对照试验，以比较包括饮酒前、饮酒内和饮酒后支持对话的短信干预与包括饮酒前和饮酒后支持对话(没有饮酒内支持)的短信干预和短信评估对照组的疗效估计。主要结果包括周末大量饮酒和通过EMA报告衡量的平均饮酒量。其他结果将包括每月总饮酒量、与酒精相关的后果以及通过基于网络的后续评估衡量的干预满意度。结果将被用来修改干预措施，并为更大的第三阶段随机对照试验做准备。这个项目的重点与NIAAA关于酒精使用的寿命视角相吻合。培训建议和研究计划符合NIAAA减少大学和未成年人饮酒的倡议。我们计划研究的ED人群符合NIAAA的战略目标，即侧重于减少少数群体和非学生群体之间的健康差距。

DESCRIPTION (provided by applicant): This purpose of this K23 Mentored Patient-Oriented Career Development Award is to expedite the candidate's development into an independent investigator with expertise in the conduct of behavioral intervention studies to reduce alcohol use and alcohol-related consequences among young adults who present to the Emergency Department (ED) for care. Within this 5 year award, focused training will be dedicated to gain expertise in: 1) psychological theories of alcohol use and behavior change; 2) behavioral interventions to prevent hazardous alcohol use; 3) computerized approaches to deliver behavioral interventions; and 4) mixed methodology analyses. The candidate will perform three studies over the course of the award to apply these acquired skills and to optimize an interactive, computerized, text-messaging (SMS) delivered, behavioral intervention to prevent hazardous alcohol use among young adults. This intervention builds upon the candidate's experience developing and testing SMS-delivered behavioral interventions and incorporates strategies to increase young adult motivations to set drinking limits prior to planned drinking occasions, reinforce goal limits during drinking episodes and assist reflection the day after drinking episodes. Communication will take place Thursday through Sunday every week, will be tailored to baseline data, and adaptive to ecological momentary assessments (EMA) of alcohol cognitions and use patterns. In Study #1, the candidate will perform focus groups with 40 young adults with hazardous drinking to identify acceptability and preferences for an SMS intervention incorporating these features. In Study #2, the candidate will test the feasibility of a user-informed SMS intervention over a 12-week period with 40 young adults identified in the ED with hazardous drinking. Assessments will be completed at baseline, through EMA reports and at week 12 via a web-based follow-up. Primary outcomes include fidelity to EMA (including intra-drinking dialogue) over 12 weekends and end-of-study ratings of program usability. In Study #3, the candidate will conduct a 3-arm RCT with 90 young adults identified in the ED with hazardous drinking to compare estimates of efficacy of an SMS intervention incorporating pre-, intra-and post- drinking support dialogue to an SMS intervention incorporating pre-and post-drinking support dialogue (no intra-drinking support) and an SMS assessment control group. Primary outcomes include weekend heavy drinking episodes and average drinks per drinking episode as measured through EMA reports. Additional outcomes will include total drinks per month, alcohol-related consequences, and intervention satisfaction as measured through web-based follow-up assessments. Outcomes will be used to modify the intervention and to prepare for a larger Phase III RCT. The focus of this project fits with the NIAAA's Lifespan perspective on alcohol use. The training proposal and research plan fits with the NIAAA initiatives to reduce college and underage drinking. The ED population we plan to study fits with the NIAAA strategic objectives to focus on reducing health disparities among minority groups and non- student populations.