Development and preliminary examination of two brief personalized feedback interventions focused on lab-based and EMA alcohol cues to reduce hazardous young adult alcohol use

项目总结/摘要 酒精滥用和负面后果在年轻人（YAs）中仍然普遍存在（Hingson等人， 2017; Schulenberg等人，2018年）。关于短期酒精干预的疗效的荟萃分析结果表明， 这些效应可能不像以前认为的那样强（Huh等人，2015年），强调继续 需要制定有效的干预措施，以减少酒精滥用。该应用程序将开发和测试两个 在线个性化反馈干预（PFI），重点是识别饮酒的冲动， 酒精提示（例如，啤酒瓶）以及应对冲动的策略。酒精提示唤起主观 饮酒者的渴望和生理和神经反应（Reynolds & Monti，2014; Schacht等人， 2013年）。提示反应已被证明在自然环境中的老年青少年和雅 酒鬼在酒精暗示存在的情况下，YAs报告更强烈的饮酒冲动， 饮酒欲望越强，他们报告的饮酒量越多（Ramirez &米兰达，2014）。PFI没有 明确针对线索反应性，并且许多YA可能对这种现象的意识有限。基于线索的 PFI可以通过提高YAs对自己的个人暗示的意识来减少YA的酒精滥用， 酒精寻求行为，并通过装备青年与技能，以应付冲动。当前的应用程序将 开发两个在线提示反应性PFI：（a）基于实验室的提示反应性PFI，总结提示反应性 来自暴露于优选酒精饮料的体内线索反应性阶段，和（B）线索反应性 PFI利用生态瞬时评估（EMA）的效用来捕获酒精线索， 在自然环境中体验。EMA期间包括17天的调查（每天4次），以报告线索 暴露、渴望和酒精结果。两个PFI都将专注于识别酒精暗示，理解 对线索的反应，以及获得应对技能。在研究1（目标1）中，将进行一系列焦点小组讨论， 大量饮酒者（18-24岁），以完善试点研究的程序和干预措施。研究2是一个 对200名YA重度饮酒者（年龄18-24岁）的社区样本进行了一项试点研究，这些饮酒者报告说他们正在考虑戒烟 或减少饮酒。参与者被随机分配到四个条件之一（每组n = 50）： 基于提示反应性PFI，（2）基于实验室的仅评估对照（AOC），（3）基于EMA的提示反应性PFI， （4）基于EMA的AOC。我们会研究私人借贷计划（目的2A）的可行性和可接受性，评估私人借贷计划的成效， 与AOC条件相比，在2周和3个月随访时对渴望、饮酒和后果的影响 (Aims 2B-C），评估基于实验室与基于EMA的PFI对饮酒结果的影响（目标2D），并检查 条件作为一个调解人之间的关联渴望和饮酒在后续以及探索 主持人（例如，生物性别）的干预效果（目标2 E）。这项研究有很大的潜力， 针对YA酒精使用的个性化反馈干预措施的进展。

PROJECT SUMMARY/ABSTRACT Alcohol misuse and negative consequences remain prevalent among young adults (YAs) (Hingson et al., 2017; Schulenberg et al., 2018). Meta-analytic findings on the efficacy of brief alcohol interventions suggest that these effects may not be as strong as previously believed (Huh et al., 2015), highlighting the continuing need to develop effective interventions to reduce YA alcohol misuse. This application will develop and test two online personalized feedback interventions (PFIs) that focus on recognizing urges to drink in response to alcohol cues (e.g., beer bottle) as well as strategies for coping with urges. Alcohol cues evoke subjective craving and physiological and neural responses among drinkers (Reynolds & Monti, 2014; Schacht et al., 2013). Cue reactivity has been demonstrated in the natural environment among older adolescent and YA drinkers. On occasions when alcohol cues are present, YAs report stronger urges to drink, and on days with stronger urges to drink they report more alcohol consumption (Ramirez & Miranda, 2014). PFIs have not explicitly targeted cue reactivity, and many YAs may have limited awareness of this phenomenon. A cue-based PFI may reduce YA alcohol misuse by enhancing YAs’ awareness of their own personal cues that elicit alcohol-seeking behavior and by equipping YAs with skills for coping with urges. This current application will develop two online Cue Reactivity PFIs: (a) a lab-based Cue Reactivity PFI that summarizes cue reactivity from an in vivo cue reactivity session with exposure to preferred alcoholic beverages, and (b) a Cue Reactivity PFI that capitalizes on the utility of ecological momentary assessment (EMA) to capture alcohol cues as experienced in the natural environment. The EMA period includes 17 days of surveys (4x/day) to report cue exposure, craving, and alcohol outcomes. Both PFIs will focus on recognizing alcohol cues, understanding responses to cues, and acquiring coping skills. In Study 1 (Aim 1), a series of focus groups will be conducted with YA heavy drinkers (ages 18-24) to refine the procedures and interventions for a pilot study. Study 2 is a pilot study with a community sample of 200 YA heavy drinkers (ages 18-24) who report thinking about stopping or reducing their drinking. Participants are randomized to one of four conditions (n = 50 per group): (1) Lab- based Cue Reactivity PFI, (2) Lab-based assessment only control (AOC), (3) EMA-based Cue Reactivity PFI, or (4) EMA-based AOC. We will examine the feasibility and acceptability of the PFIs (Aim 2A), evaluate PFI effects on craving, drinking, and consequences at 2-week and 3-month follow-ups, relative to AOC conditions (Aims 2B-C), evaluate Lab-based versus EMA-based PFI effects on drinking outcomes (Aim 2D), and examine condition as a moderator of the association between craving and drinking at follow-up as well as explore moderators (e.g., biological sex) of intervention effects (Aim 2E). This research has great potential to inform advancements to personalized feedback interventions targeting YA alcohol use.