Integrative Data Analysis of Gender and Ethnic Differences in MDFT RCTs

描述（由申请人提供）：尽管少数民族青年面临的健康差距有据可查，药物滥用治疗领域只解决了关于少数民族青年循证治疗（EBT）有效性的最基本问题。同样，测试药物滥用青年EBT的随机对照试验（从数字上讲）以男性为主。虽然最近的几次审查表明，一些EBT是有效的药物滥用，青少年司法参与，少数民族，青少年人口，许多重要的问题仍然没有答案。从根本上说，标准EBT是否对少数民族和欧洲裔美国人以及男性和女性青年同样有益的问题仍然没有答案，因为大多数研究缺乏足够的统计能力来检测调节效应（种族与治疗相互作用）。此外，我们对EBT如何在女孩和少数民族人群中发挥作用的了解更少，这主要是因为研究人员只开始使用复杂的方法来检查治疗效果的介体，而不考虑性别/种族，并且还没有开始解决不同的治疗机制是否在不同的种族和性别中起作用。Curran et al.（2008）介绍了一种有前途的方法，用于整合来自众多纵向研究的数据，即使在不同研究中观察到的结构结局指标不同，整合数据分析（IDA）。我们建议使用IDA方法将10项纵向随机对照试验中的物质使用、犯罪和家庭功能指标联系起来，这些试验测试了多维家庭治疗（MDFT）的有效性，MDFT是一种药物支持的药物滥用、涉及青少年司法的青少年治疗方法。（Liddle，2009年），并实现以下具体目标：干预有效性-在10项随机对照试验中比较MDFT与对照治疗的临床结局。目标2：调节效应-研究种族和性别调节干预结果的程度。目标3：行动机制-确定MDFT在不同种族背景的男女青年中发挥作用的机制。将对10项随机对照试验中收集的1532名青少年的物质使用、犯罪和家庭功能进行分析。将使用最先进的统计技术，包括潜在生长曲线建模（LGM）和使用渐近bootstrap置信区间方法的中介检验，来检查研究假设。 公共卫生相关性：拟议的研究使用创新的数据分析方法，综合数据分析（IDA; Curran等人，2008），以联合收割机数据从10个随机对照试验检查的有效性多维家庭治疗（MDFT）作为一个基于证据的治疗青少年药物滥用和犯罪。尽管MDFT开发人员一直关注性别和文化问题，因为它们与治疗有效性有关（Dakof，2000; Jackson-Gilfort等人，2001; Rodriguez等人，2007年），以前的单一研究MDFT试验在统计能力方面受到限制，他们必须测试有关MDFT与少数民族和白色，非拉丁美洲人以及男性和女性青年的比较有效性的有意义的研究问题。该研究有可能产生关于MDFT对女性和少数民族青年有效性的新知识，并扩展IDA方法用于临床研究。

DESCRIPTION (provided by applicant): Despite the well-documented health disparities faced by minority youth, the field of substance abuse treatment has only addressed the most elementary questions regarding the effectiveness of evidence-based treatments (EBTs) with minority youth. Similarly, randomized controlled trials testing EBTs for substance-abusing youth are dominated (numerically speaking) by males. While several recent reviews have indicated that a number of EBTs are effective with substance abusing, juvenile justice-involved, ethnic minority, adolescent populations, many important questions remain unanswered. Fundamentally, the question of whether standard EBTs are equally beneficial for ethnic minority and European American, as well as male and female, youth remains unanswered because most studies lack adequate statistical power to detect moderator effects (ethnicity by treatment interaction). Further, we know even less about how EBTs achieve their effects among girls and minority populations-largely because researchers have only begun using sophisticated methods to examine mediators of treatment effects irrespective of gender/ethnicity-and have not begun to address whether different treatment mechanisms operate in different ethnicities and genders. Curran et al. (2008) introduced a promising method for integrating data from numerous longitudinal studies, even when the observed outcome measures for a construct vary across studies, Integrative Data Analysis (IDA). We propose to use IDA methods to link measures of substance use, delinquency, and family functioning from 10 longitudinal randomized controlled trials testing the effectiveness of Multidimensional Family Therapy (MDFT), an empirically-supported treatment for substance abusing, juvenile-justice- involved youth (Liddle, 2009) and address the following specific aims: Aim 1: Intervention Effectiveness - To compare the clinical outcomes of MDFT to those achieved by comparison treatments across 10 randomized controlled trials. Aim 2: Moderating Effects - To examine the extent to which ethnicity and gender moderate intervention outcomes. Aim 3: Mechanisms of Action - To identify the mechanisms through which MDFT achieves its effects in male and female youth from diverse ethnic backgrounds. Measures of substance use, delinquency, and family functioning from a total of 1532 youth collected across 10 RCTs will be analyzed. State-of-the-art statistical techniques, including latent growth curve modeling (LGM) and mediation tests using the asymptotic bootstrap confidence interval method, will be used to examine study hypotheses. PUBLIC HEALTH RELEVANCE: The proposed study uses an innovative data analytic methodology, Integrative Data Analysis (IDA; Curran et al., 2008), to combine data from 10 randomized controlled trials examining the effectiveness of Multidimensional Family Therapy (MDFT) as an evidence-based treatment for adolescent substance abuse and delinquency. Although MDFT developers have been concerned with gender and cultural issues as they pertain to treatment effectiveness (Dakof, 2000; Jackson-Gilfort et al., 2001; Rodriguez et al., 2007), previous single-study MDFT trials have been limited in the statistical power they have to test meaningful research questions regarding MDFT's comparative effectiveness with minority and White, non-Latino, as well as male and female, youth. The study has the potential to yield new knowledge about MDFTs effectiveness with female and ethnic minority youth and extend IDA methodology for clinical research.