ESTIMATING COMPARATIVE EFFECTIVENESS OF ALCOHOL INTERVENTIONS FOR YOUNG ADULTS

项目摘要 预防未成年饮酒者和大学生过度饮酒及相关不良后果 学生是2020年健康人的重要目标。此重新提交申请的目标是 延长R01补助金(R01 AA019511)，以回应PA-15-295《筛查和简要酒精干预》 在未成年和青年人口中(R01)。以前的R01侧重于方法学的发展 用于汇集和分析来自24项研究的个人参与者数据(IPD)(基线时N=24,336；12,630 对大学生进行简明动机干预(BMI)的效果检验。正在部署 新开发的组合和分析IPD的方法，由此产生的大型汇集数据集表明，BMI 对于大学生来说，可能并不像之前的评论所说的那样强大，这表明有必要更好地理解 为什么一些干预措施成功了，而另一些干预措施失败了。我们以前对IPD的研究是有限的 研究水平样本量(24项研究)及其总体代表性。此外，最近出版的 传统的荟萃分析发现了总体干预效应，这与我们的发现相矛盾。建议数 研究通过使用尖端方法扩展和加强了我们早期的工作， 一组数据，最终目标是提供酒精干预领域的权威摘要 青少年和青壮年。除了简单地关注“任何影响”这一综合性问题之外，我们的研究还包括 旨在测试哪些干预措施更好，并探索如何使干预策略个性化 满足不同个体的不同需求，获得更大利益(即精准医疗)。我们将结合聚合 来自大约350个独立的简短酒精干预试验和49个IPD的数据(例如，均值、SDS) 审判。其中，来自303个样本的聚合数据和来自24项研究的IPD已经得到保护 支持两个独立的R01(AA020286到Tanner-Smith和AA019511到Mun)。我们将最大化 通过以下最先进的综合方法实现现有临床数据的规模和深度：网络 元分析(元回归)和多变量元分析及其对IPD的扩展。在一个大专业中 作为先前工作的扩展，拟议的调查将(1)尊重数据的自然层次(即， 研究中嵌套的参与者)；(2)同时容纳多个干预措施(改为网络 任何两对干预)；(3)解释效果异质性(即，强到弱的干预效果) 审查个人和研究层面以及跨层面的因素；以及(4)允许联合分析 多个相关结果(例如，酒精使用和问题)通过相互借鉴力量。我们的 由领先专家组成的跨学科团队，其中许多人领导了早期的成功研究，将产生新的 证据将是“可扩展的”，以便新的试验数据可以直接用于评估他们的 与现有干预措施相比的相对有效性。这项研究有助于确定未来的研究重点 指导未来试验的设计，并为从业者的临床实践提出建议。

Project Summary The prevention of excessive drinking and related negative consequences by underage drinkers and college students is an important objective for Healthy People 2020. This resubmission application is aimed at extending an R01 grant (R01 AA019511) in response to PA-15-295, “Screening and brief alcohol interventions in underage and young adult populations (R01).” The previous R01 focused on methodological developments for pooling and analyzing individual participant data (IPD) from 24 studies (N = 24,336 at baseline; 12,630 randomized) to examine the efficacy of brief motivational interventions (BMIs) for college students. Deploying newly developed methods to combine and analyze IPD, the resulting large, pooled data set showed that BMIs for college students may not be as powerful as prior reviews suggest, pointing to the need to better understand why some interventions succeed while others fail. Our previous research on IPD was limited in terms of its study-level sample size (24 studies) as well as its population representation. Moreover, recently published traditional meta-analyses have found overall intervention effects, contradicting our findings. The proposed research expands and enhances our earlier work by using the cutting-edge methodology with a comprehensive set of data with the end goal of providing an authoritative summary of the alcohol intervention field for adolescents and young adults. Beyond simply focusing on the omnibus question of “any effect,” our research is aimed at testing which interventions are better and exploring how to individualize intervention strategies to meet different needs of the individual for greater benefit (i.e., precision medicine). We will combine aggregated data (e.g., means, SDs) from approximately 350 independent brief alcohol intervention trials and IPD from 49 trials. Of these, aggregated data from 303 samples and IPD from 24 studies have already been secured with the support of two separate R01s (AA020286 to Tanner-Smith and AA019511 to Mun). We will maximize the scale and depth of the existing clinical data via the following state-of-the-art synthesis approaches: network meta-analysis (meta-regression) and multivariate meta-analysis, and their extensions for IPD. In a major extension of prior work, the proposed investigation will (1) respect the natural hierarchy of the data (i.e., participants nested within studies); (2) simultaneously accommodate multiple interventions (networks instead of any two pairs of interventions); (3) explain effect heterogeneity (i.e., strong to weak intervention effects) by examining factors at the individual- and study-level, as well as cross-level; and (4) allow joint analysis of multiple related outcomes (e.g., alcohol use and problems) by borrowing strength from one another. Our transdisciplinary team of leading experts, many of whom led the earlier, successful research will generate new evidence that will be “scalable” so that new trial data can straightforwardly be accommodated to evaluate their relative efficacy compared to existing interventions. This research can help establish future research priority areas, guide the design of future trials, and develop recommendations for practitioners’ clinical practice.