Web-based Intervention for Disaster-affected Adolescents and Families

描述（由申请人提供）：一场灾难、恐怖袭击或其他大规模事件可能会对成千上万的青少年和家庭产生不利影响。直接后果可能包括基本需求得不到满足和家庭经济负担沉重。灾难还会极大地影响家庭日常生活、婚姻压力、亲子互动，以及更广泛地影响家庭角色和关系。虽然大多数青年在灾难后具有复原力（即不会出现严重的精神或身体健康问题），但具有公共卫生重要性的各种问题仍然普遍存在，例如创伤后应激障碍、抑郁症和药物滥用。这突出表明需要采取有效、可广泛获得和具有成本效益的干预措施，以促进灾害对健康的影响之后的复原力或快速恢复。迄今为止，几乎没有开发出基于证据的早期干预措施。儿童和青少年在灾害研究中的代表性不足，受灾害影响的家庭无法充分获得基于证据的资源。很少有早期干预措施经过严格的科学评估；很少有针对年轻人的。此外，许多有效的自助和基于网络的干预措施针对一般人群，但没有针对受灾青年和家庭的干预措施。最近，我们的研究小组开发并探索了一种基于网络的成人教育干预的可行性，旨在降低普遍的心理健康风险和灾害带来的健康风险后果。911恐怖袭击发生两年后，我们对纽约市325名成年人进行了初步研究，结果支持了灾后网络教育方法的可行性和潜在效用。拟议项目的主要目标是：(a)针对灾害与健康相关的因素（即发展阶段），为受灾青少年和父母制定一项基于网络的干预措施（即b）开展一项基于人群的随机对照研究，以3,000名受灾青少年及其父母为对象，审查干预措施的可行性和初步效果（即随机对照试验阶段），(c)根据可行性和效果数据完善干预措施。(d)为灾后紧急阶段的大规模研究做好准备。我们的策略是针对广泛的症状表现，以及阈下和诊断水平，这与基于研究结果的公共卫生建议是一致的，这些发现表明，在降低医疗成本方面有益，并且与循证早期干预相关的积极结果相关。

DESCRIPTION (provided by applicant): A single disaster, terrorist attack, or other large-scale incident can adversely affect thousands of youth and families. Immediate consequences may include unmet basic needs and high economic burden to families. Disasters also can dramatically affect family routines, marital stress, parent-child interactions, and, more broadly, family roles and relationships. Whereas most youth are resilient (i.e., do not develop serious mental or physical health problems) in the aftermath of disasters, various problems of public health significance are prevalent, such as PTSD, depression, and substance abuse. This underscores the need for effective, widely accessible, and cost-efficient interventions that foster resilience or rapid recovery secondary to the health effects of disasters. To date, few evidence-based early interventions have been developed. Children and adolescents are underrepresented in disaster research, and disaster- affected families have insufficient access to evidence-based resources. Few early interventions have undergone rigorous scientific evaluation; fewer have targeted youth. Further, many efficacious self-help and Web-based interventions exist for the general population, but none exist for disaster-affected youth and families. Recently, our research team developed and explored the feasibility of a Web-delivered, education-based intervention for adults designed to reduce risk for prevalent mental health and health-risk consequences of disasters. Results of our pilot study with 325 New York City-area adults two years after the September 11th terrorist attacks supported the feasibility and potential utility of Web-based educational approaches post- disaster. The primary aims of the proposed project are to (a) develop a Web-based intervention for disaster-affected adolescents and parents targeting health-related correlates of disasters (i.e., development phase), (b) conduct a randomized controlled population-based study to examine feasibility and preliminary efficacy of the intervention with 3,000 disaster-affected adolescents and their parents (i.e., RCT phase), (c) refine the intervention based on feasibility and efficacy data, and (d) prepare for larger-scale research in the acute post-disaster phase. Our strategy to target a wide range of symptom presentations, as well as both subthreshold and diagnostic levels, is consistent with public health recommendations based on findings indicating benefits in terms of reduced health costs and positive outcomes associated with evidence- informed early interventions. PUBLIC HEALTH RELEVANCE: Disasters occur often in the U.S. and can negatively affect thousands of families simultaneously. The mental health consequences of disasters are significant, but few resources are available for youth and families to help them learn about healthy coping strategies and services that might be available to them in their communities. The goal of this project is to develop and evaluate an online, self-help resource for adolescents and parents who are affected by disasters. The self-help resource will be educational, highly interactive and engaging, and will be designed to reduce risk for the development of mental health problems after a disaster, such as posttraumatic stress reactions, depression, and alcohol and drug-use problems.