Integrative Data Analysis of Gender and Ethnic Differences in MDFT RCTs

说明(申请人提供)：尽管少数族裔青年面临的健康差距已得到充分证明，但药物滥用治疗领域只解决了关于少数族裔青年循证治疗(EBTS)有效性的最基本问题。同样，对滥用药物的青少年进行EBTS测试的随机对照试验(从数字上讲)主要由男性主导。虽然最近的几次审查表明，一些循证医学对滥用药物、涉及青少年司法、少数民族和青少年群体有效，但许多重要问题仍未得到解答。从根本上说，标准的EBT对少数族裔和欧洲裔美国人以及男女青年是否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(通过治疗相互作用的种族)。此外，我们对EBTS如何在女孩和少数群体中实现效果的了解更少--主要是因为研究人员才刚刚开始使用复杂的方法来检查治疗效果的中介因素，而不考虑性别/族裔--而且还没有开始讨论不同的治疗机制是否在不同的族裔和性别中运作。Curran等人。(2008)提出了一种很有前途的方法，用于整合来自许多纵向研究的数据，即使在不同研究之间观察到的结果衡量标准不同时也是如此，综合数据分析(IDA)。我们建议使用IDA方法将来自10个纵向随机对照试验的物质使用、犯罪和家庭功能的测量联系起来，测试多维家庭疗法(MDFT)的有效性，多维家庭疗法是一种经验性支持的针对涉及青少年司法的药物滥用的治疗方法(利德尔，2009)，并解决以下具体目标：目标1：干预有效性-在10个随机对照试验中将MDFT的临床结果与对照治疗所取得的结果进行比较。目标2：缓和效果--检查种族和性别对干预结果的调节程度。目标3：行动机制--确定千年发展目标对来自不同族裔背景的男女青年产生影响的机制。将分析从10个随机对照试验中收集的1532名青少年的药物使用、犯罪和家庭功能方面的指标。最先进的统计技术，包括潜在增长曲线建模(LGM)和使用渐近自举可信区间方法的中介测试，将被用于检验研究假设。 公共卫生相关性：拟议的研究使用一种创新的数据分析方法，综合数据分析(IDA；Curran等人，2008年)，结合来自10个随机对照试验的数据，检验多维家庭治疗(MDFT)作为青少年药物滥用和犯罪的循证治疗的有效性。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(达科夫，2000；Jackson-Gilfort等人，2001；Rodriguez等人，2007)，但以前的单研究MDFT试验在统计能力方面受到限制，无法测试MDFT与少数族裔和白人、非拉丁裔以及男性和女性、青年的比较有效性的有意义的研究问题。这项研究有可能对MDFTs在女性和少数民族青年中的有效性产生新的认识，并将IDA方法扩展到临床研究。

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.