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- Ensaio Clínico NCT04038190
Uma intervenção de ativação comportamental administrada em um curso de orientação para calouros universitários
Um estudo randomizado por cluster de uma intervenção de ativação comportamental administrada em um curso de orientação para calouros universitários
Visão geral do estudo
Status
Intervenção / Tratamento
Descrição detalhada
A transição do ensino médio para a faculdade é um período sensível ao desenvolvimento com alto risco de agravamento do uso de álcool. Embora o consumo de álcool de risco seja um problema comum entre os calouros, o engajamento nos serviços de tratamento é muito baixo. Baixas taxas de envolvimento com recursos de tratamento podem ocorrer porque as intervenções visam o consumo direto em um momento em que os alunos podem estar desinteressados em mudar seu hábito de beber. Além disso, com foco no uso de álcool, as intervenções atuais também não abordam as preocupações dos calouros, como estresse e sono. Abordagens que abordam os problemas que mais preocupam os alunos, que também reduzem indiretamente o consumo de álcool, podem ser particularmente eficazes.
A ativação comportamental (BA) é uma intervenção que aborda indiretamente a psicopatia, orientando os indivíduos a identificar objetivos em suas vidas e encorajando os indivíduos a se envolverem em atividades de reforço que se alinham com seus objetivos (Lejuez et al, 2001). Embora inicialmente usado para tratar a depressão, o BA foi aplicado com eficácia ao uso de substâncias porque o BA atua no mesmo processo de reforço implicado no problema de beber. BA aborda o consumo de álcool sem referência específica ao uso de álcool, concentrando-se no envolvimento em atividades de reforço que se alinham com os objetivos dos alunos. Um estudo piloto forneceu indicação inicial de que uma breve intervenção de BA administrada em um curso de orientação de calouros de um semestre resultou em uma diminuição significativa nos problemas relacionados à bebida, em comparação com a orientação padrão (Reynolds et al. 2011). Notavelmente, a abordagem nunca levantou a questão da bebida, a menos que fosse levantada pelos próprios alunos.
O objetivo do estudo é conduzir um teste randomizado de teste BA totalmente desenvolvido administrado em um curso de orientação para calouros de um semestre (16 semanas), em comparação com um curso de orientação padrão em 540 calouros distribuídos em 36 seções do curso (18 seções cada uma das BA e formato de orientação padrão). Uma avaliação pós-tratamento de 5 meses medirá a durabilidade dos efeitos. As análises de mediação testarão os mecanismos de ação e as análises de moderação examinarão os fatores relacionados à eficácia. Uma amostra aleatória de 20% dos participantes completará um acompanhamento de 17 meses, que ocorrerá no final do segundo ano de faculdade, para examinar os efeitos a longo prazo. Com este R01 proposto, os pesquisadores testarão uma intervenção promissora com BA que aborda os fatores que limitam a participação em outros programas, não visando o álcool diretamente e integrando uma intervenção no currículo da faculdade, com o benefício adicional de testar mediadores para orientar o trabalho futuro. Este aplicativo representa um primeiro passo para o desenvolvimento de um curso de intervenção que poderia ser amplamente divulgado para abordar o persistente problema de alcoolismo na faculdade e suas muitas consequências.
Tipo de estudo
Inscrição (Real)
Estágio
- Fase 2
Contactos e Locais
Locais de estudo
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Kansas
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Lawrence, Kansas, Estados Unidos, 66046
- University of Kansas
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Descrição
Critério de inclusão:
- Calouros universitários matriculados em cursos de seminários para calouros UNIV 101 na Universidade de Kansas designados para o estudo
Critério de exclusão:
- Nenhum
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Prevenção
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Solteiro
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
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Experimental: Curso de Ativação Comportamental
Condição de curso de ativação comportamental administrada em um seminário de orientação para calouros universitários
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A ativação comportamental (BA) é uma intervenção que aborda indiretamente a psicopatia, orientando os indivíduos a identificar objetivos em suas vidas e encorajando os indivíduos a se envolverem em atividades de reforço que se alinham com seus objetivos (Lejuez et al, 2001).
Embora inicialmente usado para tratar a depressão, o BA foi aplicado com eficácia ao uso de substâncias porque o BA atua no mesmo sistema de reforço comum a muitos distúrbios (Daughters et al., 2018).
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Sem intervenção: Curso de Orientação Padrão
Condição padrão do curso de seminário de orientação para calouros
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Alcohol Consumption (AUDIT-C Score)
Prazo: During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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Alcohol-Use Disorders Identification Test- Consumption Questions (AUDIT-C), which are the first three items of the AUDIT 10-item measure that asses frequency of drinking, typical quantity, and frequency of heavy drinking occasions (Saunders et al, 1993; Bush et al, 1998; DeMartini et al 2012).
Responses are on a likert scale ranging from 0-4.
The 3 items are summed for a total score with a possible range of 0-12, with higher scores indicating riskier drinking behavior.
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During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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Rate of High-intensity Drinking (2+ Times in Excess of NIAAA Low Risk Drinking Guidelines for Males and Females)
Prazo: During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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The Time Line Follow Back-Computerized (TLFB-C) assessment was used to measure alcohol consumption in the past 30 days (Sobell & Sobell, 2008), or since the prior measurement period.
The measure was used to obtain the number of days during which individuals engaged in high-intensity drinking of 8+ drinks for males or 10+ drinks for females per drinking occasion.
The number of days participants engaged in high intensity drinking was summed per measurement period, and converted to a rate to reflect the number of high intensity drinking days out of the number of days in the measurement period (high intensity drinking days/days in measurement period).
The rate was used because there could be slightly different numbers of days across measurement periods, depending on when participants completed the assessment.
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During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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Alcohol-related Problems (AUDIT-P) Score
Prazo: During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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Alcohol-Use Disorders Identification Test- Problem questions (AUDIT-P) are the last 7 items of the full AUDIT that assess increased salience of drinking, morning drinking, guilt after drinking, blackouts, alcohol-related injuries, and drinking that others are concerned about (Saunders et al, 1993; O'Hare & Sherrer, 2005).
Responses are on a likert scale ranging from 0-4.
The 7 items were summed for a total score on the AUDIT-P, with a possible range of 0-28, with higher scores indicating greater alcohol-related problems.
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During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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Exceeding Clinical Cutoff of 8+ for Hazardous/Harmful Drinking on the AUDIT
Prazo: During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
|
The Alcohol-Use Disorders Identification Test (AUDIT) is designed to assess hazardous alcohol use and alcohol-related problems.
The AUDIT has 10 items (Saunders et al, 1993) and responses are on a likert scale ranging from 0-4.
The 10 items are summed for a total score with a possible range of 0-40, with higher scores indicating greater likelihood of hazardous drinking behavior.
A total score of 8 or higher was used as a binary variable to identify participants with hazardous drinking (score 8+).
Outcome was the proportion of respondents exceeding the clinical cut point.
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During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Depression
Prazo: During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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Depression was measured using the Depression Anxiety Stress Scale (DASS-21), a 21 item measure designed to assess depression, anxiety and stress (Lovibond & Lovibond, 1995).
The measure provides scales for depression, anxiety, and stress and conceptualizes the difference between normal and clinical populations as a matter of degree.
The depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest / involvement, anhedonia and inertia with 7 items.
Items are on a 4-point Likert scale ranging from 0-3 and can be summed for a scale score ranging from 0-21.
Higher scores indicate greater depression.
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During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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Binge Eating
Prazo: During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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Binge eating was measured with the Eating Pathology Symptoms Inventory (EPSI; Forbush et al., 2013).
The binge eating subscale was used in the study, which includes items on overeating and loss of control eating.
The binge eating subscale has 8 items with Likert scale responses from 0=never to 4= very often.
Items are summed for a scale score ranging from 0-32.
Higher scores indicate more frequent experiences with binge eating behavior.
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During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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Stress
Prazo: During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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Stress was measured using the Depression Anxiety Stress Scale-21 (DASS-21), a 21 item measure designed to assess depression, anxiety and stress (Lovibond & Lovibond, 1995).
The stress scale score was used to assess stress.
Items are on a 4-point Likert scale ranging from 0-3 and can be summed for a scale score ranging from 0-21.
Higher scores indicate greater stress.
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During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3); post-treatment follow up assessment at and 5 months (all participants) and 17 months (for participants in cohorts 1-3)
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Outras medidas de resultado
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Delay Discounting Rate
Prazo: During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3)
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Delay discounting was calculated from a computer adjusting delay discounting task that asked participants to choose between smaller immediate rewards and larger, delayed rewards.
The reward used in the task was hypothetical money.
Mazur's hyperbolic function, V = A/ 1 + kD, was used to estimate each participant's delay discounting rate (i.e., k) for use in analyses.
For this formula, V is the discounted value of a delayed reward (i.e., indifference point), A is the reward amount, D is the delay in days, and k represents the estimated delay discounting rate.
Greater k values indicated stronger discounting and a preference for immediate monetary rewards.
K values across the sample ranged from -11.06 to 2.43.
Negative values generally indicate stronger discounting, whereas positive values typically represent less steep discounting.
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During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3)
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Total Reinforcement Ratio (TRR) Between Alcohol-related and Alcohol-free Sources of Reinforcement
Prazo: During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3)
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The Adolescent Reinforcement Survey Schedule - Alcohol Use Version assesses the frequency of past-month engagement in and enjoyment derived from 45 activities (Hallgren et al, 2016).
Each question is posed twice - once to assess the frequency and enjoyment of the activity while using alcohol and the once to assess the frequency and enjoyment of the activity while not using alcohol.
Items range from 0-4.
Frequency and enjoyment items are summed to form respective scores.
From these scales, two subscales are created for alcohol-related reinforcement and alcohol-free reinforcement, calculated as the cross product between frequency and enjoyment items for alcohol-related and alcohol-free questions.
The two subscales were used to calculate the outcome, the total reinforcement ratio (TRR) between alcohol-related and alcohol-free reinforcement.
The ratio has values between 0 and 1, with higher values indicating more relative enjoyment of activities when using alcohol.
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During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3)
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Moderation of Treatment Effects (AUDIT Total) Based on Coping-motivated Drinking
Prazo: During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3)
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Moderator: The Drinking Motives Questionnaire-Revised (DMQ-R) is designed to measure the relative frequency of drinking for four distinct reason motives: enhancement, social, conformity, and coping (Cooper, 1994; Cox & Klinger, 1988). The study used the coping motives scale, which contains 5 items. Items are assessed on a Likert scale ranging from 1-5 and are summed for form a scale score, which higher scores indicating greater endorsement of drinking to cope with stress/distress. Outcome: The outcome used in the analysis was the Alcohol Use Disorder Identification Test (AUDIT) total score; we originally planned to use AUDIT-Consumption and AUDIT-Problems subscales for two separate analyses and outcomes (in parallel with other moderation analyses); however the models did not converge. Therefore, AUDIT total score was used as the outcome in analyses. |
During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3)
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Grade Point Average (GPA)
Prazo: GPA was available and assessed during post-treatment follow up at and 5 months (all participants) and 17 months (for participants in Years 1-3)
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Academic performance was measured using participant self-reported grade point average (GPA).
College freshmen first received their GPA in the spring semester of college, which was at the 5 month follow up.
Thus, we examined whether there were significant differences in GPA across treatment and control conditions at 5 month adn 17 month follow ups.
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GPA was available and assessed during post-treatment follow up at and 5 months (all participants) and 17 months (for participants in Years 1-3)
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Moderation of Treatment Effects (AUDIT-C) by Sex
Prazo: During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3)
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The moderator used in analyses was sex.
The outcome was the Alcohol Use Disorder Identification Test- Consumption (AUDIT-C) subscale score.
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During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3)
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Moderation of Treatment Effects (AUDIT-P) by Sex
Prazo: During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3)
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The moderator in the model was sex.
The outcome was the Alcohol Use Disorder Identification Test-Problems (AUDIT-P) subscale score
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During treatment assessment at baseline (Visit 1), 2 months (Visit 2), 4 months (Visit 3)
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Tera L Fazzino, PhD, University of Kansas
Publicações e links úteis
Publicações Gerais
- Fazzino TL, Lejuez CW, Yi R. A behavioral activation intervention administered in a 16-week freshman orientation course: Study protocol. Contemp Clin Trials. 2020 Mar;90:105950. doi: 10.1016/j.cct.2020.105950. Epub 2020 Jan 23.
- Jun D, Fazzino TL. Associations between Alcohol-Free Sources of Reinforcement and the Frequency of Alcohol and Cannabis Co-Use among College Freshmen. Int J Environ Res Public Health. 2023 Feb 7;20(4):2884. doi: 10.3390/ijerph20042884.
- Exum AC, Sutton CA, Bellitti JS, Yi R, Fazzino TL. Delay discounting and substance use treatment outcomes: A systematic review focused on treatment outcomes and discounting methodology. J Subst Use Addict Treat. 2023 Jun;149:209037. doi: 10.1016/j.josat.2023.209037. Epub 2023 Apr 16.
- Fazzino TL, Kunkel A, Bellitti J, Romine RS, Yi R, McDaniel C, Lejuez CW. Engagement with Activity Monitoring During a Behavioral Activation Intervention: A Randomized Test of Monitoring Format and Qualitative Evaluation of Participant Experiences. Behav Change. 2023 Jun;40(2):103-116. doi: 10.1017/bec.2022.7. Epub 2022 Jun 16.
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Conclusão Primária (Real)
Conclusão do estudo (Real)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
- Transtornos Mentais, Desordem Mental
- Hiperfagia
- Sinais e Sintomas Digestivos
- Sintomas Comportamentais
- Transtornos Relacionados a Substâncias
- Distúrbios induzidos quimicamente
- Distúrbios Relacionados ao Álcool
- Condições Patológicas, Sinais e Sintomas
- Comportamento
- Sinais e sintomas
- Bulimia
- Alcoolismo
- Depressão
Outros números de identificação do estudo
- STUDY00143954
- 1R01AA027791-01 (Concessão/Contrato do NIH dos EUA)
Plano para dados de participantes individuais (IPD)
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