Project INTEGRATE has been supported by grants from the National Institute of Alcohol Abuse and Alcoholism since 2010. Our goal is to better understand why adolescents and young adults, including college students, misuse alcohol and how to help them drink less and have fewer problems. The summaries below describe the goals of the major waves of Project INTEGRATE.
Project INTEGRATE (2017 – Present): Estimating Comparative Effectiveness of Alcohol Interventions for Young Adults
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.
Project INTEGRATE (2010 – 2016): Innovative Analyses of Alcohol Intervention Trials for College Students
This investigator-initiated R01 application (PA-07-070) proposes integrative data analysis (IDA) of existing raw data (N = 20,595 at baseline) pooled from 20 independent intervention trial studies to overcome shortcomings of individual studies and to generate a new body of knowledge to move beyond efficacy. Among individually-oriented interventions to reduce heavy drinking on college campuses, there is evidence that interventions that combine brief cognitive-behavioral skills with norms clarification and motivational enhancement, brief motivational enhancement interventions, and alcohol expectancy challenges are efficacious. However, critical questions remain unanswered with respect to how these interventions work, what may modify their effectiveness, and what secondary outcomes may be affected. This lack of clear understanding has been hampered by conceptual and design limitations of individual clinical trial studies, including relatively homogeneous samples, relatively small sample sizes, limited statistical power, limited psychometric assessment of constructs of potential mechanisms of change, and limited assessments in terms of frequency and duration under observation. The present application proposes to address these limitations of single studies by pooling data together and directly analyzing them as a single data set drawing on recent advances in psychometrics, longitudinal data analysis, and intervention evaluation methodology. This application pursues four specific aims: (1) to develop a more rigorous set of measures based on data from different studies to ensure that each measure shares a common underlying metric using a modified item response theory model, (2) to evaluate whether and when distinctive transitions in post-intervention trajectories of alcohol and drug use occur over time, and whether individual and situational differences contribute to different trajectories post-intervention, (3) to test distinctive mechanisms of change (e.g., changes in alcohol expectancies, protective strategies, readiness to change, peer norms) and to examine whether potential moderators (e.g., family history of alcoholism, gender) either facilitate or hinder post-intervention changes, and (4) to test the efficacy of alcohol interventions for drug use and other secondary outcomes. The proposed study has the potential for having a significant impact by making unique contributions to the field of alcohol intervention research for college students and, more broadly, to clinical treatment research and to the field of quantitative methodology. PUBLIC HEALTH RELEVANCE: The results of this study will have a large impact by providing important information to prevention designers and policy makers to guide improvements in alcohol interventions for college students. Improved interventions will reduce the multitude of problems associated with heavy drinking and enhance the lives of college students and those with whom they interact. These interventions will also have the potential to be used with other populations, such as emerging adults who do not go to college and younger adolescents.