Optimizing Digital Health Interventions for Binge Drinking and Violence for Adult Emergency Department Patients - This 5-year K23 Mentored Career Development Award resubmission proposes a research and training program to facilitate the applicant’s development as a physician-scientist with expertise in technology-augmented adaptive behavioral interventions for reducing binge drinking and aggression in young adults (YA; ages 18-30) seeking care at Emergency Departments (EDs), while addressing resource linkage and structural and social determinants of health (SSDH). CONTEXT: YAs are at the highest risk for engaging in binge drinking and aggression, with some groups disproportionately affected due to SSDHs. However, scalable, efficacious interventions for YAs are generally lacking despite the fact that YAs often seek care in EDs. SafERteens, a Health Coach (HC) delivered, ED brief intervention (BI) that uses motivational interviewing (MI) and cognitive skill- building techniques (CBT) shows promise for reducing alcohol consequences and violence among teens. However, SafERteens has not been tested among YAs, who may benefit from tailored intervention content addressing issues for older ages (e.g., family, partnerships, career) and extension of the intervention post- discharge. Such extensions may include portal messaging and text messaging, which are novel modalities that can provide therapeutic content and early resource connections after an ED visit. Further, considering the range of responses to behavioral interventions, adaptive interventions (ADIs) are an innovative approach to address heterogeneity by individualizing timing, intensity, and/or type of treatment. RESEARCH STRATEGY: To inform the adaptation of a technology-augmented ADI (MiGuide) for ED YAs engaging in recent binge drinking and aggression, the applicant will adapt the SafERteens HC delivered BI for older YAs, as well as text messaging (completely automated) and portal messaging (using a HC) platforms, and conduct a Sequential, Multiple Assignment, Randomized Trial (SMART). To inform MiGuide adaptation, Aim 1 will focus on the iterative refinement of a technology-augmented ADI using a community engaged approach. Aim 2 will pilot a non- restricted SMART (N=80) of MiGuide, examining acceptability, feasibility, and fidelity, as well as preliminary efficacy to inform a fully powered SMART (R01). TRAINING PLAN: To facilitate the applicant's goal of becoming an independent physician-scientist focused on developing interventions to reduce binge drinking and aggression, parallel training goals are: Aim 1: gain expertise in theory-based interventions for high-risk alcohol behaviors, including content tailored to unique characteristics among a broad sample of ED patients, and MI/CBT techniques to reduce binge drinking and aggression; Aim 2: develop expertise in intervention science with a focus on adapting/testing ED-based technology-augmented ADIs using a community engaged approach; and, Aim 3: obtain training in ADI/SMART analytic approaches to develop future ADIs. These training aims will be accomplished through applied research experiences, working closely with mentors, attending didactic activities/conferences, and completing manuscript/grant proposal (i.e., R01) submissions.
