Opioid misuse frequently starts in adolescence. In 2018, an estimated 699,000 adolescents aged 12-17 and 1.9 million young adults aged 18-25 misused opioids in the past year. As such, adolescence is the time to intervene with prevention interventions. However, few interventions exist that prevent initiation of opioid misuse. Digital interventions such as serious videogames can improve health behaviors and are accessible by adolescents. Although digital interventions are feasible and effective, this finding is not universal across adolescent groups and the factors that facilitate or hinder their efficacy are unclear. This proposal will study factors that may act as facilitators or barriers to the efficacy of digital interventions by studying the effects of family functioning and race/ethnicity on how adolescents respond to PlaySmart, a novel digital videogame intervention developed to prevent the initiation of opioid misuse. Family functioning, which describes aspects of the relationship between parent and adolescent, and race/ethnicity have been linked to opioid misuse and may influence the response to prevention interventions. Specific family functioning factors include: parent- adolescent conflict, family cohesion, parent-adolescent connection, parent-adolescent communication, parental monitoring and family support of adolescents. Adolescents from different racial/ethnic groups have different risk and protective factors for the development of opioid misuse and the way adolescents respond to programs to prevent substance use may be different based on their race/ethnicity. However, studies examining the effect of family functioning and race/ethnicity on the response to digital interventions to prevent opioid misuse are lacking. The specific aims of this diversity supplement proposal are: 1) to assess if adolescent report of family functioning (a) modifies the effect of PlaySmart in reducing risk factors for opioid misuse (perception of great risk of harm from opioid misuse, intentions to misuse opioids, self-efficacy for refusing opioids) and (b) influences the level of game engagement; 2) to assess if the effect of PlaySmart in reducing risk factors for opioid misuse differs by adolescent race/ethnicity; and 3) to explore if differences in how adolescents and their parents perceive family functioning affects PlaySmart outcomes. We hypothesize that: 1) participants with high baseline scores of family functioning in the PlaySmart group will have better outcomes at three months post- randomization compared to participants with low scores of family functioning in the PlaySmart group and compared with participants in the control group; and 2) non-Hispanic white adolescents will have better outcomes at three months post-randomization compared to Black and Hispanic adolescents. Findings from this proposal will advance our understanding of factors that impact digital prevention programs targeting opioid misuse and inform novel strategies to improve the efficacy of digital interventions to prevent negative health outcomes and promote adaptive behaviors across a diverse population of adolescents.

This project will examine factors that could improve or hinder how older teens respond to a new videogame intervention, PlaySmart to prevent initiation of opioid misuse. These factors include: 1) family functioning which is reflective of the relationship between parents and adolescents; and 2) race/ethnicity. Knowing how family functioning and race/ethnicity affects an adolescent's response to PlaySmart will advance our understanding of specific factors that impact opioid misuse prevention interventions among adolescents and could inform the development of new digital prevention interventions for adolescent opioid misuse that are culturally informed and effective across a diverse population of adolescents.