Contextual factors of the risk environment surrounding injection drug use: A real-time approach

注射吸毒风险环境的背景因素：实时方法

• 批准号: 10299975
• 负责人: Kristina T. Phillips
• 金额: $ 19.83万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10299975
• 关键词: Affect; Alcohols; Attention; Bacterial Infections; Behavior; Behavior Therapy; Blood; Complex; Cross-Sectional Studies; Data Collection; Discrimination; Disease; Drug user; Ecological momentary assessment; Economic Factors; Economics; Endocarditis; Environment; Environmental Risk Factor; Equipment; Frequencies; Generations; Geography; Goals; HIV; Harm Reduction; Health; Health behavior change; Hepatitis C; Hepatitis C virus; Hygiene; Income; Individual; Infectious Skin Diseases; Injecting drug user; Injections; Interview; Literature; Location; Methodology; Methods; Modeling; Neighborhoods; Opioid; Outcome; Overdose; Participant; Persons; Pharmaceutical Preparations; Pharmacotherapy; Policies; Public Health; Qualitative Methods; Risk; Risk Factors; Services; System; Time; Viral; Virus Diseases; Withdrawal; Work; contextual factors; craving; ethnic diversity; experience; handheld mobile device; health care service; high risk; housing instability; injection drug use; multiple drug use; negative affect; neighborhood disadvantage; opioid epidemic; outreach; recruit; service intervention; social; social factors; social stigma; substance use; treatment services

Project Summary Amidst the current opioid crisis in the U.S., overdose (OD) rates among people who inject drugs (PWID) are high and many PWID continue to be at risk for viral (HIV, HCV) and bacterial infections (e.g., skin infections, endocarditis). Select high-risk drug and injection practices (“risk practices”), such as sharing injection equipment or using multiple drugs in combination (e.g., opioids and alcohol), have been shown to increase risk for these health outcomes. However, much of the past work on risk practices has been cross-sectional, retrospective, and/or focuses on individual-level behaviors, limiting the ecological validity of findings. One methodology that could mitigate limitations associated with past studies is ecological momentary assessment (EMA). EMA allows for data collection in real-time, in a person's natural environment, using mobile devices. One advantage when considering this methodology is that it can capture momentary information as the individual's context, location, or affect changes. This convergent parallel mixed methods study will apply both qualitative methods and EMA to the “risk environment” framework proposed by Rhodes (2002, 2009). The risk environment model suggests that complex environmental factors (subtypes: physical, policy, economic, social) interact with varying levels of micro- (individual and his/her immediate context) and macro-level (system) influence to produce drug-related harm. Few studies have examined multiple components of the risk environment model in combination or within the real-world context. This mixed-methods study has two primary goals: 1) conduct exploratory qualitative interviews with PWID to better inform the literature on micro- and macro-level (“contextual,” i.e., exogenous to the person) factors that may not have been previously identified, and 2) use EMA to examine relationships between risk practices and individual and contextual factors, thus providing real-time information on predictors of risk that have only been examined previously in cross-sectional studies or not at all, in the participant's natural environment. Street outreach will be used to recruit ethnically diverse PWID (N = 75) in Honolulu, HI to participate in a qualitative interview, baseline assessment, and 2-week EMA. The findings from this study will inform a larger project powered to examine complex relationships between contextual and individual-level factors with risk practices. The long-term objective of this line of work is to develop a comprehensive model of the risk environment that can be used to inform the delivery of harm reduction services and interventions for PWID, as well as impact policy decisions that affect people who use drugs.

项目概要 在美国当前的阿片类药物危机中，注射吸毒者 (PWID) 的服药过量 (OD) 率 许多吸毒者仍然面临病毒（HIV、HCV）和细菌感染（例如皮肤感染、 心内膜炎）。选择高风险的药物和注射做法（“风险做法”），例如共用注射 设备或组合使用多种药物（例如阿片类药物和酒精）已被证明会增加风险 为了这些健康成果。然而，过去有关风险实践的大部分工作都是跨部门的， 回顾性和/或关注个体层面的行为，限制了研究结果的生态有效性。一 可以减轻与过去研究相关的局限性的方法是生态瞬时评估 （EMA）。 EMA 允许使用移动设备在人的自然环境中实时收集数据。 考虑这种方法时的一个优点是它可以捕获瞬时信息作为 个人的背景、位置或影响发生变化。这项收敛并行混合方法研究将同时应用 Rhodes（2002，2009）提出的“风险环境”框架的定性方法和 EMA。这 风险环境模型表明，复杂的环境因素（子类型：物理、政策、经济、 社会）与不同层面的微观（个人及其直接背景）和宏观层面的互动 （系统）影响产生与毒品有关的危害。很少有研究考察风险的多个组成部分 结合或在现实世界环境中的环境模型。这项混合方法研究有两种 主要目标：1) 对注射吸毒者进行探索性定性访谈，以更好地为相关文献提供信息 以前可能没有考虑到的微观和宏观层面（“背景”，即对人来说是外生的）因素 确定，2) 使用 EMA 来检查风险实践与个人和背景之间的关系 因素，从而提供有关风险预测因素的实时信息，而这些信息之前仅在 在参与者的自然环境中进行横断面研究或根本不进行横断面研究。街道外展将用于 在夏威夷州檀香山招募不同种族的吸毒者 (N = 75) 参加定性访谈、基线 评估和 2 周 EMA。这项研究的结果将为一个更大的项目提供信息，该项目旨在检查 背景因素和个人因素与风险实践之间的复杂关系。长期来看 该工作线的目标是开发一个可用于风险环境的综合模型 为注射吸毒者提供减少危害服务和干预措施提供信息，并影响政策决策 这会影响吸毒者。