LONGITUDINAL STUDY OF SUBSTANCE USE, INCARCERATION, AND STI IN THE US

描述(由申请人提供)：我们建议进行二次数据分析，以检查监禁、药物使用和性传播感染/艾滋病毒风险之间的纵向关系。2008年，美国有200多万成年人被关进监狱。监狱和监狱囚犯往往是我国人口中经济和社会处境最不利的一部分，他们也面临着不成比例的传染病风险。性传播感染(STI)，包括艾滋病毒，聚集在被监禁人口中。囚犯的配偶、性伴侣和他们的性网络的其他成员也有很高的感染风险。在一些人口中，监禁率令人震惊，社区经历着相当一部分人口不断迁入和迁出刑事司法系统。性传播感染和艾滋病毒在性网络中断的情况下蓬勃发展。因此，由于监禁导致的性网络中断可能会导致新的、多个和同时发生的性伙伴关系，所有这些都助长了性传播感染/艾滋病毒的传播。监禁的破坏性影响是否会导致性传播感染/艾滋病毒风险？或者，毒品使用等不利的经济和社会因素--可能导致监禁--是否在现任和前任囚犯及其性关系网络成员中推高性风险和性传播感染/艾滋病毒水平？我们不知道--监禁和性传播感染/艾滋病毒之间的密切联系仍然没有得到解释，需要进行调查。利用国家青少年健康纵向研究，我们将应用先进的统计程序来衡量青少年使用药物对多次(E)性伴侣以及成年后生物确认的衣原体、淋病或滴虫病感染的影响。我们将评估成年监禁在多大程度上调解药物使用和性传播感染/艾滋病毒风险之间的关系。我们将研究的性传播感染具有明显的公共卫生相关性，不仅因为它们导致了大量的发病率，而且因为它们增加了艾滋病毒的传播。这项拟议研究的具体目的是：目标1：测量青春期物质使用与成年期多发性伙伴关系和性传播感染之间的纵向联系，并评估种族或刑事司法参与是否缓和了这种关系。目的2：测量监禁与成年后多性伴和性传播感染之间的联系。目的3：评估成年期监禁在多重性伴和成年期性传播感染与青少年物质使用之间的中介作用程度。这项研究在对性传播感染、药物依赖流行病学和刑事司法领域的独特综合和公共卫生相关性方面具有创新性。拟议的分析旨在为开发更大的R01提供经验基础，以(1)检查监禁时亲密伙伴关系中断对性传播感染/艾滋病毒风险的影响，以及(2)测试性传播感染/艾滋病毒预防干预措施的有效性，旨在减轻监禁和药物依赖的有害影响。 公共卫生相关性：通过确定监禁和使用药物单独和共同增加性传播感染/艾滋病毒风险的方式，我们将更好地了解是否应该优先使用稀缺的预防资源：预防和治疗药物使用、制定和实施减轻监禁破坏性影响的干预措施，或者两者兼而有之。由于任何时候都有200多万成年人被关押在美国监狱和监狱中，即使监禁对性传播感染/艾滋病毒风险的影响不大，也会在人口层面产生重大影响。因此，可在一定程度上根据这项研究制定的减少与监禁有关的性传播感染/艾滋病毒传播的有效干预措施将防止大量新感染。

DESCRIPTION (provided by applicant): We propose to conduct secondary data analysis to examine the longitudinal relationships among incarceration, substance use, and STI/HIV risk. In 2008 more than 2 million adults in the United States were behind bars. Jail and prison inmates, often among the most economically and socially disadvantaged segment of our population, also face disproportionate infectious disease risk. Sexually transmitted infections (STIs), including HIV, cluster in incarcerated populations. Prisoners' spouses, sexual partners, and other members of their sexual networks also experience high risk of infection. In some populations, incarceration rates are staggering and communities experience continual migrations of substantial segments of the population in and out of the criminal justice system. STIs and HIV thrive on sexual network disruption. Thus, disruption of sexual networks due to incarceration may lead to new, multiple, and concurrent sexual partnerships, all of which fuel STI/HIV transmission. Does the disruptive effect of incarceration contribute to STI/HIV risk? Or, do adverse economic and social factors such as drug use-that may have led to the incarceration-drive high sexual risk and STI/HIV levels among current and former inmates and members of their sexual networks? We do not know- the strong association between incarceration and STI/HIV remains unexplained and warrants investigation. Using the National Longitudinal Study of Adolescent Health, we will apply advanced statistical procedures to measure the effects of adolescent substance use on multiple (e 2) sexual partnerships and biologically confirmed infection with chlamydia, gonorrhea, or trichomoniasis in adulthood. We will evaluate the degree to which incarceration in adulthood mediates the relationship between substance use and STI/HIV risk. The STIs we will study have clear public health relevance not only because they contribute to substantial morbidity but because they increase HIV transmission. The specific aims of the proposed study are to: Aim 1: Measure longitudinal associations between adolescent substance use and multiple sexual partnerships and STI in adulthood and evaluate whether race or criminal justice involvement moderates the relationships. Aim 2: Measure associations between incarceration and multiple sexual partnerships and STI in adulthood. Aim 3: Evaluate the degree to which incarceration in adulthood mediates the relationships between adolescent substance use and multiple sexual partnerships and STI in adulthood. This research is innovative in its unique synthesis of and public health relevance to STI and drug dependence epidemiology and the criminal justice field. The proposed analyses are designed to provide an empirical basis for development of larger R01s to (1) examine the effect of disruptions in intimate partnerships at the time of incarceration on STI/HIV risk and (2) test the effectiveness of STI/HIV prevention interventions that aim to mitigate the deleterious effects of incarceration and drug dependence. PUBLIC HEALTH RELEVANCE: By identifying ways that incarceration and substance use work independently and together to increase STI/HIV risk, we will better understand whether scarce prevention resources should be prioritized for: substance use prevention and treatment, development and implementation of interventions that mitigate the disruptive effects of incarceration, or both. Since more than 2 million adults are in United States jails and prisons at any given time, even modest effects of incarceration on STI/HIV risk have significant ramifications at the population level. Hence, interventions effective in reducing incarceration-related STI/HIV transmission that may be developed, in part, based on this research would prevent substantial numbers of new infections.