A Self-Assessment Intervention for Young Adult Polydrug Users at Risk for HIV

针对有艾滋病毒风险的年轻成年多吸毒者的自我评估干预措施

• 批准号: 8073629
• 负责人: Steven P Kurtz
• 金额: $ 56.13万
• 依托单位: NOVA SOUTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8073629
• 关键词: Age; Aging; Alcohol or Other Drugs use; Behavior; Behavioral; Cocaine; Dancing; Data; Drug usage; Drug user; Effectiveness; Environmental Risk Factor; Equipment and supply inventories; Evaluation Research; Florida; Freedom; HIV; HIV Infections; Health; Health Status; Heterosexuals; Internet; Intervention; Interviewer; Knowledge; Literature; Measures; Mental Health; Natural History; Outcome; Outcome Measure; Parents; Participant; Pharmaceutical Preparations; Play; Population; Prevalence; Process; Public Health; Qualitative Research; Randomized Clinical Trials; Recording of previous events; Relative (related person); Reporting; Resistance; Risk; Risk Assessment; Risk Behaviors; Risk Reduction; Risk Reduction Behavior; Sampling; Self Administration; Self Assessment; Self Perception; Self-Administered; Sex Behavior; Sexual Partners; Social Problems; Substance abuse problem; Theoretical model; Time; Unsafe Sex; Vulnerable Populations; Woman; alcohol and other drug; arm; authority; base; behavior change; brief intervention; club drug; cost; demographics; design; ecstasy; efficacy testing; follow-up; high risk; high risk sexual behavior; instrument; intervention effect; men; novel; parent grant; peer; programs; public health relevance; response; sex risk; social; young adult

DESCRIPTION (provided by applicant): Drug use is normative in urban club scenes, with MDMA (ecstasy) and cocaine being the most prevalent "club" drugs. The parent grant which this application proposes to continue has documented not only high rates of mental health problems and extensive arrest and abuse histories, but also unexpectedly and alarmingly high rates of undiagnosed HIV infection among a predominately heterosexual young adult sample. The parent grant, now in its fifth year, is an 18-month longitudinal natural history study of 600 club and prescription drug using young adults. A key finding from that study is the extent to which the comprehensive health and social risk assessments induced participants to reduce their substance use and sexual risk behaviors. Over 70% of participants substantially reduced their substance use at the first follow-up assessment after baseline. Qualitative research with study completers showed that participants attributed the strong intervention effect of the baseline assessment to: 1) the friendly, non-judgmental field staff of age-peers; 2) the thorough and detailed assessments; and 3) an emerging self-awareness of substance use-related problems based on their responses to the assessment items. Study completers also reported that risk reduction tended to occur precisely because the study was not framed as an intervention. Within this context, the specific aims of the proposed 5-year renewal project are to: 1) identify the covariates of baseline substance abuse and sexual risks (including demographics, social risk measures, peer norms, abuse history, and mental health status) among a sample of 750 heterosexually active, not-in-treatment, club and prescription drug users ages 18 to 39 in Miami, Florida; 2) evaluate, through random assignment, the relative effectiveness of two intervention conditions and a waitlist control in reducing sex risks and drug use, as measured at 3-, 6- and 12-month follow-ups: Arm 1, an interviewer-administered comprehensive health and social risk assessment intervention (CAPI Intervention) similar to the baseline instrument used in the parent grant; Arm 2, an identical self-administered comprehensive assessment intervention (ACASI Intervention); and Arm 3, a waitlist control condition (Control). Outcome measures, including past 90-day counts of unprotected sex acts and days' drug use, will be obtained from brief risk behavior inventories at baseline and follow-ups; and 3) conduct qualitative process evaluation research with 40 participants in each study arm to contextualize the study findings and intervention outcomes. The proposed project is significant, as it responds to the need for brief interventions for a highly vulnerable, high risk population. The self-assessment intervention, if proven efficacious in reducing HIV risk, could be delivered at low cost and broad scale, and might well be adaptable to other high risk groups who are resistant to public health warnings and/or professional intervention. PUBLIC HEALTH RELEVANCE: Club drug users report high levels of sexual risk behaviors as well as other problems related to substance use. The proposed study is a randomized clinical trial to evaluate the efficacy of a substance use and sexual risk reduction intervention among heterosexually active men and women in the club culture. The self-assessment intervention, if proven efficacious in reducing HIV risk, could be delivered at low cost and broad scale, and might well be adaptable to other high risk groups who are resistant to public health warnings and/or professional intervention.

描述（由申请人提供）：吸毒在城市俱乐部场景中很常见，其中摇头丸（摇头丸）和可卡因是最流行的“俱乐部”毒品。本申请建议继续提供的家长补助金不仅记录了高比例的精神健康问题和广泛的逮捕和虐待历史，而且还记录了以异性恋为主的年轻成年人样本中未确诊的艾滋病毒感染率出人意料且令人震惊的高比例。 家长补助金现已进入第五个年头，是一项为期 18 个月的纵向自然历史研究，对象为 600 名青少年俱乐部和处方药。该研究的一个重要发现是，全面的健康和社会风险评估在多大程度上促使参与者减少药物使用和危险性行为。超过 70% 的参与者在基线后的第一次后续评估中大幅减少了物质使用。对研究完成者的定性研究表明，参与者将基线评估的强大干预效果归因于：1）同龄人的友好、不带偏见的现场工作人员； 2）彻底、详细的评估； 3) 根据他们对评估项目的反应，逐渐形成对药物使用相关问题的自我意识。研究完成者还报告说，风险降低往往发生正是因为该研究并未被视为干预措施。 在此背景下，拟议的 5 年更新项目的具体目标是： 1) 在佛罗里达州迈阿密 750 名 18 至 39 岁的异性恋活跃、未接受治疗、俱乐部和处方药使用者样本中确定基线药物滥用和性风险的协变量（包括人口统计、社会风险测量、同伴规范、滥用史和心理健康状况）； 2) 通过随机分配，评估两种干预条件和候补名单控制在减少性风险和吸毒方面的相对有效性，在 3、6 和 12 个月的随访中进行测量：第 1 组，访谈员实施的综合健康和社会风险评估干预措施（CAPI 干预），与家长补助金中使用的基线工具类似；第 2 组，相同的自我管理综合评估干预（ACASI 干预）； Arm 3，等待名单控制条件（Control）。结果测量，包括过去 90 天无保护性行为的计数和吸毒天数，将从基线和后续的简要风险行为清单中获得； 3) 对每个研究组的 40 名参与者进行定性过程评估研究，以将研究结果和干预结果结合起来。 拟议的项目意义重大，因为它满足了对高度脆弱、高风险人群进行简短干预的需求。如果证明自我评估干预措施能有效降低艾滋病毒风险，则可以以低成本和大范围实施，并且很可能适用于对公共卫生警告和/或专业干预有抵抗力的其他高风险群体。 公共卫生相关性：俱乐部吸毒者报告了高水平的性危险行为以及与药物使用相关的其他问题。拟议的研究是一项随机临床试验，旨在评估俱乐部文化中异性恋活跃男性和女性的物质使用和性风险降低干预措施的效果。如果证明自我评估干预措施能有效降低艾滋病毒风险，则可以以低成本和大范围实施，并且很可能适用于对公共卫生警告和/或专业干预有抵抗力的其他高风险群体。