Rural and Urban African American Cocaine Users' Perceived Need for Care

描述(由申请者提供)：我们试图研究城乡在对药物滥用治疗和艾滋病毒检测的感知需求方面存在差异的相关因素，因为这些是补充服务，可以整合到正式的药物滥用治疗计划或其他地点，以更好地满足非裔美国人可卡因使用者的需求。我们重点关注非洲裔美国人可卡因吸毒者的感知需求，因为他们在全国范围内接受药物滥用治疗和艾滋病毒检测的比率很低，在我们之前的研究中，他们对药物滥用治疗的感知需求很低，危险性行为的比率很高，并且不愿到当地卫生部门寻求艾滋病毒检测。鉴于我们之前的自然历史研究没有包括任何城市地区，我们不知道阿肯色州农村地区药物滥用治疗和艾滋病毒检测率低是否农村居民特有(例如，非洲裔农村美国人在获得治疗方面是否存在差距)，或者城市非裔美国人吸食可卡因的人在其他关键因素上是否有所不同。为了解决这些问题，我们计划对居住在阿肯色州农村和城市地区的非裔美国人可卡因使用者进行一项基于社区的混合方法研究。具体地说，我们提出了一种顺序混合方法设计，首先进行定性的关键信息者访谈(农村30人，城市30人)，然后使用标准化工具进行更大规模的结构化访谈(200农村，200城市)，使用我们先前农村卫生服务和艾滋病毒研究的中肯措施，以及在我们最初定性工作的基础上新开发的问题。受访者驱动抽样(RDS)是雪球抽样的一种变体，将用于识别和招募参与者。这项研究的主要目的是：1)使用定性方法，描述吸毒途径和吸毒文化的城乡差异，对获得药物滥用治疗和艾滋病毒检测的看法，对什么是药物滥用治疗和艾滋病毒检测的认识和看法，对正式或非正式药物滥用治疗和艾滋病毒检测的偏好，以及艾滋病毒检测的地点和地点；2)使用定量和定性方法，比较和对比农村和城市可卡因使用者对药物滥用治疗和艾滋病毒检测的感知需求以及可能阻碍或促进感知需求的关键诱因、促成因素、健康和其他因素；3)使用定量方法，调查城乡对药物滥用治疗和艾滋病毒检测感知需求的差异是否由关键的诱因、使能和健康因素以及治疗和检测意识和偏好所中介。从该项目中获得的知识将使卫生政策制定者、治疗计划经理和提供者能够就如何鼓励和促进美国南部非裔美国人可卡因使用者使用药物滥用治疗和艾滋病毒检测做出更明智的决定，非裔美国人可卡因使用者是一个服务不足的高危人群。 公共卫生相关性：公共卫生关注的问题是非裔美国人可卡因使用者的药物滥用治疗率低和艾滋病毒感染率高，特别是在美国南部。从拟议的研究中获得的知识将使公共和行为卫生系统的管理者能够就如何针对和定制旨在提高对药物滥用治疗和艾滋病毒检测好处的认识的文化敏感信息做出更明智的决定。拟议的研究还将为艾滋病毒检测是否应纳入药物滥用治疗设施，以更好地满足农村和城市非裔美国人可卡因使用者的需要提供新的见解。

DESCRIPTION (provided by applicant): We seek to study the factors associated with rural/urban differences in perceived need for both drug abuse treatment and HIV testing because these are complementary services which could be integrated within formal drug abuse treatment programs or other locations to better meet the needs of African American cocaine users. We focus on perceived need among African American cocaine users because of their low rates of drug abuse treatment and HIV testing nationally as well as their demonstrated low perceived need for drug abuse treatment, high rates of risky sexual behaviors, and aversion to seeking HIV testing at local health departments in our prior research. Given that our prior natural history research did not include any urban areas, we do not know whether the low rates of drug abuse treatment and HIV testing among rural Arkansans are specific to rural residents (e.g., whether there is a disparity in access for rural African Americans) or whether urban African American cocaine users differ in other critical factors. To address these issues, we plan to conduct a community-based mixed methods study of African American cocaine users residing in rural and urban areas of Arkansas. Specifically, we propose a sequential mixed-method design, with qualitative key informant interviews conducted first (30 rural, 30 urban), followed by larger-scale, structured interviews (200 rural, 200 urban) using standardized instruments, pertinent measures from our prior rural health services and HIV research, and newly developed questions based on our initial qualitative work. Respondent-Driven Sampling (RDS), a variant of snowball sampling, will be used to identify and recruit participants. The primary aims of the study are: 1) Using qualitative methods, to describe rural/urban differences in pathways to drug use and drug use cultures, perceptions of access to drug abuse treatment and HIV testing, awareness and perceptions of what constitutes drug abuse treatment and HIV testing, and preferences for formal or informal drug abuse treatment and the site or location of HIV testing; 2) Using quantitative and qualitative methods, to compare and contrast rural and urban cocaine users' perceived need for drug abuse treatment and HIV testing and key predisposing, enabling, health, and other factors which could impede or facilitate perceived need; and 3) Using quantitative methods, to investigate whether rural/urban differences in perceived need for drug abuse treatment and HIV testing are mediated by key predisposing, enabling, and health factors as well as treatment and testing awareness and preferences. The knowledge gained from this project will enable health policy makers, treatment program managers, and providers to make more informed decisions about how to encourage and facilitate the utilization of drug abuse treatment and HIV testing among African American cocaine users in the Southern U.S., an underserved and high risk population. PUBLIC HEALTH RELEVANCE: Of public health concern are the low rates of drug abuse treatment and high rates of HIV among African American cocaine users, especially in the Southern U.S. The knowledge gained from the proposed research would enable managers of public and behavioral health systems to make more informed decisions about how to target and tailor culturally sensitive messages aimed at increasing awareness of the benefits of drug abuse treatment and HIV testing. The proposed research would also provide new insight into whether HIV testing should be integrated within drug abuse treatment facilities to better meet the needs of rural as well as urban African American cocaine users.