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

描述（由申请人提供）：我们寻求研究与药物滥用治疗和艾滋病毒检测需求的城乡差异相关的因素，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，以更好地满足非洲裔美国人可卡因使用者的需求。我们专注于非裔美国人可卡因使用者的感知需求，因为他们在全国范围内的药物滥用治疗和艾滋病毒检测率较低，以及他们对药物滥用治疗的感知需求较低，危险性行为的发生率较高，并且在我们之前的研究中厌恶在当地卫生部门寻求艾滋病毒检测。鉴于我们之前的自然史研究不包括任何城市地区，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是农村居民特有的（例如，农村非洲裔美国人在获得可卡因方面是否存在差异），或者城市非洲裔美国人可卡因使用者在其他关键因素方面是否存在差异。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以社区为基础的混合方法研究。具体来说，我们提出了一个顺序的混合方法设计，与定性的关键知情人访谈进行第一（30个农村，30个城市），其次是大规模的，结构化的访谈（200农村，200城市）使用标准化的工具，从我们以前的农村卫生服务和艾滋病毒研究的相关措施，并根据我们最初的定性工作新开发的问题。应答者驱动抽样（RDS）是滚雪球抽样的一种变体，将用于识别和招募参与者。研究的主要目的是：1）使用定性方法，描述农村/城市在吸毒途径和吸毒文化、对获得吸毒治疗和艾滋病毒检测的看法、对什么是吸毒治疗和艾滋病毒检测的认识和看法、对正规或非正规吸毒治疗的偏好以及艾滋病毒检测的地点或地点方面的差异;（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要，以及可能阻碍或促进感知需要的主要诱因、促成因素、健康因素和其他因素;和3）使用定量方法，调查农村/城市在药物滥用治疗和艾滋病毒检测的感知需要方面的差异是否受到以下因素的影响：和健康因素以及治疗和检测意识和偏好。从该项目中获得的知识将使卫生政策制定者，治疗计划管理者和提供者能够就如何鼓励和促进美国南部非洲裔美国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，服务不足的高危人群 公共卫生相关性：公共卫生关注的是药物滥用治疗率低和非洲裔美国人可卡因使用者中艾滋病毒感染率高，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人员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益处的认识的文化敏感信息做出更明智的决定。拟议的研究还将提供新的见解，以了解是否应将艾滋病毒检测纳入药物滥用治疗设施，以更好地满足农村和城市非洲裔美国人可卡因使用者的需要。

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.