Quantifying Exposure to Illicit Drugs & Psychosocial Stress in Real Time

对吸毒和社会心理压力的评估是复杂的，因为它们往往都是短暂的，很难准确回忆。由于因果联系的复杂性和构成环境的难以捉摸的性质，对它们彼此之间的因果联系以及它们的遗传和环境决定因素的评估是复杂的。在这项拟议的研究中，我们将通过生态瞬间评估(EMA)近乎实时地评估药物使用和心理社会压力，在EMA中，参与者使用手持电子日记记录事件发生时，并根据全天随机定时的提示报告最近或正在发生的事件。我们还将通过让参与者携带全球定位系统(GPS)设备来跟踪他们的下落，从而保持报告事件发生地点的实时记录，空间分辨率可能达到几米。拓宽环境因素的定义，我们将评估社区一级的药物暴露和压力，以专门开发的指数--药物环境指数(DEI)和社区心理社会危害指数(NPH)--衡量，每个指数都基于从公共来源获得的客观统计数据，独立于自我报告。为了进行比较，还将通过回溯性音频-计算机辅助结构访谈(ACASI)和生物样本(头发和汗水)评估药物暴露，并通过ACASI和生理指标(心率和平衡负荷)评估压力。该项目是NIDA IRP(我们已经在对依赖多药的门诊患者使用EMA)和Johns Hopkins Alive研究调查人员(跟踪一个特征良好的社区吸毒者队列，其中大多数人没有接受治疗)之间的合作。在NIDA的开发工作与Alive的实地试验相联系之后，预计结果将是一套可现场部署的、先进的工具，对于未来影响药物使用和应激的基因-环境相互作用的研究不可或缺。

Assessment of exposure to drug use and psychosocial stress is complicated by the fact that each is often transient and difficult to recall accurately. Assessment of their causal connections with one another, and of their genetic and environmental determinants, is complicated by the complexity of the causal connections and by the elusive nature of what constitutes the environment. In the proposed study, we will assess drug use and psychosocial stress in near-real time through Ecological Momentary Assessment (EMA), in which participants use handheld electronic diaries to record events as they occur and to report recent or ongoing events in response to randomly timed prompts throughout the day. We will also maintain real-time records of where the reported events occurred by having participants carry Global Positioning System (GPS) devices to track their whereabouts with a likely spatial resolution of several meters. Broadening the definition of environmental factors, we will evaluate neighborhood-level exposures to drugs and stress measured in terms of specially developed indices, the Drug Environment Index (DEI) and the Neighborhood Psychosocial Hazards index (NPH), each based on objective statistical data available from public sources and independent of self-report. For comparison, drug exposure will also be assessed through retrospective audio-computer assisted structure interview (ACASI) and from biological specimens (hair and sweat), and stress will be assessed through ACASI and physiological measures (heart rate and allostatic load). The project represents a collaboration between the NIDA IRP (where we are already using EMA with polydrug-dependent outpatients) and Johns Hopkins ALIVE Study investigators (following a well-characterized community cohort of drug abusers, most of whom are not in treatment). After developmental work at NIDA linked to field trials in ALIVE, the result is expected to be a set of field-deployable, state-of-the-art tools indispensable to future studies of gene-environment interactions affecting drug use and stress.