Gender differences in perceived costs of safer injection among injection drug use

注射吸毒者对更安全注射的感知成本存在性别差异

• 批准号: 7574428
• 负责人: Karla D. Wagner
• 金额: $ 1.39万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2009-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7574428
• 关键词: Accounting; Address; Adult; Adverse effects; Behavior; Behavioral; Blood-Borne Pathogens; California; Cognition; Cognitive; Data; Development; Drug usage; Equation; Equipment; Exhibits; Female; Gender; Gossypium; HIV; Habits; Health behavior; Individual; Infection; Influentials; Injecting drug user; Injection of therapeutic agent; Intervention; Interview; Investigation; Knowledge; Life; Literature; Los Angeles; Measures; Modeling; Motivation; Needle Sharing; Needle-Exchange Programs; Outcome; Participant; Pharmaceutical Preparations; Phase; Play; Predisposition; Preventive Intervention; Publishing; Qualitative Methods; Recruitment Activity; Reporting; Residual state; Risk; Risk Behaviors; Role; Route; Sampling; Self Efficacy; Severities; Sex Characteristics; Shares syringes; Structure; Surveys; Syringes; Testing; Theoretical model; Virus Diseases; Water; Woman; base; cost; design; health belief; high risk; male; men; response; social; success; theories; therapy design; transmission process

DESCRIPTION (provided by applicant): High-risk drug injection behavior (e.g., injecting with shared syringes, cookers, cotton, and/or water, or splitting drugs with shared syringes) is a significant route of transmission for human immunodeficiency virus (HIV) among IDUs. Though reductions in HIV risk behavior among IDUs have been observed in recent years, residual injection risk behavior persists. For example, from 2000 to 2003, 38% of California syringe exchange program (SEP) participants reported syringe sharing and up to 62% reported paraphernalia sharing. Significant gender differences exist in HIV risk among IDUs. Among women, injection-related risk is often associated with the social and environmental context in which they use drugs, whereas this influence appears to be less significant among men. Several individual-level, cognitive behavioral theories have been used to explain risky injection practices, employing constructs such as perceived susceptibility, perceived severity, self-efficacy, response efficacy, social norms, and HIV knowledge. To date, theoretically-based studies have had mixed success in explaining injection risk behavior using these constructs. Few studies have examined the association between perceived costs or barriers to safer injection and injection risk, and even fewer have examined gender differences in the explanatory power of these theoretical models. These omissions may partially explain the inconsistent results reported by existing studies. In order to more fully understand the persistence of injection risk behavior, the proposed study will test a theoretical model that integrates both individual-level cognitive and environmental- level factors in the form of perceived costs of safer injection. The model incorporates constructs from several cognitive theoretical models, with a focus on the moderating influence of perceived costs and gender. The proposed study will collect data from 20 semi-structured, qualitative interviews and 200 cross- sectional, quantitative interviews with IDUs recruited from a Los Angeles, California SEP. The sample will be ethnically diverse and 33% female. The study has four specific aims: 1) Identify the perceived costs associated with safer injection behavior via qualitative interviews and develop a measure of perceived costs that will be used in a quantitative survey; 2) Assess the relationship between HIV-related cognitive factors and injection risk behavior; 3) Use Structural Equation Modeling (SEM) to explore the moderating influence of perceived costs on the association between other cognitive variables and injection risk behavior; and 4) Use SEM to explore gender differences in perceived costs and in the strength of associations between cognitive and behavioral variables. Findings from the proposed study could be used to design interventions to mitigate the social and environmental costs of safer injection among IDUs, and specifically to help alleviate barriers to safer injection among female IDUs. If the costs of safer behavior can be minimized, IDUs may be more likely to act upon existing HIV cognitions to reduce their injection-related risk behavior. By identifying those factors that contribute to persistent injection-related risk for HIV among injection drug users, interventions designed to address those factors can be developed. Specifically, this study will identify the perceived costs of safer injection behavior, allowing for the development of HIV prevention interventions designed to mitigate the costs of safer behavior. Additionally, a detailed understanding of how these factors differ by gender will help in the design and implementation of tailored interventions that take into account the social and environmental context of both men and women, and those factors that contribute to elevated risk for HIV among women.

描述（由申请人提供）：高危药物注射行为（例如，注射共享的注射器，炊具，棉花和/或水，或用共享注射器的分裂药物）是IDU中人类免疫缺陷病毒（HIV）的重要传播途径。尽管近年来已经观察到IDU中的艾滋病毒风险行为降低，但残留注射风险行为仍然存在。例如，从2000年到2003年，加利福尼亚注射器交换计划（SEP）参与者报告了注射器共享，高达62％的参与者报告了用具分享。 IDU中的艾滋病毒风险存在重大性别差异。在妇女中，与注射相关的风险通常与他​​们使用药物的社会和环境环境有关，而这种影响在男性中似乎不那么重要。几种个人级别的认知行为理论已被用来解释危险的注射习惯，采用诸如感知的易感性，感知的严重性，自我效能，反应效率，社会规范和HIV知识等结构。迄今为止，基于理论上的研究在使用这些构造来解释注射风险行为方面取得了成功。很少有研究检查了感知到的成本或更安全的注入风险的障碍之间的关联，甚至更少的研究了这些理论模型的解释性能力上的性别差异。这些遗漏可能部分解释了现有研究报告的不一致结果。为了更充分地了解注射风险行为的持久性，拟议的研究将测试一个理论模型，该模型以更安全的注射成本的形式将个体水平的认知和环境水平因素整合在一起。该模型结合了几种认知理论模型的结构，重点是感知成本和性别的调节影响。拟议的研究将从20种半结构化的定性访谈和200次横断面的跨分类访谈中收集数据，并从加利福尼亚州洛杉矶招募的IDUS进行定量访谈。样本将在种族上多样化，女性为33％。该研究具有四个具体的目的：1）通过定性访谈确定与更安全的注射行为相关的感知成本，并制定一定量度的成本，这些成本将在定量调查中使用； 2）评估与HIV相关的认知因素与注射风险行为之间的关系； 3）使用结构方程建模（SEM）来探索感知成本对其他认知变量与注射风险行为之间关联的调节影响； 4）使用SEM探索感知成本的性别差异以及认知变量和行为变量之间的关联力量。拟议的研究的发现可用于设计干预措施，以减轻IDU中更安全注射的社会和环境成本，特别是帮助减轻女性IDU中更安全注射的障碍。如果可以最大程度地减少更安全的行为成本，则IDU可能更有可能采取现有的HIV认知来减少与注射相关的风险行为。通过确定那些导致注射吸毒者中与持续注射相关的艾滋病毒风险的因素，可以开发出旨在解决这些因素的干预措施。具体而言，这项研究将确定更安全的注射行为的感知成本，从而开发旨在减轻更安全行为成本的艾滋病毒预防干预措施。此外，对这些因素如何因性别而差异的详细理解将有助于设计和实施量身定制的干预措施，这些干预措施考虑了男性和女性的社会和环境环境，以及那些导致女性艾滋病毒风险升高的因素。