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Substance Use Among Violently Injured Youth in an Urban ER: Services and Outcome

城市急诊室中遭受暴力伤害的青少年的药物使用：服务和结果

基本信息

批准号：
8261973
负责人：
REBECCA M. CUNNINGHAM
金额：
$ 56.94万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-05-01 至 2014-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8261973
关键词：
Abdominal Pain Accident and Emergency department Accidental Injury Acute Address Admission activity Adolescent Adolescent Risk Behavior Adult Affect African American Age Aggressive behavior Alcohol consumption Alcohol or Other Drugs use Alcohols Behavior Biological Markers Caring Caucasians Caucasoid Race Cause of Death Centers for Disease Control and Prevention (U.S.)Characteristics Clinical Cocaine Collaborations Communities Criminal Justice DSM-IV Data Demographic Factors Development Diagnosis Discipline Drug usage Drug user Economic Factors Education Enabling Factors Environment Exhibits Family Firearms Future Gender Guns HIV HIV Infections Health Health Services Health Services Accessibility Hispanics Homicide Hospitalization Hospitals Human immunodeficiency virus test Illicit Drugs Imprisonment Individual Inhalant dose form Injury Institutes Intentional injury Intervention Justice Laceration Life Location Marijuana Measures Medical Mental Health Mental Health Services Minor Modeling Multiple Partners Observational Study Organism Outcome Participant Patients Pattern Physicians Population Population Study Predisposing Factor Prevention Preventive Intervention Problem behavior Race Recording of previous events Reliance Reporting Research Research Personnel Resources Risk Risk Behaviors Risk Factors Sample Size Sampling Schools Services Severities Staging Substance abuse problem System Time Trauma Vehicle crash Violence Violent injury Visit Vulnerable Populations Work Youth adolescent drug use adolescent substance use assault base binge drinking care seeking cohort condoms data registry demographics design experience falls follow-up health belief health care service utilization health disparity high risk high risk sexual behavior income insurance indexing injured inner city innovation interest interpersonal conflict longitudinal course peer peer influence prospective recidivism service utilization sex risk socioeconomics substance abuse treatment therapy development transmission process weapons wound

项目摘要

DESCRIPTION (provided by applicant): Intentional injury (violence) is the leading cause of death among African-American youth. The provision of medical services in an inner-city Emergency Department (ED) provides a critical opportunity to identify and characterize future timing and pattern of service use among youth with drug use, who may be missed in school-based samples, and who may not yet be in the criminal justice system. Health disparities exist in rates of violent injury among inner-city youth, many of whom are African-American, and are mirrored in limited access to substance use treatment services and over representation in the criminal justice system. Currently, there is a paucity of data on the timing, pattern, barriers, and trajectory of youth with multiple risks (illicit drug use and ED visit for acute violent injury) in terms of their intersection with health services (substance use treatment, mental health, medical) and criminal justice system, which limits the development of optimal timing and setting for interventions. Youth treated in the ED may have exacerbated rates of illicit drug use, and other risk behaviors (e.g., delinquency, HIV risk behaviors, weapon carriage) and different trajectories of outcomes and interactions with service use sectors based on presentation for intentional injury as compared to other complaints (medical, unintentional injuries). Understanding the outcomes and service utilization among inner- city youth with drug use with and without acute violent injury is critically important in developing prevention and treatment services to address these multiple risk factors. We propose a prospective observational study over a two-year period to identify a high risk group of youth with past year illicit drug use (N=800) seeking care in an inner city ED. The specific aims of the study, chosen to obtain data necessary to determine the location and content of subsequent interventions, are: (1) To describe characteristics of youth (ages 14-24; n=800) who report illicit drug use presenting to an urban ED for an acute violent injury (n=400), compared to youth with drug use who seek non-violence related ED care (n=400), including socio-demographic characteristics, problem severity (e.g., substance use, violence, HIV risk behaviors, etc.), enabling factors, and service utilization (i.e., substance use treatment, mental health, and medical); (2) To identify the trajectories of participants' interactions with health services during the two years following their ED visit and the key characteristics (i.e., predisposing, enabling, and need factors) associated with types of service use (substance use treatment, mental health, medical/ ED, and HIV testing) and barriers to these services; and, (3) To measure two-year outcomes for this cohort including, HIV risk behaviors, and to identify key socio- demographic and clinical characteristics of youth with drug use, who have poor outcomes in the two years after ED visit for intentional injury and other medical care. The proposed study represents collaboration with an established team of investigators who have a successful history of conducting substance use research in ED settings. There is a critical need to understand who is at greatest risk for poor outcomes (substance use, criminal justice, medical), and, who is least likely to enter treatment in order to target substance use and mental health interventions for those with greatest need. Results from this proposed study are essential to inform future ED prevention and intervention development to reduce health disparities among inner-city youth with substance use. PUBLIC HEALTH RELEVANCE: Youth treated in the Emergency Department (ED) for violent injury have high rates of alcohol and illicit drug misuse, and other multiple risk behaviors (i.e. delinquency, HIV risk behaviors, and weapon carriage). The results of this proposed study will inform future intervention development among inner-city youth with substance use.

描述（由申请人提供）：故意伤害（暴力）是非洲裔美国青年死亡的主要原因。在市内急诊科提供医疗服务提供了一个重要的机会，以确定和描述吸毒青年未来使用服务的时间和模式，这些人可能在学校样本中被遗漏，并且可能尚未进入刑事司法系统。在市中心青年中，暴力伤害率存在健康差异，其中许多是非裔美国人，这反映在获得药物使用治疗服务的机会有限以及在刑事司法系统中的代表性过高。目前，在与卫生服务（药物使用治疗、精神卫生、医疗）和刑事司法系统的交叉方面，缺乏关于具有多重风险（非法药物使用和急性暴力伤害急诊）的青年的时间、模式、障碍和轨迹的数据，这限制了干预措施的最佳时间和环境的发展。在急诊科接受治疗的青年可能加剧了非法药物使用和其他危险行为（例如，犯罪、艾滋病毒风险行为、携带武器）的比率，并且根据与其他投诉（医疗、意外伤害）相比的故意伤害陈述，结果轨迹和与服务使用部门的相互作用也有所不同。了解有或没有急性暴力伤害的吸毒市中心青年的结果和服务利用情况，对于开发预防和治疗服务以解决这些多重风险因素至关重要。我们提出了一项为期两年的前瞻性观察研究，以确定过去一年有非法药物使用的青少年（N=800）在市中心ED寻求护理的高风险群体。该研究的具体目的是获得必要的数据，以确定后续干预的位置和内容，包括：(1)描述青少年(14-24岁；与寻求非暴力相关ED治疗的吸毒青少年（n=400）相比，包括社会人口统计学特征、问题严重程度（如物质使用、暴力、艾滋病毒风险行为等）、使能因素和服务利用（即物质使用治疗、心理健康和医疗）；(2)确定参与者在急诊科就诊后两年内与卫生服务的互动轨迹，以及与服务使用类型（药物使用治疗、心理健康、医疗/急诊科和艾滋病毒检测）相关的关键特征（即易感因素、使能因素和需求因素）和这些服务的障碍；(3)测量该队列的两年结局，包括艾滋病毒风险行为，并确定吸毒青年的关键社会人口统计学和临床特征，他们在ED就诊后两年内因故意伤害和其他医疗护理而预后不佳。拟议的研究代表了与一个已建立的研究团队的合作，他们在ED环境中进行物质使用研究方面取得了成功的历史。迫切需要了解谁面临不良后果（药物使用、刑事司法、医疗）的最大风险，以及谁最不可能接受治疗，以便针对最需要的人进行药物使用和精神卫生干预。这项研究的结果对未来ED的预防和干预发展至关重要，以减少市中心青少年药物使用的健康差异。公共卫生相关性：在急诊科（ED）接受暴力伤害治疗的青少年酗酒和滥用非法药物以及其他多重风险行为（即犯罪、艾滋病毒风险行为和携带武器）的比例很高。本研究的结果将为未来市中心青少年药物使用的干预发展提供信息。