Health-Seeking Behaviors among Men with Criminal Justice and Substance Abuse Hist

有刑事司法和药物滥用史的男性寻求健康的行为

• 批准号: 8029102
• 负责人: Pamela Valera
• 金额: $ 12.73万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-21 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8029102
• 关键词: Health; Seeking; Behaviors; among; Men

DESCRIPTION (provided by applicant): The proposed training program will focus on cancer risks, screening behaviors and preventive health care among men returning to the community after incarceration. Individuals who have extensive criminal justice histories have disproportionately high rates of smoking, greater burden of viral infections associated with cancer (e.g., hepatitis, HPV, HIV) and greater barriers to establishing and obtaining routine health care. Although efforts are underway to connect people to health care settings upon release, there is an absence of evidence about men's health-seeking behaviors after returning to the community. Little is known about men's motivations and intentions to participate in screening, prevention or treatment, or about contextual factors that affect their health behavior. A five year research and training program is proposed to prepare the principal investigator for a career in cancer-health disparities and participatory health services research focused on socially-marginalized, at-risk groups, such as former prisoners. The candidate's long-term goals are to advance her skills in community-partnered research, research design and psychometric development of measures. This program will build upon her strong background in HIV/AIDS, community practice and qualitative research, by providing a deeper understanding of factors that foster cancer-related health disparities among men with histories of criminal justice and substance abuse problems. Specific training objectives are: 1) to become proficient in the development, design, and use of psychometrically-sound instruments to measure health-seeking behavior among high-risk, socioeconomically disadvantaged men; 2) to gain experience with participatory research methods, in order to maximize former offenders' involvement in research and engagement in interventions to increase their use of needed health services; 3) to learn about the design of multilevel health services interventions, in order to create a program focusing on ethnic minority men with extensive criminal justice and substance abuse histories, and; 4) to develop an understanding of the ethical issues that enter into health services research among people recently released from the criminal justice system. Structured training activities involve coursework in methodology, psychometrics/scale development, biostatistics, epidemiology, bioethics, advanced data analysis, and correctional health research. Mentors and advisors will provide additional readings, research supervision and consultation. The research and training activities will be pursued through the Division of Community Collaboration and Implementation Science in the Department of Epidemiology and Population Health at the Albert Einstein College of Medicine with senior researchers in a number of institutions including Columbia University and the University of Michigan. This training will provide an important foundation for collaborative planning of evidence-based community health services for this population. The proposed research will examine the health-related needs and health-seeking behaviors of 300 men ages 35-64 that have criminal justice and substance abuse histories in New York City. Specific aims are: 1) to explore unmet health and psychosocial needs and quality of life among ethnic minority men who have extensive criminal justice and substance histories; 2) to assess health-seeking behaviors among these men, including influences on their decisions to participate in cancer screening, prevention and treatment; 3) to describe contextual barriers and facilitators that affect men's use of services; and 4) to evaluate the reliability and validity of instruments developed or adapted for use with men with criminal justice and substance use histories. In addition to characterizing men's health concerns, this study will describe barriers and facilitators to seeking care and treatment as well as the complex set of circumstances (e.g. health/illness, parenting, vocational skills, housing stability, employment, and social support) that may impede men's ability to prioritize their health care needs. Research and training activities described in this proposal are intended to develop the community connections, preliminary data and research skills necessary for the candidate to launch an independent program of community intervention research, designed to improve health and well-being and reduce cancer burden among vulnerable and largely disenfranchised segments of our society. PUBLIC HEALTH RELEVANCE: The proposed K01 Research Scientist Development Award title, "Health Seeking among Men with Criminal Justice and Substance Abuse Histories" has serious relevance to public health agenda and priorities. Of the 7.3 million adults who are under some form of correctional supervision (e.g., probation, parole, prison and jail inmates), ethnic minority men are four times as likely than whites and nearly 2.5 times as likely to be under correctional supervision[40]. Nationwide, many states are recognizing that chronic and infectious diseases are concentrated in correctional populations and the punitive responses to nonviolent offenders are no longer a viable, economical option. Once these men return to the community, men who have extensive criminal justice and substance abuse histories often have unequal or lack access to health care services and fail to continue treatments that were initiated during incarceration[42]. Not only do ex-offenders report a wide array of problems and unmet health needs, but cancer-health disparities also exist. The proposed study contributes to the area of cancer-health disparities research and is consistent with NCI's strategic plan to chart the risk trajectories that may contribute to cancer and other adverse health conditions among vulnerable and disadvantaged populations.

描述（由申请人提供）：拟议的培训计划将侧重于癌症风险，筛查行为和预防保健的男子返回社区后，监禁。具有广泛刑事司法史的个人吸烟率不成比例地高，与癌症相关的病毒感染负担更大（例如，肝炎、人乳头瘤病毒、艾滋病毒）以及建立和获得常规保健的更大障碍。虽然正在努力使人们在获释后与医疗机构联系起来，但没有证据表明男子在返回社区后有寻求健康的行为。人们对男性参与筛查、预防或治疗的动机和意图知之甚少，也不了解影响其健康行为的背景因素。 提出了一个为期五年的研究和培训计划，以准备在癌症健康差距和参与性卫生服务研究的职业生涯的主要研究员，重点是社会边缘化，在危险群体，如前囚犯。候选人的长期目标是提高她在社区合作研究，研究设计和测量的心理测量发展方面的技能。该计划将建立在她在艾滋病毒/艾滋病，社区实践和定性研究的强大背景，通过提供对促进与刑事司法和药物滥用问题的男性之间与癌症相关的健康差异的因素的更深入的了解。具体的培训目标是：1）精通开发、设计和使用心理测量学健全的工具，以测量高风险、社会经济上处于不利地位的男性的求医行为; 2）获得参与性研究方法的经验，以最大限度地使前罪犯参与研究和参与干预措施，增加他们对所需卫生服务的使用; 3）了解多层次卫生服务干预措施的设计，以创建一个专注于具有广泛刑事司法和药物滥用历史的少数民族男性的计划; 4）了解最近从刑事司法系统释放的人中进入卫生服务研究的伦理问题。 结构化的培训活动涉及方法学、心理测量学/量表开发、生物统计学、流行病学、生物伦理学、高级数据分析和矫正健康研究等课程。导师和顾问将提供额外的阅读，研究监督和咨询。研究和培训活动将通过阿尔伯特·爱因斯坦医学院流行病学和人口健康系社区合作和执行科学司与包括哥伦比亚大学和密歇根大学在内的一些机构的高级研究人员一起进行。这项培训将为这一人群循证社区卫生服务的合作规划提供重要基础。 这项拟议中的研究将调查纽约市300名年龄在35-64岁之间、有刑事司法和药物滥用史的男性的健康相关需求和寻求健康的行为。具体目标是：1）探索未满足的健康和心理社会需求和生活质量的少数民族男子谁有广泛的刑事司法和药物的历史; 2）评估这些人的健康寻求行为，包括对他们的决定参与癌症筛查，预防和治疗的影响; 3）描述上下文的障碍和促进因素，影响男子使用的服务;和4）评估为有刑事司法和物质使用史的男性开发或改造的工具的可靠性和有效性。除了描述男性的健康问题，这项研究将描述寻求护理和治疗的障碍和促进因素，以及可能阻碍男性优先考虑其医疗保健需求的复杂情况（例如健康/疾病、养育子女、职业技能、住房稳定性、就业和社会支持）。 本提案中描述的研究和培训活动旨在发展候选人启动社区干预研究独立计划所需的社区联系，初步数据和研究技能，旨在改善健康和福祉，减少我们社会中弱势群体和大部分被剥夺权利群体的癌症负担。 公共卫生相关性：拟议的K 01研究科学家发展奖标题，“寻求健康的男子与刑事司法和药物滥用史”有严重的相关性，公共卫生议程和优先事项。在730万处于某种形式的教养监督下的成年人中（例如，缓刑，假释，监狱和监狱囚犯），少数民族男子的可能性是白人的四倍，近2.5倍的可能性受到惩教监督[40]。在全国范围内，许多州都认识到慢性病和传染病集中在教养人口中，对非暴力罪犯的惩罚性反应不再是一个可行的，经济的选择。一旦这些人回到社区，有广泛刑事司法和药物滥用历史的人往往无法平等或缺乏获得医疗保健服务的机会，并且无法继续在监禁期间开始的治疗[42]。不仅前罪犯报告了一系列问题和未满足的健康需求，而且癌症健康差异也存在。拟议的研究有助于癌症健康差异研究领域，并与NCI的战略计划相一致，以绘制可能导致弱势和弱势群体癌症和其他不良健康状况的风险轨迹。