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

描述(由申请者提供)：拟议的培训计划将侧重于癌症风险、筛查行为和在监禁后返回社区的男性的预防性保健。有广泛刑事司法记录的个人吸烟率高得不成比例，与癌症(如肝炎、人乳头瘤病毒、艾滋病毒)相关的病毒感染负担更大，建立和获得常规保健的障碍更大。虽然正在努力使人们在获释后与卫生保健机构联系起来，但尚无证据表明男子返回社区后的求医行为。人们对男性参与筛查、预防或治疗的动机和意图或影响其健康行为的背景因素知之甚少。 建议实施一项为期五年的研究和培训计划，为首席调查员在癌症-健康差距和参与性卫生服务研究方面的职业生涯做好准备，重点是社会边缘化的高危群体，如前囚犯。这位候选人的长期目标是提高她在社区合作研究、研究设计和心理测量发展方面的技能。该计划将以她在艾滋病毒/艾滋病、社区实践和定性研究方面的强大背景为基础，通过更深入地了解在有刑事司法和药物滥用问题史的男性中导致癌症相关健康差距的因素。具体的培训目标是：1)熟练使用健全的心理测量工具来衡量高风险、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，以便最大限度地让罪犯参与研究并参与干预措施，以增加他们对所需医疗服务的利用；3)了解多级医疗服务干预措施的设计，以便创建一项以有广泛刑事司法和药物滥用史的少数民族男性为重点的方案；4)在最近从刑事司法系统释放的人中培养对医疗服务研究中伦理问题的认识。 有组织的培训活动涉及方法学、心理测量学/量表制定、生物统计学、流行病学、生物伦理学、高级数据分析和惩教卫生研究方面的课程工作。导师和顾问将提供额外的阅读资料、研究指导和咨询。研究和培训活动将通过阿尔伯特·爱因斯坦医学院流行病和人口健康系的社区合作和执行科学司与哥伦比亚大学和密歇根大学等一些机构的高级研究人员一起进行。这项培训将为合作规划这一人群的循证社区卫生服务提供重要的基础。 这项拟议的研究将调查300名年龄在35岁至之间、在纽约市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行为。具体目标是：1)探索有广泛刑事司法和吸毒历史的少数民族男子未得到满足的健康和心理社会需求以及生活质量；2)评估这些男子的求医行为，包括对他们参与癌症筛查、预防和治疗决定的影响；3)描述影响男子使用服务的背景障碍和促进者；4)评估为有刑事司法和吸毒历史的男子开发或改编的工具的可靠性和有效性。除了描述男性的健康问题外，这项研究还将描述寻求护理和治疗的障碍和促进者，以及可能阻碍男性优先考虑其卫生保健需求的一系列复杂情况(例如健康/疾病、育儿、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必要的社区联系、初步数据和研究技能，以便候选人启动一项独立的社区干预研究计划，旨在改善我们社会中脆弱和在很大程度上被剥夺公民权的阶层的健康和福祉，并减少癌症负担。 公共卫生相关性：拟议的K01研究科学家发展奖标题“有刑事司法和药物滥用史的男性寻求健康”与公共卫生议程和优先事项具有严重相关性。在730万成年人接受某种形式的管教监督(例如，缓刑、假释、监狱和监狱囚犯)中，少数民族男子接受管教监督的可能性是白人的四倍，几乎是白人的2.5倍[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回应不再是一个可行的、经济的选择。一旦这些男子返回社区，有广泛刑事司法和药物滥用史的男子往往不平等或缺乏获得保健服务的机会，无法继续在监禁期间开始的治疗[42]。有前科的人不仅报告了一系列的问题和未得到满足的健康需求，而且癌症与健康之间的差距也存在。这项拟议的研究对癌症-健康差异研究领域做出了贡献，并与NCI的战略计划相一致，该计划旨在绘制可能导致脆弱和弱势人群中癌症和其他不利健康状况的风险轨迹。

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.