Contextual factors of the risk environment surrounding injection drug use: A real-time approach

项目摘要 在美国目前的阿片类药物危机中，注射吸毒者中的过量(OD)率(PWID)为 高PWID和许多PWID继续处于病毒(艾滋病毒、丙型肝炎)和细菌感染(例如，皮肤感染， 心内膜炎)。选择高风险的药物和注射做法(“风险做法”)，例如共用注射 使用设备或联合使用多种药物(如阿片类药物和酒精)已被证明会增加风险 对于这些健康结果。然而，过去关于风险实践的许多工作都是横向的， 回顾和/或关注个人层面的行为，限制了研究结果的生态有效性。一 可以缓解与过去研究相关的限制的方法是生态学瞬时评估 (EMA)。EMA允许使用移动设备在人的自然环境中实时收集数据。 考虑这种方法的一个优点是，它可以将瞬时信息捕获为 个人的背景、位置或受影响的变化。这项收敛的并行混合方法研究将同时应用两种方法 Rhodes(2002,2009)提出的“风险环境”框架的定性方法和EMA。这个 风险环境模型表明，复杂的环境因素(子类型：物理、政策、经济、 社会)与不同程度的微观(个人和他/她的直接背景)和宏观层面互动 (系统)产生毒品危害的影响。很少有研究研究这种风险的多个组成部分 环境模型结合在一起或在真实世界的背景下。这项混合方法的研究有两个 主要目标：1)对PWID进行探索性的定性访谈，以更好地向文献提供信息 微观和宏观层面(“背景”，即个人的外生性)因素，这可能是以前没有的 确定，以及2)使用EMA检查风险做法与个人和背景之间的关系 因素，从而提供有关以前仅在 在参与者的自然环境中进行横断面研究或根本不进行研究。街道外展将用于 在HI火奴鲁鲁招募不同种族的PWID(N=75)参加定性面试，基线 评估，和为期两周的EMA。这项研究的发现将为一个更大的项目提供信息，该项目将有权审查 背景因素和个人因素与风险做法之间的复杂关系。长期的 这项工作的目标是开发一个全面的风险环境模型，可用于 通报为残疾人提供的减害服务和干预措施以及影响政策决定 会影响到吸毒者。

Project Summary Amidst the current opioid crisis in the U.S., overdose (OD) rates among people who inject drugs (PWID) are high and many PWID continue to be at risk for viral (HIV, HCV) and bacterial infections (e.g., skin infections, endocarditis). Select high-risk drug and injection practices (“risk practices”), such as sharing injection equipment or using multiple drugs in combination (e.g., opioids and alcohol), have been shown to increase risk for these health outcomes. However, much of the past work on risk practices has been cross-sectional, retrospective, and/or focuses on individual-level behaviors, limiting the ecological validity of findings. One methodology that could mitigate limitations associated with past studies is ecological momentary assessment (EMA). EMA allows for data collection in real-time, in a person's natural environment, using mobile devices. One advantage when considering this methodology is that it can capture momentary information as the individual's context, location, or affect changes. This convergent parallel mixed methods study will apply both qualitative methods and EMA to the “risk environment” framework proposed by Rhodes (2002, 2009). The risk environment model suggests that complex environmental factors (subtypes: physical, policy, economic, social) interact with varying levels of micro- (individual and his/her immediate context) and macro-level (system) influence to produce drug-related harm. Few studies have examined multiple components of the risk environment model in combination or within the real-world context. This mixed-methods study has two primary goals: 1) conduct exploratory qualitative interviews with PWID to better inform the literature on micro- and macro-level (“contextual,” i.e., exogenous to the person) factors that may not have been previously identified, and 2) use EMA to examine relationships between risk practices and individual and contextual factors, thus providing real-time information on predictors of risk that have only been examined previously in cross-sectional studies or not at all, in the participant's natural environment. Street outreach will be used to recruit ethnically diverse PWID (N = 75) in Honolulu, HI to participate in a qualitative interview, baseline assessment, and 2-week EMA. The findings from this study will inform a larger project powered to examine complex relationships between contextual and individual-level factors with risk practices. The long-term objective of this line of work is to develop a comprehensive model of the risk environment that can be used to inform the delivery of harm reduction services and interventions for PWID, as well as impact policy decisions that affect people who use drugs.