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，注射毒品者（PWID）的过量（OD）率是 高和许多PWID继续处于病毒（HIV，HCV）和细菌感染（例如，皮肤感染， 心内膜炎）。选择高风险药物和注射做法（“风险做法”），如共用注射 设备或联合使用多种药物（例如，阿片类药物和酒精），已被证明会增加风险 这些健康结果。然而，过去关于风险实践的许多工作都是跨部门的， 回顾性的，和/或侧重于个人层面的行为，限制了研究结果的生态有效性。一 一种可以减轻与过去研究相关的局限性的方法是生态瞬时评估 （EMA）。EMA允许使用移动的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，它可以捕获瞬时信息， 个人背景、位置或影响变化。这种收敛的并行混合方法研究将同时应用于 定性方法和EMA的“风险环境”框架提出的罗兹（2002年，2009年）。的 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）与微观（个人及其直接环境）和宏观不同层次相互作用 （系统）影响产生毒品危害的。很少有研究检查风险的多个组成部分 环境模型的组合或在现实世界的背景下。这种混合方法的研究有两个 主要目标：1）对PWID进行探索性定性访谈，以更好地为以下文献提供信息： 微观和宏观水平（“上下文”，即，外生的人）的因素，可能没有以前 识别，2）使用EMA检查风险实践与个人和环境之间的关系 因素，从而提供有关风险预测因素的实时信息，这些风险预测因素以前仅在 在参与者的自然环境中进行横断面研究或根本不进行。街道外展将用于 招募来自檀香山（HI）的种族多样性PWID（N = 75）参与定性访谈，基线 2周EMA评估。这项研究的结果将为一个更大的项目提供信息， 背景和个人层面的因素与风险实践之间的复杂关系。长期 这一系列工作的目标是开发一个全面的风险环境模型，可用于 为PWID提供减少危害服务和干预措施，以及影响政策决策 会影响到吸毒的人

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.