Drug Use, HIV, and Other Comorbidities In A Vulnerable Population

描述(由申请人提供)： 最近的基于人群的流行病学研究探讨了物质使用/精神健康发病率与性取向之间的关系，已经开始记录女同性恋者、男同性恋者和双性恋者中使用物质的风险、精神健康发病率和精神卫生服务的高水平。尽管越来越多的证据表明这种脆弱性更大，精神卫生服务的使用率更高，但到目前为止，我们还不知道这种脆弱性的来源，也无法评估精神卫生服务的高使用率是否是需求或获得和/或提供的护理质量方面的问题所致。作为对NIDA PA-04-100的回应，我们建议利用即将到来的2005年加州健康访谈调查(CHIS；N“52,740)中的现有数据，对2,700名受访者进行跟踪结构的电话访谈调查，对少数族裔的性取向进行过度抽样。访谈将评估酒精和药物使用模式、药物使用/精神健康发病率、对治疗需求的看法、获得和接受药物使用/精神健康服务的经验，以及个人和社会背景因素，这些因素可能是最近研究中发现的更大风险模式的基础。获得的数据将允许对发病率和服务使用模式、护理障碍、对未得到满足的需求的看法以及针对药物使用和精神健康问题的护理质量方面可能存在的问题进行必要的检查。具体地说，我们将利用现有来源和CHIS后续调查的数据，1)检验性取向在物质使用、精神健康发病率、儿童虐待以及当前非法和非医疗药物和酒精使用的规范和社会背景方面的差异的证据；2)调查性取向相关物质质量问题和精神健康相关护理和治疗的证据；3)审查社会弱势地位(例如，少数民族/种族少数群体和性取向少数群体)在造成发病率和服务使用方面的健康差异方面可能产生的共同影响；以及4)在少数性取向人群中找出影响药物使用风险和心理健康发病率的因素。调查结果将产生必要的经验性信息，可用于为这一群体设计循证治疗干预措施，提高保健服务提供者对性少数群体(男、女同性恋和双性恋)客户的独特需求的认识，并进一步了解社会逆境、歧视、药物使用和精神健康发病率之间的关系如何导致这一群体经常出现的健康差距。由于这项研究不是基于理论或概念框架，研究结果将主要是描述性和探索性的。然而，即使有了这一限制，它也将做出重大贡献。

DESCRIPTION (provided by applicant): Recent population-based epidemiologic studies examining the association between substance use/mental health morbidity and sexual orientation have begun to document an elevated risk for substance use, mental health morbidity and high levels of mental health services use among lesbians, gay men and bisexual individuals. Despite the growing evidence for this greater vulnerability and higher rates of mental health services use, we do not know, as yet, the source of this vulnerability nor are we able to evaluate whether the high mental health services use rates are a function of need or problems in access and/or the quality of care provided. In response to NIDA PA-04-100, we propose to capitalize on data available in the upcoming 2005 California Health Interview Survey (CHIS; N "52,740) to conduct a follow back structured telephone interview survey of 2,700 respondents, over sampled for minority sexual orientation. The interview will assess patterns of alcohol and drug use, substance use/mental health morbidity, perceptions of treatment needs, experiences in accessing and receipt of substance use/mental health services, and individual and social contextual factors that may underlie the greater risk patterns that are now being uncovered in recent studies. Data obtained will allow needed examination of morbidity and services use patterns, barriers to care, perceptions of unmet needs, and possible problems in the quality of care for substance use and mental health concerns. Specifically, using data from both existing sources and the CHIS follow back survey, we will 1) examine evidence for sexual orientation related differences in substance use, mental health morbidity, childhood maltreatment, and norms and social contexts for current illicit and non medical drug and alcohol use; 2) investigate evidence for sexual orientation-associated problems in the quality of substance and mental health-related care and treatment; 3) examine the possible joint effects of socially disadvantaged statuses (e.g., ethnic/racial minority and sexual orientation minority) in generating health disparities in morbidity and services use; and 4) identify factors among those of minority sexual orientation that modify risk for substance use and mental health morbidity. Findings will generate needed empirically-based information that can be used to design evidence-based treatment interventions for this population, increase awareness among health-care service providers of the unique needs of sexual minority (gay, lesbian and bisexual) clients, and further understanding of how the relationships among social adversity, discrimination, and substance use and mental health morbidity result in the health disparities often seen in this population. Because the study is not based on a theoretical or conceptual framework, findings will be primarily descriptive and exploratory. Even with this limitation, however, it will make a major contribution.