Assessing the Feasibility of Economic Approaches to Prevention of Substance Abuse among Adolescents

评估预防青少年药物滥用的经济方法的可行性

• 批准号: 10618956
• 负责人: Rachel Brathwaite
• 金额: $ 19.4万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-10 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10618956
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Affect; Africa; Africa South of the Sahara; Age; Alcohol consumption; Alcohols; Attention; Behavior; Bereavement; Biological; Caring; Cessation of life; Clinic; Communities; Coping Skills; Country; Data; Development; Discrimination; Disease; Drug usage; Economics; Enrollment; Environment; Epidemic; Epidemiologic Factors; Epidemiology; Evidence based intervention; Exclusion; Family; Feeling hopeless; Fishes; Goals; Grant; HIV; HIV Seropositivity; HIV risk; HIV/AIDS; Health; Household; Human immunodeficiency virus test; Income; Individual; Infection; Intervention; Knowledge; Learning; Long-Term Effects; Low income; Measures; Mental Depression; Mental Health; Mental Health Associations; Methods; Modeling; Motivation; Patient Self-Report; Personal Satisfaction; Persons; Pharmaceutical Preparations; Play; Population; Poverty; Prevalence; Prevention approach; Psychotropic Drugs; Public Health; Reporting; Resource-limited setting; Resources; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Risk Taking; Role; Sahara; Sampling; Savings; School Drop-Outs; Schools; Stress; Stress and Coping; Student Dropouts; Supervision; Testing; Treatment outcome; Uganda; Unsafe Sex; Urine; Viral; Vulnerable Populations; Youth; adolescent alcohol and drug use; alcohol consequences; alcohol measurement; alcohol misuse; alcohol risk; antiretroviral therapy; binge drinking; care outcomes; chronic pain; cohort; coping mechanism; design; deter alcohol use; drug abuse prevention; drug misuse; empowerment; evidence base; experience; financial literacy; high risk; illicit drug use; improved; innovation; low income country; mortality; poverty reduction; prevent; preventive intervention; protective factors; reduced alcohol use; resilience factor; response; social; social stigma; stressor; substance abuse prevention; substance use; theories; vulnerable adolescent

PROJECT ABSTRACT Adolescent alcohol and drug use (ADU) is a significant public health challenge in sub-Saharan Africa (SSA). About 41.6% of adolescents in SSA reported using at least one psychoactive agent, with alcohol being the most commonly used drug. Uganda, one of the poorest countries in SSA, has the second highest rate of per capita alcohol consumption in SSA (15.1 liters of pure alcohol vs regional average of 6.2 liters of pure alcohol) and over one third of Ugandan adolescents have used alcohol in their lifetime, 22.5 million are current drinkers, and over 50% engage in heavy episodic drinking. These estimates reach even greater magnitudes in the country’s fishing villages – a key HIV vulnerable population- where ADU is normative. A few studies have assessed ADU among AYLHIV, yet AYLHIV are at higher risk for ADU, and ADU impedes adherence to anti-retroviral therapy (ART), retention in care, and viral suppression. Several studies have examined the risk and resilience factors for ADU but few interventions targeting ADU have been tested in SSA. Only 10 ADU interventions have been evaluated in SSA and only a few have been successful. The majority have been implemented in school settings, which may exclude adolescents in fishing communities that have high rates of school dropout. Moreover, none has targeted risk factors such as poverty and mental health, which are rampant among AYLHIV and their families, undermine AYLHIV’s coping skills and resources, and have been associated with increased risk for ADU among adolescents. Family-based economic empowerment (FEE) interventions have the potential to prevent ADU among AYLHIV by reducing poverty and its associated mental health impacts, and also bolstering AYLHIV and their families’ resources to overcome the challenges associated with HIV. Given the lack of evidence-based culturally tailored interventions to prevent ADU in AYLHIV in low-income settings such as Uganda, this study proposes to: Aim 1a. Examine the prevalence and consequences of ADU in a sample of 200 AYLHIV (ages 15- 24) seen at six (6) HIV clinics located in the fishing communities of southwestern Uganda. ADU will be measured using self-report and biological data (i.e. urine). Aim 1b. Using a mixed methods approach, identify the multi- level (individual, interpersonal, community and structural) factors associated with ADU among AYLHIV. Aim 2: Using a subset of the sample, explore the feasibility and short-term effects of a FEE intervention on ADU among AYLHIV. Our intervention focuses on older adolescents and young adults in a high-risk environment (i.e. fishing communities) to elucidate the contextually relevant risk and resilience factors for ADU among AYLHIV undergoing social transitions. Additionally we innovatively target the most commonly occurring risk factors for ADU (i.e. poverty and mental health problems) through the FEE that includes provision of youth development savings accounts, financial literacy sessions and ADU risk reduction sessions. Our findings will inform the design of an R01 grant to examine the long-term effects of a family-based economic empowerment intervention on ADU among AYLHIV.

项目摘要 青少年酒精和药物使用（ADU）是撒哈拉以南非洲（SSA）的一个重大公共卫生挑战。 SSA中约41.6%的青少年报告使用至少一种精神活性药物，其中酒精是最多的 常用药物。乌干达是撒南非洲最贫穷的国家之一，人均收入在非洲国家中排名第二。 撒哈拉以南非洲地区的酒精消费量（15.1升纯酒精，而该地区的平均水平为6.2升纯酒精）及以上 三分之一的乌干达青少年在其一生中使用过酒精，2250万人目前是饮酒者， 50%的人偶尔会酗酒。这些估计数在该国的渔业中甚至达到更高的水平 艾滋病毒/艾滋病感染者是艾滋病毒/艾滋病感染者的主要群体，在这些村庄，艾滋病毒/艾滋病感染者是正常的。一些研究评估了ADU， AYLHIV，然而AYLHIV患ADU的风险更高，ADU阻碍了抗逆转录病毒治疗（ART）的依从性， 保持护理和抑制病毒。一些研究已经检查了ADU的风险和弹性因素 但在撒哈拉以南非洲地区，很少有针对性的干预措施得到测试。仅对10项ADU干预措施进行了评价 只有少数几个成功了。大多数已在学校环境中实施， 可能会将辍学率高的渔业社区的青少年排除在外。此外， 有针对性的风险因素，如贫困和心理健康，这是艾滋病毒/艾滋病感染者及其家庭中普遍存在的问题， 破坏AYLHIV的应对技能和资源，并与ADU的风险增加有关， 青少年。以家庭为基础的经济赋权干预措施有可能预防成人吸毒 通过减少贫困及其相关的心理健康影响，并支持艾滋病毒/艾滋病感染者， 他们的家庭资源，以克服与艾滋病毒有关的挑战。由于缺乏证据， 在乌干达等低收入环境中，这项研究旨在采取文化上适合的干预措施来预防AYLHIV中的ADU， 目标1a。在200名AYLHIV（年龄15- 18岁）样本中检查ADU的患病率和后果。 24)在乌干达西南部渔业社区的六（6）个艾滋病诊所看到。将测量ADU 使用自我报告和生物数据（即尿液）。目标1b。使用混合方法，确定多个 AYLHIV中ADU的相关水平（个体、人际、社区和结构）因素。目标二： 使用样本的一个子集，探索FEE干预对ADU的可行性和短期影响， Aylhiv。我们的干预措施侧重于处于高风险环境（即捕鱼）中的大龄青少年和年轻人 社区），以阐明AYLHIV中ADU的背景相关风险和弹性因素 正在经历社会转型。此外，我们创新性地针对最常见的风险因素， ADU（即贫困和心理健康问题），通过FEE，其中包括提供青年发展 储蓄账户、金融扫盲课程和ADU风险降低课程。我们的发现将为设计提供信息 研究以家庭为基础的经济赋权干预措施对成人年龄不足的长期影响 在艾滋病病毒中。