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Substance Use Among Violently Injured Youth in an Urban ER: Services and Outcome

城市急诊室中遭受暴力伤害的青少年的药物使用：服务和结果

基本信息

批准号：
7808069
负责人：
REBECCA M. CUNNINGHAM
金额：
$ 58.87万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-05-01 至 2014-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7808069
关键词：
Abdominal Pain Accident and Emergency department Accidental Injury Acute Address Admission activity Adolescent Adolescent Risk Behavior Adult Affect African American Age Aggressive behavior Alcohol consumption Alcohol or Other Drugs use Alcohols Behavior Biological Markers Caring Caucasians Caucasoid Race Cause of Death Centers for Disease Control and Prevention (U.S.)Characteristics Clinical Cocaine Collaborations Communities Criminal Justice DSM-IV Data Demographic Factors Development Diagnosis Discipline Drug usage Drug user Economic Factors Education Enabling Factors Environment Exhibits Family Firearms Future Gender Guns HIV HIV Infections Health Health Services Health Services Accessibility Hispanics Homicide Hospitalization Hospitals Human immunodeficiency virus test Illicit Drugs Imprisonment Individual Inhalant dose form Injury Institutes Intentional injury Intervention Justice Laceration Life Location Marijuana Measures Medical Mental Health Mental Health Services Minor Modeling Multiple Partners Observational Study Organism Outcome Participant Patients Pattern Pharmaceutical Preparations Physicians Population Population Study Predisposing Factor Prevention Preventive Intervention Problem behavior Race Recording of previous events Registries Reliance Reporting Research Research Personnel Resources Risk Risk Behaviors Risk Factors Sample Size Sampling Schools Services Severities Staging Substance abuse problem System Time Trauma Vehicle crash Violence Violent injury Visit Vulnerable Populations Work Youth adolescent drug use adolescent substance use assault base binge drinking care seeking cohort condoms demographics design experience falls follow up assessment follow-up health belief health care service utilization health disparity high risk high risk sexual behavior income insurance indexing injured inner city innovation interest interpersonal conflict longitudinal course peer peer influence prospective public health relevance recidivism service utilization sex risk socioeconomics substance abuse treatment therapy development transmission process weapons wound

项目摘要

DESCRIPTION (provided by applicant): Intentional injury (violence) is the leading cause of death among African-American youth. The provision of medical services in an inner-city Emergency Department (ED) provides a critical opportunity to identify and characterize future timing and pattern of service use among youth with drug use, who may be missed in school-based samples, and who may not yet be in the criminal justice system. Health disparities exist in rates of violent injury among inner-city youth, many of whom are African-American, and are mirrored in limited access to substance use treatment services and over representation in the criminal justice system. Currently, there is a paucity of data on the timing, pattern, barriers, and trajectory of youth with multiple risks (illicit drug use and ED visit for acute violent injury) in terms of their intersection with health services (substance use treatment, mental health, medical) and criminal justice system, which limits the development of optimal timing and setting for interventions. Youth treated in the ED may have exacerbated rates of illicit drug use, and other risk behaviors (e.g., delinquency, HIV risk behaviors, weapon carriage) and different trajectories of outcomes and interactions with service use sectors based on presentation for intentional injury as compared to other complaints (medical, unintentional injuries). Understanding the outcomes and service utilization among inner- city youth with drug use with and without acute violent injury is critically important in developing prevention and treatment services to address these multiple risk factors. We propose a prospective observational study over a two-year period to identify a high risk group of youth with past year illicit drug use (N=800) seeking care in an inner city ED. The specific aims of the study, chosen to obtain data necessary to determine the location and content of subsequent interventions, are: (1) To describe characteristics of youth (ages 14-24; n=800) who report illicit drug use presenting to an urban ED for an acute violent injury (n=400), compared to youth with drug use who seek non-violence related ED care (n=400), including socio-demographic characteristics, problem severity (e.g., substance use, violence, HIV risk behaviors, etc.), enabling factors, and service utilization (i.e., substance use treatment, mental health, and medical); (2) To identify the trajectories of participants' interactions with health services during the two years following their ED visit and the key characteristics (i.e., predisposing, enabling, and need factors) associated with types of service use (substance use treatment, mental health, medical/ ED, and HIV testing) and barriers to these services; and, (3) To measure two-year outcomes for this cohort including, HIV risk behaviors, and to identify key socio- demographic and clinical characteristics of youth with drug use, who have poor outcomes in the two years after ED visit for intentional injury and other medical care. The proposed study represents collaboration with an established team of investigators who have a successful history of conducting substance use research in ED settings. There is a critical need to understand who is at greatest risk for poor outcomes (substance use, criminal justice, medical), and, who is least likely to enter treatment in order to target substance use and mental health interventions for those with greatest need. Results from this proposed study are essential to inform future ED prevention and intervention development to reduce health disparities among inner-city youth with substance use. PUBLIC HEALTH RELEVANCE: Youth treated in the Emergency Department (ED) for violent injury have high rates of alcohol and illicit drug misuse, and other multiple risk behaviors (i.e. delinquency, HIV risk behaviors, and weapon carriage). The results of this proposed study will inform future intervention development among inner-city youth with substance use.

描述（由申请人提供）：故意伤害（暴力）是非洲裔美国青年死亡的主要原因。提供医疗服务，在市中心的急诊室（艾德）提供了一个重要的机会，以确定和表征未来的时间和模式的服务使用青少年吸毒，谁可能会错过以学校为基础的样本，谁可能还没有在刑事司法系统。市中心青年（其中许多是非洲裔美国人）的暴力伤害率存在健康差距，反映在获得药物使用治疗服务的机会有限以及在刑事司法系统中的代表性过高。目前，在与卫生服务（药物使用治疗、心理健康、医疗）和刑事司法系统的交叉方面，缺乏关于具有多种风险（非法药物使用和因急性暴力伤害而就诊的艾德）的青年的时间、模式、障碍和轨迹的数据，这限制了制定干预措施的最佳时间和环境。在艾德接受治疗的青少年可能会加剧非法药物使用率和其他风险行为（例如，犯罪、艾滋病毒风险行为、携带武器）以及基于故意伤害与其他投诉（医疗、意外伤害）相比的不同结果轨迹和与服务使用部门的相互作用。了解有和没有急性暴力伤害的市中心吸毒青年的结果和服务利用率，对于制定预防和治疗服务以解决这些多重风险因素至关重要。我们提出了一项为期两年的前瞻性观察性研究，以确定一个高风险组的青年与过去一年的非法药物使用（N=800）寻求照顾，在内城ED的具体目标的研究，选择获得必要的数据，以确定后续干预的位置和内容，是：（1）描述青年的特点（14-24岁; n=800）报告非法药物使用到城市艾德寻求急性暴力伤害（n=400），与寻求非暴力相关艾德护理的药物使用青年（n=400）相比，包括社会人口统计学特征，问题严重程度（例如，药物使用、暴力、艾滋病毒危险行为等），使能因素和服务利用率（即，物质使用治疗、心理健康和医疗）;（2）确定参与者在艾德就诊后两年内与卫生服务机构互动的轨迹和关键特征（即，与服务使用类型相关的诱发因素、使能因素和需求因素（药物使用治疗、心理健康、医疗/艾德和艾滋病毒检测）以及获得这些服务的障碍;以及（3）测量该队列的两年结果，包括艾滋病毒风险行为，并确定吸毒青年的关键社会人口统计学和临床特征，因故意伤害或其他医疗护理而就诊艾德后两年内结局较差的患者。这项拟议的研究代表了与一个已建立的研究人员团队的合作，该团队具有在艾德环境中进行物质使用研究的成功历史。有一个关键的需要了解谁是在最大的风险为不良结果（物质使用，刑事司法，医疗），以及，谁是最不可能进入治疗，以针对物质使用和心理健康干预措施，为那些最需要的。这项研究的结果对未来艾德预防和干预发展至关重要，以减少城市内青少年药物使用的健康差异。公共卫生相关性：在急诊室（艾德）接受暴力伤害治疗的青少年有很高的酒精和非法药物滥用率，以及其他多种风险行为（即犯罪，艾滋病毒风险行为和携带武器）。这项拟议的研究结果将告知未来的干预发展与物质使用的内城青年。