Drug Use and Sexual Risk Behaviors Among Emerging Adults in the ER

这个指导职业发展奖旨在联合收割机计划的重点 研究，指导和教学法，以提供先进的培训，这将有助于我 过渡到一个独立的以病人为导向的研究事业，重点是发展， 提供和评价针对药物使用的技术强化干预措施 （包括非法药物和处方药的非医疗使用）和减少艾滋病毒风险 （与艾滋病毒有关的性风险行为[HIV SRB];例如，多次使用避孕套 性伴侣，醉酒时的性行为;以及预防注射毒品使用） 新兴成年人（EAs）。关于选举机构中药物使用和艾滋病毒工作人员代表机构的研究 一般集中在校园环境中的大学生中的酒精使用; 然而，药物使用和艾滋病毒（以及其他相关的性传播感染） 生活在城市、低资源社区的年轻人中， 尤其是非裔美国人。在日常和事件层面，药物使用和艾滋病毒 SRB可能受到社会认知因素的影响（例如，实质动机 使用/艾滋病毒SRB，进行安全性行为/不使用药物的自我效能）， 特定物质的药理学。然而，日常流程数据侧重于社交 认知因素，物质使用和艾滋病毒SRB之间的EA，特别是那些来自非校园 环境，是缺乏的，但将是高度翔实的发展， 为幼儿园提供量身定制的药物使用和艾滋病毒风险降低简短干预措施。的 急诊科（艾德）是一个关键的场所，为接触风险EA从事 物质使用和艾滋病毒危险行为。研究表明，高比率的物质使用和 艾滋病毒SRB之间的EA患者在艾德，但没有干预存在EA在这种情况下。 艾德可能是干预这些年轻人的唯一机会， 在城市，资源匮乏的环境往往缺乏初级保健提供者， 从儿科到成人药物，可能没有保险或保险不足，也可能没有 参与到传统的大学校园环境中。进一步利用技术（例如， 移动的电话）在这个年龄组中相对普遍，并且大多数人更喜欢 基于技术的通信（例如，短信），因此， 可以通过这种技术来增强。我的职业目标是发展专业知识： 1)在使用技术来评估社会认知因素之间的日常关系时， 物质使用（即，非法药物，包括注射和非医疗使用处方 （2）在制定和评估 药物使用和艾滋病毒性工作人员代表性关系干预措施，适用于低资源社区， 城市艾德等医疗机构，通过整合基于新技术的 通信拟议培训计划的目的是：1）增加知识 社会认知因素、物质使用、艾滋病毒SRB和相关的 后果（例如，艾滋病毒/性传播感染，伤害），2）学习使用 评估和分析有关社会认知因素的日常数据的技术， 3）获得制定、实施和管理艾滋病毒/艾滋病方案的技能， 评估一项针对药物使用和艾滋病毒性工作场所的技术强化干预措施， 艾德的环境影响评估，以及4）进一步培训如何负责任地进行人类研究 科目这些培训目标与具体的研究目标密切相关： 从艾德环境中招募的EA进行前瞻性、纵向、每日数据收集 使用基于移动的文本消息的物质使用评估（即，非法药物和 非医疗使用的处方药）和艾滋病毒风险行为（主要是SRB，但也 注射毒品使用），包括测量可能导致 物质使用与艾滋病毒风险之间的关系（例如，实质动机 使用/危险性行为，与安全套使用相关的自我效能），以及2）根据 在研究目标1中进行的前瞻性研究，开发和试点测试量身定制的 干预（例如，使用的物质、伴侣类型、社会认知因素和性别） 对于艾德的EA患者，重点是减少物质使用和HIV SRB，这将 通过使用针对药物使用的移动的手机短信得到加强 和艾滋病毒SRB。我将通过密切合作来实现这些研究和培训目标。 来自在这些内容领域，教学课程，和 定向读数。

This mentored career development award seeks to combine a program of focused research, mentorship, and didactics to provide advanced training which will facilitate my transition into an independent patient-oriented research career focusing on developing, delivering, and evaluating technology-enhanced interventions targeting substance use (including illicit drugs and non-medical use of prescription drugs) and HIV risk reduction (HIV-related sexual risk behaviors [HIV SRBs]; e.g., inconsistent condom use, multiple partners, sex while intoxicated; and prevention of injection drug use) among at-risk emerging adults (EAs). Research regarding substance use and HIV SRBs among EAs has generally focused on alcohol use among college students from campus settings; however, substance use and HIV (and other associated Sexually Transmitted Infections) disproportionately occur among young people living in urban, low-resource communities, particularly African Americans. At the daily and event-level, substance use and HIV SRBs may be influenced by social cognitive factors (e.g., motivations for substance use/HIV SRBs, self-efficacy to engage in safe sex/not use substances) in addition to the pharmacology of specific substances. However, daily process data focusing on social cognitive factors, substance use, and HIV SRBs among EAs, especially those from noncampus settings, is lacking, yet would be highly informative to the development of tailored substance use and HIV risk reduction brief interventions for EAs. The Emergency Department (ED) is a critical venue for accessing at-risk EAs engaging in substance use and HIV risk behaviors. Research shows high rates of substance use and HIV SRBs among EA patients in the ED, yet no intervention exists for EAs in this setting. The ED may be the only opportunity to intervene with these young people because EAs in urban, low-resource settings often lack a primary care provider during the transition from pediatric to adult medicine, may be un-insured or under-insured, and may not be involved in a traditional college campus setting. Further the use of technology (e.g., mobile phones) is relatively ubiquitous among this age group, and most prefer technology-based communication (e.g., text messaging), therefore interventions for EAs may be enhanced by this type of technology. My career goals are to develop expertise: 1) in the use of technology to assess daily relationships between social cognitive factors, substance use (i.e., illicit drugs, including injection, and non-medical use of prescription drugs), and HIV SRBs among EAs; and 2) in the development and evaluation of substance use and HIV SRB interventions, applicable in low-resource community and healthcare settings such as the urban ED, through the integration of novel technologybased communication. Aims of the proposed training plan are to: 1) Increase knowledge of the content areas of social cognitive factors, substance use, HIV SRBs, and related consequences (e.g., HIV/STI, injury) among EAs, 2) Learn techniques for using technology to assess and analyze daily-level data regarding social cognitive factors, substance use, and HIV SRBs among EAs, 3) Acquire skills to develop, implement, and evaluate a technology-augmented intervention for substance use and HIV SRBs among EAs in the ED, and 4) Further training in the responsible conduct of research with human subjects. These training aims are closely aligned with specific research aims: 1) Among EAs recruited from an ED setting, conduct prospective, longitudinal, daily data collection using mobile text message-based assessment for substance use (i.e., illicit drugs and prescription drugs used non-medically)and HIV risk behaviors (primarily SRBs, but also injection drug use) including measuring critical social cognitive factors that may underlie the relationships between substance use and HIV risk (e.g., motives for substance use/risky sex, self-efficacy related to condom use), and 2) Based on findings from the prospective study conducted in research Aim 1, develop and pilot test a tailored intervention (e.g., substances used, partner type, social cognitive factors, and gender) for EA patients in the ED focusing on reducing substance use and HIV SRBs, which will be enhanced through the use of mobile phone text messages targeting substance use and HIV SRBs. I will accomplish these research and training goals through close mentorship from a team with expertise in these content areas, didactic coursework, and directed readings.