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

这个辅导式职业发展奖旨在结合一个专注于 研究、指导和教学，提供高级培训，这将促进我的 过渡到独立的以患者为导向的研究生涯，专注于开发、 提供和评估针对物质使用的技术增强干预措施 (包括非法药物和非医疗用途的处方药)和减少艾滋病毒风险 (艾滋病毒相关的性危险行为[艾滋病毒SRB]；例如，安全套使用不一致，多次 性伴侣、醉酒时的性行为和预防注射吸毒)属于高危人群 新兴成人(EA)。环境保护者中药物使用和HIV-SRB的研究 普遍关注校园环境下大学生的饮酒情况； 然而，药物使用和艾滋病毒(以及其他相关的性传播感染) 不成比例地发生在生活在城市低资源社区的年轻人中， 尤其是非洲裔美国人。在日常和活动层面，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，物质动机 使用/艾滋病毒SRB，从事安全性行为的自我效能/不使用物质) 特定物质的药理学。然而，关注社交网络的日常流程数据 EAs，特别是非校区EAs的认知因素、物质使用和HIV SRB 环境，是缺乏的，但将对开发高度信息量 为紧急救济机构量身定做的物质使用和减少艾滋病毒风险的简短干预措施。这个 急诊科(ED)是接触处于危险中的紧急救援人员的重要场所 物质使用和艾滋病毒危险行为。研究表明，高物质使用率和 在急诊室的EA患者中存在HIV SRB，但在这种情况下对EA没有干预措施。 教育署可能是与这些年轻人沟通的唯一机会，因为教育署 在城市，低资源环境在过渡期间往往缺乏初级保健提供者 从儿科到成人医学，可能没有保险或保险不足，也可能不是 参与了传统的大学校园环境。进一步使用技术(例如， 手机)在这个年龄段中相对普遍，大多数人更喜欢 以技术为基础的通信(例如，文本消息)，因此对环境影响评估的干预 可以通过这种类型的技术来增强。我的职业目标是发展专业知识： 1)在使用技术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，包括注射和非医疗用途的处方 (2)制定和评价 物质使用和艾滋病毒SRB干预，适用于低资源社区和 通过整合以新技术为基础的医疗保健环境，如城市教育 沟通。拟议培训计划的目标是：1)增加知识 社会认知因素、物质使用、艾滋病毒和相关SRB等内容领域 环境影响(如艾滋病毒/性传播感染、伤害)，2)学习使用技术 评估和分析有关社会认知因素的日常数据的技术， EAs中的物质使用和艾滋病毒SRB，3)获得开发、实施和 评估针对物质使用和HIV SRB的技术强化干预 教育部门的EAS，以及4)进一步培训负责任地进行人类研究 研究对象。这些培训目标与具体的研究目标密切相关：1) 从ED环境招聘的EAS，进行前瞻性的、纵向的、日常的数据收集 使用基于移动短信的药物使用评估(即非法药物和 非医疗用处方药)和艾滋病毒危险行为(主要是SRB，但也 注射吸毒)，包括测量可能构成其基础的关键社会认知因素 物质使用与艾滋病毒风险之间的关系(例如，物质的动机 使用/危险性行为，与使用避孕套相关的自我效能)，以及2)基于 在研究目标1中进行的前瞻性研究，开发和试行量身定做的 干预(例如，使用的物质、伴侣类型、社会认知因素和性别) 对于急诊室的EA患者，重点是减少药物使用和艾滋病毒SRB，这将 通过使用针对物质使用的移动电话短信来加强 和艾滋病毒SRB。我将通过CLOSE完成这些研究和培训目标 来自拥有这些内容领域专业知识的团队的指导，教学课程，以及 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.