Understanding Risk Factors, Including Substance Use, for Recurrent Assault Related Injury

项目总结 拟议奖学金的目标是为申请者的独立研究生涯做好准备，重点是 改善获得药物使用障碍治疗的机会，特别是为遭受攻击的伤者提供的治疗 并向以医院为基础的暴力干预方案提供信息，以防止再次发生暴力伤害。 暴力和吸毒已成为美国的公共卫生危机，迫切需要医疗保健 系统响应。黑人男性的暴力发生率存在很大的性别和种族差异。这个 在美国，吸毒和酗酒的流行率很高，而且已被证明与 暴力。然而，描述两者之间的复杂关系和交集的研究有限 吸毒/酗酒和与袭击有关的伤害，特别是反复发生的伤害。此外，有限的研究已经 审查了具体的物质使用类型和暴力受害情况，特别是与袭击有关的伤害需要 医疗护理和反复受伤。许多相关研究更多地依赖于自我报告的药物使用情况 而不是像毒理学报告这样的客观措施。此外，多项研究表明，酒精是 与暴力有关，有证据支持可卡因使用和暴力之间的联系 然而，在成年人中，关于其他药物类型(如大麻、阿片类药物、 镇静剂)和暴力。这项研究的目的是进一步了解患者(包括药物/酒精 与复发相关的使用和共病诊断)、邻里关系和损伤相关因素 在马里兰州巴尔的摩一家医院就诊的18至34岁成年人中与袭击相关的伤害 有钝器、割伤/刺伤或与枪击有关的伤害。这项研究的具体目的是： 目标1：检查患者是否(吸毒/酗酒、共病诊断、人口统计学和社会经济状况)， 邻里(邻里暴力、酒类销售点、家庭教育、家庭收入、空置 房屋和毒品逮捕)，以及与伤害有关的因素(伤害严重程度评分和伤害机制 因钝器伤、割伤/刺伤或与枪击相关的伤害而到医院就诊的情况是可预测的 与袭击有关的反复受伤。目标2：描述#年暴力和吸毒/酗酒的经历 在过去的一年中经历过与袭击相关的伤害并且毒理学呈阳性的个人 在受伤时进行筛查。目标3：描述围绕暴力和吸毒/酗酒的主题 目标2中揭示的进一步解释和扩展目标1中确定的风险因素。这项研究直接 响应NIDA的战略计划，确定药物使用和成瘾对个人、家庭、 同龄人和社会；具体地说，物质使用障碍对公共健康的影响。这个 从这项研究中获得的知识将为今后旨在改善获得有效医疗服务的机会的干预措施提供信息 对遭受攻击受伤的人进行物质使用治疗，有可能降低再次受伤的风险。

PROJECT SUMMARY The goal of the proposed fellowship is to prepare the applicant for an independent research career focused on improving access to treatment for substance use disorders, especially those provided to assault-injured individuals; and to inform hospital-based violence intervention programs in preventing repeat violent injury. Violence and substance use have become public health crises in the US, demanding an urgent health care systems response. There are large gender and racial disparities in rates of violence among Black males. The prevalence of drug and alcohol use is immense in the US, and has been shown to be strongly associated with violence. However, there is limited research describing the complex relationship and intersection between drug/alcohol use and assault-related injury, especially recurrent injury. Additionally, limited studies have examined specific substance use types and violence victimization, specifically assault-related injuries requiring medical care and recurrent injury. Many of the relevant studies have relied on self-reported drug use rather than objective measures such as toxicology reports. Additionally, multiple studies have shown alcohol to be associated with violence and there is evidence to support the association between cocaine use and violence among adults, however results have been mixed regarding other drug types (e.g., marijuana, opioids, sedatives) and violence. The purpose of this study is to further understand patient (including drug/alcohol use & comorbid diagnoses), neighborhood, and injury-related factors associated with recurrent assault-related injury among adults aged 18 to 34 years who present to a hospital in Baltimore, MD with a blunt force, cutting/piercing, or firearm assault-related injury. The specific aims of this study are: Aim 1: Examine if patient (drug/alcohol use, comorbid diagnoses, demographics, and socioeconomic status), neighborhood (neighborhood violence, alcohol outlets, household education, household income, vacant houses, and drug arrests), and injury-related factors (injury severity score and mechanism of injury) at the time of presentation to the hospital for a blunt force, cutting/piercing, or firearm assault-related injury are predictive of recurrent assault-related injury. Aim 2: Describe experiences with violence and drug/alcohol use in individuals who have experienced a past year repeat assault-related injury and had a positive toxicology screen at the time of injury. Aim 3: Describe how the themes surrounding violence and drug/alcohol use revealed in Aim 2 further explain and extend the identified risk factors in Aim 1. This study is directly responsive to NIDA's Strategic Plan to determine the impact of drug use and addiction on individuals, families, peers, and society; specifically, the impact of substance use disorders on public health outcomes. The knowledge gained from this study will inform future interventions directed at improving access to effective substance use treatment among assault-injured people, potentially reducing risk for recurrent injury.