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

项目摘要 拟议奖学金的目标是准备申请人的独立研究生涯的重点是 改善药物使用障碍的治疗，特别是向受攻击者提供的治疗 个人;并告知医院暴力干预方案，以防止重复暴力伤害。 暴力和药物使用已成为美国的公共卫生危机，需要紧急医疗保健 系统响应。黑人男性的暴力发生率在性别和种族方面存在很大差异。的 在美国，药物和酒精的使用率很高，并且已被证明与 暴力然而，描述这两个概念之间复杂关系和交叉点的研究有限。 药物/酒精使用和与攻击有关的伤害，特别是复发性伤害。此外，有限的研究 审查了具体的药物使用类型和暴力受害情况，特别是与攻击有关的伤害， 医疗护理和复发性损伤。许多相关研究都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指标。此外，多项研究表明，酒精 有证据表明可卡因使用与暴力之间存在关联 然而，在成年人中，关于其他药物类型的结果好坏参半（例如，大麻阿片类药物 镇静剂）和暴力。本研究旨在进一步了解患者（包括药物/酒精） 使用和共病诊断），邻居，和与复发相关的损伤相关因素 在马里兰州巴尔的摩的一家医院就诊的18至34岁成人中的攻击相关损伤 钝力、切割/刺穿或火器袭击相关伤害。这项研究的具体目标是： 目的1：检查患者（药物/酒精使用、共病诊断、人口统计学和社会经济状况）， 邻里（邻里暴力，酒精出口，家庭教育，家庭收入，空置 房屋和毒品逮捕），以及当时的损伤相关因素（损伤严重程度评分和损伤机制） 因钝力、切割/刺穿或火器袭击相关损伤而到医院就诊的患者中， 反复发作的袭击相关伤害目标2：描述在暴力和吸毒/酗酒方面的经历， 过去一年中经历过与袭击有关的伤害并具有阳性毒理学的人 受伤时的屏幕。目标3：描述围绕暴力和吸毒/酗酒的主题 目标2中揭示的风险因素进一步解释和扩展了目标1中确定的风险因素。这项研究直接 响应NIDA的战略计划，以确定药物使用和成瘾对个人，家庭， 同侪和社会;特别是物质使用障碍对公共卫生结果的影响。的 从这项研究中获得的知识将为未来旨在改善获得有效药物的干预措施提供信息。 在袭击受伤者中进行物质使用治疗，可能会降低复发性伤害的风险。

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.