Substance Use Disorders & Service Use Among Rural Youth

描述(由申请人提供)： 针对PA-04-061和PA-01-097，本订正提案描述了一个保健服务研究项目，旨在利用R21探索/发展赠款机制(PA-02-171)审查农村地区有药物滥用问题的青少年使用服务的模式。该项目的具体目的是：1)通过以下方式对农村青少年利用行为健康服务治疗药物使用障碍产生新的认识：a)描述接受公共资助的药物使用治疗的农村和非农村青少年在易感、使能和需要特征方面的差异，重点放在物质使用水平、心理健康问题和身体健康特征上，以及b)检验关于农村和城市人口在获得和服务使用模式及临床结果方面的差异的假设；2)完善已建立的服务使用和结果的理论模型，以便今后对这一人群进行卫生服务研究。该项目将使用之前收集的访谈和行政数据。二次分析是了解农村地区青少年与药物滥用问题作斗争的经验的有效方法。描述性和假设检验分析围绕两个方面提出：1)在接受公共资助的药物滥用治疗的农村青年中，使用的物质的类型、物质使用的模式和物质使用的后果是什么？这些与城市青年有什么不同？2)农村青年使用的药物滥用服务的类型、服务使用的模式和治疗的后果(结果)？这些人与城市青年有什么不同？描述性分析将侧重于未调整的差异。多元假设检验分析将考虑农村和城市青年在服务使用和临床结果方面的差异，使用多水平建模来评估社区和服务系统变量的影响。相关性：正如NIDA赞助的农村社区药物滥用研究：药物滥用和农村研究专家会议(2004年12月)上强调的那样，提高对农村地区药物滥用及其治疗的了解是一项全国性的任务，需要进行比较研究。该项目提供了一个独特的机会，通过研究农村和城市药物滥用模式的差异、治疗障碍、服务利用和对青年的结果，解决这些关键问题。鉴于医疗补助是美国最大的青少年健康保险计划，而且每五项物质服务中至少有一项是由医疗补助资助的，研究这些针对参加医疗补助的年轻人的问题可以加强研究结果的政策相关性。

DESCRIPTION (provided by applicant): In response to PA-04-061 and PA-01-097, this revised proposal describes a health services research project to examine patterns of service use by adolescents with substance abuse problems living in rural areas using the R21 Exploratory/Developmental Grant mechanism (PA-02-171). The specific aims of this project are: 1) To generate new knowledge on rural adolescents' use of behavioral health services for substance use disorders by: a) Describing differences in predisposing, enabling and need characteristics between rural and non-rural youth entering publicly funded substance use treatment, with a focus on levels of substance use, mental health issues and physical health characteristics, and b) Testing hypotheses about differences between rural and urban populations in access and service use patterns and clinical outcomes; and 2) To refine established theoretical models of service use and outcomes for future health services research with this population. The project will use previously collected interview and administrative data. Secondary analysis is an efficient method for gaining insight into the experiences of youth struggling with substance abuse problems in rural settings. Descriptive and hypothesis-testing analyses are proposed around two areas: 1) what are the types of substances used, patterns of substance use, and consequences of substance use among rural youth entering publicly-funded substance abuse treatment? How do these differ from urban youth? 2) What are types of substance abuse services used, patterns of service use, and consequences (outcomes) of treatment for rural youth? How do these differ from urban youth? Descriptive analyses will focus unadjusted differences. The multivariate hypothesis-testing analyses will consider differences in service use and clinical outcomes between rural and urban youth, using multi-level modeling to assess the influence of community and service system variables. Relevance: As highlighted at the NIDA-sponsored Drug Abuse Research in Rural Communities: Current Knowledge and Future Directions meeting (12/2004) of experts in substance abuse and rural studies, improving understanding of substance abuse and its treatments in rural areas is a national imperative, and comparative studies are needed. This project provides a unique opportunity to address these critical issues by studying differences in rural and urban substance abuse patterns, barriers to treatment, service utilization and outcomes for youth. Given that Medicaid is the largest health insurance program in the country for adolescents and that at least one out of every five substance services are funded by Medicaid, examining these questions for Medicaid-enrolled youth strengthens the policy relevance of the findings.