Methamphetamine use in inmates: risk behaviors, health status and recidivism

描述(由申请人提供)：项目摘要/摘要物质滥用与高危性行为和与毒品有关的行为以及监禁密切相关。甲基苯丙胺尤其与高危行为和暴力有关。监狱为被监禁的人提供初级护理，并可能成为干预的场所。那些自认为是吸毒者的人可能会从监狱的干预中受益，而对目标人群的描述对于发展适当的服务至关重要。本研究的目的是测量服刑人群中甲基苯丙胺的使用和相关危险行为、健康状况、卫生服务使用和累犯率。这项研究是朝着确定和测试干预措施以改善药物滥用治疗和结果的长期目标迈出的第一步。该项目的具体目标是衡量自我报告的使用甲基苯丙胺的流行率，并将其使用与性和吸毒危险行为联系起来；描述因使用甲基苯丙胺而向囚犯提供的健康状况和保健服务；比较一年期间因使用甲基苯丙胺而被监禁的时间和累犯率。该项目将在加利福尼亚州圣克拉拉县监狱进行，包括两种方法：一种是通过访谈和监狱入狱时的医疗记录进行的横断面研究。将从200名囚犯中随机抽取100名男性和100名女性。同意的参与者将接受访问，以了解社会人口信息(年龄、种族/族裔、教育、入狱前的生活情况、社会和家庭支持)、与药物使用有关的信息、健康状况、包括性行为在内的风险因素、获得和使用医疗保健的机会和使用情况(包括以前的药物滥用治疗服务经验)、被认为的耻辱和护理障碍，以及获释后过去和被认为需要服务和护理的情况。分析将描述样本并评估甲基苯丙胺使用与高危性行为和毒品行为之间的联系。第二种方法是一项历史队列研究，通过病历审查，研究提供的医疗服务和一段时间内的累犯率。将随机抽取成人监护健康服务机构在2007年六个月期间看到的300名囚犯的记录，其中包括150名男性和150名女性。将摘录2007年医疗保健访问后一年的信息，包括：社会人口数据、健康状况(包括药物使用)、接受的服务和护理结果，以及随后的刑期。对每个性别的分析将根据甲基苯丙胺的使用情况描述：服务的使用、疾病的数量和流行率，并将检验以下假设，即甲基苯丙胺使用者在一年的后续行动中再次逮捕的时间较短；逮捕的人数更多，入狱的时间更长。公共卫生相关性：这项研究与公共卫生的相关性在于其重点关注被监禁者以及有关甲基苯丙胺的使用和相关的健康风险和状况的未解答问题。当人们进入监狱时，社区中面临边缘化人群的众所周知的护理障碍就被消除了，监狱是被监禁者的初级保健提供者；因此，监狱越来越多地成为确定健康状况和开始治疗的场所，有时还成为这一群体的唯一医疗保健来源。在这种情况下获得的知识可能会为其他监狱在评估、管理和向被监禁的甲基苯丙胺滥用者提供方案方面提供洞察力。

DESCRIPTION (provided by applicant): Project Summary/Abstract Substance abuse is strongly associated with both high-risk sexual and drug-related behaviors and incarceration. Methamphetamine in particular has been associated with high-risk behavior and violence. Jails provide primary care to the incarcerated and may be a setting for interventions. Those who self-identify as substance users may benefit from interventions in jail, and the description the target population is critical to development of appropriate services. The purpose of this study is to measure methamphetamine use and associated risk behaviors, health status, health service use and recidivism, in a jailed population. This study is an initial step toward the long-term goal of identifying and testing interventions to improve substance abuse treatment and outcomes. The specific aims of this project are to measure the prevalence of self-reported methamphetamine use and correlate its use with sexual and drug-use risk behaviors; describe the health conditions of and health services provided to inmates by methamphetamine use; and compare length of jail stay and recidivism over a one-year period by methamphetamine use. The project will take place at the Santa Clara County, California, Jail and includes two approaches: one is a cross-sectional study, by interview and medical record at jail entry. A random sample of 200 inmates, 100 men and 100 women, will be drawn. Consenting participants will be interviewed for socio-demographic information (age, race/ethnicity, education, living situation before jail, social and family support), information related to substance use, health status, risk factors including sexual practices, healthcare access and use including prior experience with substance abuse treatment services, perceived stigma and barriers to care, and past and perceived needs for services and care after release. Analyses will describe the sample and evaluate the association between methamphetamine use and high-risk sexual and drug behaviors. The second approach is a historical cohort study, by medical record review, of healthcare services provided and recidivism over time. A random sample of 300 inmate records, 150 men and 150 women, of inmates seen by Adult Custody Health Services during a six-month period in 2007 will be drawn. Information for one year following the 2007 healthcare visit will be extracted, including: socio-demographic data, health conditions (including substance use) and services received and outcome of care, and subsequent jail terms. Analyses for each gender will describe, by methamphetamine use: the use of services, number and prevalence of conditions, and will test the hypothesis that methamphetamine users have less time to re-arrest; have more arrests and longer time in jail in the one-year follow-up. PUBLIC HEALTH RELEVANCE: The relevance of this study to public health is in its focus on the incarcerated and on the unanswered questions about methamphetamine use and associated health risks and conditions. Well-known barriers to care that face marginalized persons in the community are removed when persons enter jails, which serve as primary care providers for the incarcerated; thus jails have increasingly become settings for identification of health conditions and initiation of treatment, and sometimes have become the only source of healthcare for this population. Knowledge gained in this setting is likely to provide insight to other jails in the assessment, management, and provision of programs to incarcerated methamphetamine abusers.