LONGITUDINAL STUDY OF SUBSTANCE USE, INCARCERATION, AND STI IN THE US

描述（由申请人提供）：我们建议进行二次数据分析，以检查监禁，物质使用和STI/HIV风险之间的纵向关系。2008年，美国有200多万成年人被关进监狱。监狱和监狱囚犯往往是我国人口中经济和社会处境最不利的群体，他们也面临着不成比例的传染病风险。包括艾滋病毒在内的性传播感染集中在被监禁人口中。囚犯的配偶、性伴侣及其性关系网的其他成员也有很高的感染风险。在某些人口中，监禁率高得惊人，社区中有相当一部分人口不断迁移进出刑事司法系统。性传播疾病和艾滋病毒在性网络中断的情况下茁壮成长。因此，由于监禁而造成的性网络中断可能导致新的、多重的和同时发生的性伙伴关系，所有这些都助长了性传播感染/艾滋病毒的传播。监禁的破坏性影响是否会增加性传播感染/艾滋病毒的风险？或者，诸如可能导致监禁的吸毒等不利的经济和社会因素是否导致了现任和前任囚犯及其性网络成员的高性风险和性传播疾病/艾滋病毒水平？我们不知道-监禁与性传播感染/艾滋病毒之间的密切联系仍然没有得到解释，需要进行调查。利用国家青少年健康纵向研究，我们将应用先进的统计程序来衡量青少年物质使用对多（E2）性伴侣关系和生物学证实的成年期衣原体，淋病或滴虫感染的影响。我们将评估成年监禁在多大程度上介导了物质使用和STI/HIV风险之间的关系。我们将研究的性传播感染具有明显的公共卫生相关性，这不仅是因为它们导致了大量的发病率，而且还因为它们增加了艾滋病毒的传播。拟议的研究的具体目标是：目标1：测量青少年物质使用和多重性伙伴关系和成年期性传播感染之间的纵向关联，并评估种族或刑事司法参与是否会调节这种关系。目标2：衡量监禁和多个性伙伴关系与成年期性传播感染之间的关联。目标3：评估成年监禁在多大程度上调解青少年药物使用和多重性伙伴关系与成年性传播感染之间的关系。这项研究是创新的，因为它独特地综合了性传播感染和药物依赖流行病学以及刑事司法领域，并与公共卫生相关。拟议的分析旨在为制定更大的R 01提供经验基础，以（1）检查监禁时亲密伙伴关系中断对STI/艾滋病毒风险的影响，（2）测试旨在减轻监禁和药物依赖的有害影响的STI/艾滋病毒预防干预措施的有效性。 公共卫生相关性：通过确定监禁和药物使用单独或共同增加性传播感染/艾滋病毒风险的方式，我们将更好地了解稀缺的预防资源是否应优先用于：药物使用预防和治疗，制定和实施减轻监禁破坏性影响的干预措施，或两者兼而有之。由于在任何时候都有200多万成年人被关押在美国监狱和监狱中，即使监禁对性传播感染/艾滋病毒风险的影响不大，也会对人口产生重大影响。因此，在一定程度上根据这项研究制定的有效减少与监禁有关的性传播感染/艾滋病毒传播的干预措施将防止大量新的感染。

DESCRIPTION (provided by applicant): We propose to conduct secondary data analysis to examine the longitudinal relationships among incarceration, substance use, and STI/HIV risk. In 2008 more than 2 million adults in the United States were behind bars. Jail and prison inmates, often among the most economically and socially disadvantaged segment of our population, also face disproportionate infectious disease risk. Sexually transmitted infections (STIs), including HIV, cluster in incarcerated populations. Prisoners' spouses, sexual partners, and other members of their sexual networks also experience high risk of infection. In some populations, incarceration rates are staggering and communities experience continual migrations of substantial segments of the population in and out of the criminal justice system. STIs and HIV thrive on sexual network disruption. Thus, disruption of sexual networks due to incarceration may lead to new, multiple, and concurrent sexual partnerships, all of which fuel STI/HIV transmission. Does the disruptive effect of incarceration contribute to STI/HIV risk? Or, do adverse economic and social factors such as drug use-that may have led to the incarceration-drive high sexual risk and STI/HIV levels among current and former inmates and members of their sexual networks? We do not know- the strong association between incarceration and STI/HIV remains unexplained and warrants investigation. Using the National Longitudinal Study of Adolescent Health, we will apply advanced statistical procedures to measure the effects of adolescent substance use on multiple (e 2) sexual partnerships and biologically confirmed infection with chlamydia, gonorrhea, or trichomoniasis in adulthood. We will evaluate the degree to which incarceration in adulthood mediates the relationship between substance use and STI/HIV risk. The STIs we will study have clear public health relevance not only because they contribute to substantial morbidity but because they increase HIV transmission. The specific aims of the proposed study are to: Aim 1: Measure longitudinal associations between adolescent substance use and multiple sexual partnerships and STI in adulthood and evaluate whether race or criminal justice involvement moderates the relationships. Aim 2: Measure associations between incarceration and multiple sexual partnerships and STI in adulthood. Aim 3: Evaluate the degree to which incarceration in adulthood mediates the relationships between adolescent substance use and multiple sexual partnerships and STI in adulthood. This research is innovative in its unique synthesis of and public health relevance to STI and drug dependence epidemiology and the criminal justice field. The proposed analyses are designed to provide an empirical basis for development of larger R01s to (1) examine the effect of disruptions in intimate partnerships at the time of incarceration on STI/HIV risk and (2) test the effectiveness of STI/HIV prevention interventions that aim to mitigate the deleterious effects of incarceration and drug dependence. PUBLIC HEALTH RELEVANCE: By identifying ways that incarceration and substance use work independently and together to increase STI/HIV risk, we will better understand whether scarce prevention resources should be prioritized for: substance use prevention and treatment, development and implementation of interventions that mitigate the disruptive effects of incarceration, or both. Since more than 2 million adults are in United States jails and prisons at any given time, even modest effects of incarceration on STI/HIV risk have significant ramifications at the population level. Hence, interventions effective in reducing incarceration-related STI/HIV transmission that may be developed, in part, based on this research would prevent substantial numbers of new infections.