Substance Use Among Violently Injured Youth in an Urban ER: Services and Outcome

描述(申请人提供)：故意伤害(暴力)是非裔美国青年的主要死亡原因。市中心急诊科提供的医疗服务提供了一个重要的机会，可以在吸毒的青少年中确定和描述未来的服务使用时间和模式，这些青少年在学校的样本中可能被遗漏，而他们可能还不在刑事司法系统中。市中心青年--其中许多是非洲裔美国人--的暴力伤害率存在健康差距，这反映在获得药物使用治疗服务的机会有限以及在刑事司法系统中的代表性过高。目前，在与卫生服务(药物使用治疗、心理健康、医疗)和刑事司法系统的交叉方面，缺乏关于具有多种风险的青年(非法药物使用和因急性暴力伤害就诊)的时间、模式、障碍和发展轨迹的数据，这限制了最佳干预时机和环境的发展。在急诊室接受治疗的青少年可能加剧了非法药物使用和其他危险行为(例如，青少年犯罪、艾滋病毒危险行为、携带武器)的发生率，以及与其他投诉(医疗、意外伤害)相比，故意伤害的陈述导致结果的不同轨迹以及与服务使用部门的互动。了解有和没有急性暴力伤害的市中心青少年吸毒的结果和服务利用情况，对于发展预防和治疗服务以应对这些多重风险因素至关重要。我们提出了一项为期两年的前瞻性观察性研究，以确定过去一年有非法药物使用(N=800)在市中心ED寻求治疗的高危青年群体。这项研究的具体目的是为了获得确定后续干预措施地点和内容所需的数据，其具体目的是：(1)描述因急性暴力伤害向城市急诊科报告非法吸毒的青年(14-24岁；n=800)与寻求非暴力相关急诊科护理的吸毒青年(n=400)的特征，包括社会人口特征、问题严重性(例如，药物使用、暴力、艾滋病毒危险行为等)、促成因素和服务利用(即，药物使用治疗、心理健康和医疗)；(2)确定参与者在接受ED访问后的两年内与医疗服务互动的轨迹，以及与服务使用类型(药物使用治疗、精神健康、医疗/ED和艾滋病毒检测)和这些服务的障碍相关的主要特征(即诱因、促成因素和需要因素)；及(3)衡量这一队列的两年结果，包括艾滋病毒危险行为，并确定在ED访问后两年因故意伤害和其他医疗护理而结果较差的吸毒青少年的主要社会人口学和临床特征。这项拟议的研究代表了与一个成熟的调查团队的合作，这些调查团队有在ED环境中进行物质使用研究的成功历史。迫切需要了解谁是不良结果的最大风险(药物使用、刑事司法、医疗)，以及谁最不可能接受治疗，以便针对最有需要的人使用药物和心理健康干预。这项拟议研究的结果对于为未来的ED预防和干预发展提供信息，以减少市中心吸毒青年的健康差距是至关重要的。公共卫生相关性：在急诊科接受暴力伤害治疗的青少年酗酒和滥用非法药物以及其他多种危险行为(如犯罪、艾滋病毒危险行为和携带武器)的比例很高。这项研究的结果将为今后在市中心青少年吸毒人群中开展干预活动提供参考。

DESCRIPTION (provided by applicant): Intentional injury (violence) is the leading cause of death among African-American youth. The provision of medical services in an inner-city Emergency Department (ED) provides a critical opportunity to identify and characterize future timing and pattern of service use among youth with drug use, who may be missed in school-based samples, and who may not yet be in the criminal justice system. Health disparities exist in rates of violent injury among inner-city youth, many of whom are African-American, and are mirrored in limited access to substance use treatment services and over representation in the criminal justice system. Currently, there is a paucity of data on the timing, pattern, barriers, and trajectory of youth with multiple risks (illicit drug use and ED visit for acute violent injury) in terms of their intersection with health services (substance use treatment, mental health, medical) and criminal justice system, which limits the development of optimal timing and setting for interventions. Youth treated in the ED may have exacerbated rates of illicit drug use, and other risk behaviors (e.g., delinquency, HIV risk behaviors, weapon carriage) and different trajectories of outcomes and interactions with service use sectors based on presentation for intentional injury as compared to other complaints (medical, unintentional injuries). Understanding the outcomes and service utilization among inner- city youth with drug use with and without acute violent injury is critically important in developing prevention and treatment services to address these multiple risk factors. We propose a prospective observational study over a two-year period to identify a high risk group of youth with past year illicit drug use (N=800) seeking care in an inner city ED. The specific aims of the study, chosen to obtain data necessary to determine the location and content of subsequent interventions, are: (1) To describe characteristics of youth (ages 14-24; n=800) who report illicit drug use presenting to an urban ED for an acute violent injury (n=400), compared to youth with drug use who seek non-violence related ED care (n=400), including socio-demographic characteristics, problem severity (e.g., substance use, violence, HIV risk behaviors, etc.), enabling factors, and service utilization (i.e., substance use treatment, mental health, and medical); (2) To identify the trajectories of participants' interactions with health services during the two years following their ED visit and the key characteristics (i.e., predisposing, enabling, and need factors) associated with types of service use (substance use treatment, mental health, medical/ ED, and HIV testing) and barriers to these services; and, (3) To measure two-year outcomes for this cohort including, HIV risk behaviors, and to identify key socio- demographic and clinical characteristics of youth with drug use, who have poor outcomes in the two years after ED visit for intentional injury and other medical care. The proposed study represents collaboration with an established team of investigators who have a successful history of conducting substance use research in ED settings. There is a critical need to understand who is at greatest risk for poor outcomes (substance use, criminal justice, medical), and, who is least likely to enter treatment in order to target substance use and mental health interventions for those with greatest need. Results from this proposed study are essential to inform future ED prevention and intervention development to reduce health disparities among inner-city youth with substance use. PUBLIC HEALTH RELEVANCE: Youth treated in the Emergency Department (ED) for violent injury have high rates of alcohol and illicit drug misuse, and other multiple risk behaviors (i.e. delinquency, HIV risk behaviors, and weapon carriage). The results of this proposed study will inform future intervention development among inner-city youth with substance use.