Emergence and Diffusion of Crack and Related Health Risk Behaviors in Mexico City

描述（申请人提供）：本申请拟对墨西哥DF地区快克的出现和传播进行社会流行病学研究。该应用程序利用了一套独特的资源：1）休斯顿大学药物和社会政策研究中心在难以接触的人群中成功实施流行病学药物研究的科学和方法学专业知识，以及2）被认为是墨西哥领先的药物研究人员的国家Psiquiatrma研究所研究人员。吸食可卡因是墨西哥最近出现的一种现象。接受治疗的数据表明，墨西哥DF的接受率从2003年的8%上升到2007年的40%。鉴于可能出现的快克流行病可能导致艾滋病毒的快速传播和其他健康后果，这种国际研究合作具有重要意义。更重要的是，鉴于墨西哥和美国高度一体化的经济和大规模的循环移民模式，与快克流行病传播相关的风险相关行为可能对墨西哥和美国产生重大的公共卫生后果，并对两国产生影响。该申请建议采访150名成年人，他们在过去30天内从墨西哥DF的三个代表团的社区招募自我报告使用快克。我们将采用人种学方法，实施一种适应性抽样方法，其中包括实地密集外联、快速评估反应和评价以及有针对性的反应者驱动抽样等要素。将使用深入的半结构化人种学访谈和观察收集数据，包括生态瞬时评估（EMA）的元素。目的是：1）确定并详细描述目标使用人群的特征，包括社会人口统计学，裂缝和其他药物使用模式和做法以及与健康相关的性和药物使用风险行为; 2）描述导致裂缝使用行为和与健康相关的高风险性和药物使用行为出现的创新过程。重点将是获得知识、对目前药物或做法的满意度、进入新兴药物市场的机会、与现有药物亚文化规范的兼容性、复杂性、可试用性和可观察性;第三章记录在人口稠密的大城市的独特背景下，导致采用和传播快克使用做法以及相关的高风险性行为和药物使用行为的扩散过程。城市在发展中国家。重点将放在启动，使用的进展，社交网络的影响，以及对社会和文化背景的理解;和4）检查与治疗利用和治疗障碍相关的因素，如快克用户所认为的。创新包括将创新扩散理论应用于发展中国家毒品流行的动态，加强现有的墨西哥毒品监测系统，以及将RARE和EMA纳入街头人种学方法。 公共卫生相关性：拟议的国际研究合作将对墨西哥城成年人使用快克的出现和传播进行社会流行病学研究。具体来说，使用分析结构从创新理论的扩散和人种学方法，我们将探讨与裂纹使用和相关的高风险性和药物使用行为的启动和快速传播的过程。这项研究的结果具有重要的两国公共卫生影响，并将有助于开发一种基于理论的艾滋病毒和性传播感染干预措施，用于墨西哥使用快克的高危人群。

DESCRIPTION (provided by applicant): This application proposes to conduct a social epidemiological study on the emergence and spread of crack in Mexico DF. This application takes advantage of a unique set of resources: 1) The University of Houston, Center for Drug and Social Policy Research scientific and methodological expertise in successfully implementing epidemiological drug studies among hard to reach populations and 2) The National Institute of Psiquiatrma researchers who are considered Mexico's leading drug investigators. Smoking crack is a recent emerging phenomenon in Mexico. Data on treatment admissions indicate that Mexico DF admissions increased from 8% in 2003 to 40% in 2007. This international research collaboration is of importance given the potential for an emerging crack epidemic that can contribute to the rapid transmission of HIV and other health consequences. More importantly, the risk related behaviors associated with the spread of a crack epidemic could have major public health consequences with bi- national implications for Mexico and the U.S. given the highly integrated economies and large scale circular migration patterns. The application proposes to interview 150 adults who self-report crack use within the last 30 days recruited from neighborhoods in three delegations in Mexico DF. Using an ethnographic approach, we will implement an adaptive sampling methodology with elements of field-intensive outreach, Rapid Assessment for Response and Evaluation (RARE) and targeted respondent-driven sampling. Data will be collected using in-depth semi-structured ethnographic interviews and observations including elements of Ecological Momentary Assessment (EMA). Aims are to: 1) Identify and provide a detailed description of the characteristics of the targeted crack using population including socio-demographics, crack and other drug use patterns and practices and health related sexual and drug using risk behaviors; 2) Describe the processes of innovation that have contributed to the emergence of crack use practices and health related high risk sexual and drug using behaviors. Focus will be on the acquisition of knowledge, satisfaction over current drugs or practices, accessibility to new emerging drug market, compatibility with existing drug subcultural norms, complexity, triability, and observability; 3) Document the process of diffusion that has led to the adoption and transmission of crack use practices and related high risk sexual and drug using behaviors within the unique context of a large and densely populated city in a developing country. Focus will be on initiation, progression of use, influence of social networks, and understanding of the social and cultural context; and 4) Examine factors associated with treatment utilization and barriers to treatment as perceived by crack users. Innovations include the application of the Diffusion of Innovation Theory to the dynamics of drug epidemics in a developing country, enhancement of the existing Mexico drug surveillance system and integration of RARE and EMA into street ethnography approaches. PUBLIC HEALTH RELEVANCE: The proposed international research collaboration will conduct a social epidemiological study on the emergence and spread of crack use among adults in Mexico City. Specifically, using analytical constructs from the Diffusion of Innovation Theory and an ethnographic methodological approach we will explore the processes associated with the initiation and rapid spread of crack use and related high risk sexual and drug using behaviors. Findings from this study have important bi-national public health implications and will contribute to the development of a theory based HIV and STI intervention for crack using high risk populations in Mexico.