Assessing the Impact of State-Level Policies on Drug Use and HIV Risk for YMSM

 描述（申请人提供）：这个指导研究科学家发展奖（K 01）的目的是帮助我成为一个独立的研究人员，专注于确定可改变的结构因素，可以解释和解决物质使用和性风险行为的差异，从而艾滋病毒感染率，从这个K 01的培训将使我能够1）应用我的定性技能，以政策案例研究分析; 2）学习和应用关键的定量方法（即， 结构方程模型和纵向数据分析），以分析基于人口的数据和结构性干预措施的影响; 3）了解影响YMSM的物质使用和性风险的多层次因素;以及4）获得与物质使用，艾滋病毒和YMSM相关的公共卫生伦理技能。我的职业发展计划包括具体的研讨会，讲习班，课程，会议，动手实践和量身定制的辅导与指导团队由结构性艾滋病毒预防，艾滋病毒风险YMSM，药物使用和性健康为重点的政策，定量方法和公共卫生政策分析的专家组成。对YMSM的关注特别重要，因为与异性恋同龄人相比，他们使用药物的风险几乎是他们的两倍。2013年，青年男男性接触者占青年男性艾滋病毒新感染者的92%;事实上，青年男男性接触者是艾滋病毒发病率增长最快的群体。大多数以青年医学会为重点的艾滋病毒干预措施都针对个人因素;对于结构性因素如何影响YMSM的HIV风险知之甚少为了实现美国国家HIV/AIDS战略中概述的联合HIV预防方法，以及NIDA的目标，重要的是要确定可修改的结构层面因素，（例如，国家一级的政策），可以干预，以解决艾滋病毒的风险，青年男男性接触者在人口水平。然而，没有发表的研究已经研究了如何国家一级的政策气候，即，公共卫生政策的总体影响影响YMSM感染艾滋病毒的风险。为了填补这一空白，拟议的研究将首先研究州一级的政策气候是否解释了美国各地YMSM在物质使用和性风险方面的差异。然后，它将使用纵向数据分析和政策案例研究分析，以评估一个国家的政治背景如何影响通过两个具体的政策有关的艾滋病毒风险YMSM处方药监测数据库程序和未成年人的艾滋病毒检测的父母通知。这项研究将提供关键的形成性数据，将用于制定NIDA R 01提案，该提案将研究州一级政策影响YMSM艾滋病毒风险行为的病因学途径。通过这个K 01获得的新技能将帮助我实现我的职业目标，成为一名独立的调查员，进行创新，高影响力的研究，研究州一级因素如何以及为什么影响YMSM的物质使用和性风险行为，目的是为结构层面的艾滋病毒干预提供信息。这次培训将使我成为少数几个在艾滋病毒预防政策领域工作的多方法研究人员之一，并使我能够为哥伦比亚大学社会医学科学系做出独特的贡献。

 DESCRIPTION (provided by applicant): The purpose of this Mentored Research Scientist Development Award (K01) is to help me become an independent researcher focused on identifying modifiable structural factors that can explain and address disparities in substance use and sexual risk behaviors, and thus rates of HIV acquisition, among young men who have sex with men (YMSM) in the U.S. The training from this K01 will allow me to 1) apply my qualitative skills to policy case study analysis; 2) learn and apply key quantitative methods (i.e. structural equation modeling and longitudinal data analysis) to analyze population-based data and the impact of structural interventions; 3) understand the multi-level factors that influence substance use and sexual risk for YMSM; and 4) gain skills in public health ethics relevant to substance use, HIV and YMSM. My career development plan includes specific seminars, workshops, coursework, conferences, hands-on practica and tailored mentoring with a mentorship team comprised of experts in structural HIV prevention, HIV risk for YMSM, substance use- and sexual health- focused policies, quantitative methods and public health policy analysis. The focus on YMSM is particularly important as they are at nearly twice the risk of substance use compared to their heterosexual peers. In 2013 YMSM constituted 92% of new HIV infections among young men; indeed, YMSM are the group for whom HIV incidence is increasing most rapidly. The majority of YMSM-focused HIV interventions have targeted individual- level factors; little is known about how structural factors influence HIV risk for YMSM To achieve the combination HIV prevention approach outlined in the US National HIV/AIDS Strategy, and a goal of NIDA, it is important to identify modifiable structural-level factors (e.g. state-level policies) that can be intervened upon to address HIV risk for YMSM on a population level. However, no published studies have examined how the state-level policy climate-i.e., the aggregate impact of public health policies-affects HIV risk for YMSM. To fill this gap, the proposed research will first examine whether the state-level policy climate explains differences in substance use and sexual risk for YMSM across the US. It will then use longitudinal data analysis and policy case study analysis to assess how a state's political context influences the adoption of two specific policies relevant to HIV risk for YMSM-prescription drug monitoring database programs and parental notification of minors' HIV testing. This research will provide critical formative data that will be used to develop a NIDA R01 proposal that will examine the etiologic pathways through which state-level policies affect HIV risk behaviors for YMSM. The new skills acquired through this K01 will help me achieve my career goal to become an independent investigator who conducts innovative, high impact research examining how and why state-level factors affect substance use and sexual risk behaviors for YMSM with a goal of informing structural-level HIV interventions. This training will position me as one of the few mult-methods researchers working in the policy domain of HIV prevention and enable me to uniquely contribute to the Department of Sociomedical Sciences at Columbia University.