Examining the Stress Processes Relating Ethnicity and Sex to Substance Misuse and Services Outcomes (ESPRESSO)

项目摘要 拟议的项目从数量和质量两个方面调查和传播 物质使用障碍（SUD）风险的潜在种族/民族和性别差异以及SUD的差异 司法介入青少年的治疗服务（JIA）。JIA是一个严重缺乏服务的人群， 特别容易受到SUD的影响。青少年司法系统中的某些族裔群体和女性， 易受药物滥用的严重后果的影响，更容易患上未确诊的 SUD。级联护理是调查未满足的治疗需求的一个新框架。应力过程 模型假设，差异的发生是由于压力源和资源的不平等分配，提供了一个 这是将种族/族裔和性别与级联检查站的差异联系起来的主要途径。这项研究将协同 跨学科的理论和方法，通过整合a）卫生保健的社会学理论， 压力过程模型，B）衡量未满足治疗需求的新框架-护理级联，c） 先进的定量方法-结构方程模型中的中介分析，以及d）创新的 定性方法-将主题分析与尖端技术相结合。具体研究目标 是1）调查压力和资源是否介导药物滥用中的种族/民族和性别差异 (SM)模式; 2）测试压力和资源是否介导SUD筛查的种族和性别差异， 诊断SUD，治疗开始和治疗完成;和3）定性探索压力和 资源涉及在特殊用途儿童服务和释放后结果方面的族裔和性别差异。该研究采用 中介分析在结构方程模型分析全州纵向数据库的100，000 JIA 来自美国第三大少年司法人口。为了更深入地了解 根据统计结果，该项目对60名个人进行了深入访谈和调查， 在未成年时经历过SM和监禁的人将采用混合专题分析， 定量和定性数据。这些目标有助于实现NIDA的使命，以推进病因学的科学 改善SUD的预防和治疗，并推进对少数民族，女性和其他 面临滥用后果的人口比例过高。为了完成研究目标， 将执行由该领域领导人专家导师网络指导的培训计划。培训 目的是发展在刑事司法系统中提供SUD服务的专门知识; SEM中的调解分析， 心理测量学、审查数据和纵向设计;健康研究和分析中的访谈方法 使用ATLAS.ti软件;压力仪器;以及实施和转化科学。这些 培训和随后的研究活动是发展和测试文化的重要一步。 适当的，性别敏感的，创伤知情的SUD风险评估协议和减少差异 在少年司法系统中创新性的SUD筛查和治疗提供的干预措施。

PROJECT SUMMARY The proposed project quantitatively and qualitatively investigates and disseminates the mechanisms underlying potential racial/ethnic and sex differences in risk for substance use disorder (SUD) and disparities in SUD treatment services among justice-involved adolescents (JIA). JIA are a critically underserved population who are especially vulnerable to SUD. Certain ethnic groups and females in the juvenile justice system are predisposed to harsher consequences of substance misuse and are more prone to suffer from undiagnosed SUDs. The cascade of care is a novel framework for investigating unmet treatment needs. The stress process model hypothesizes that disparities occur due to unequal distribution of stressors and resources, offering a major pathway linking race/ethnicity and sex to disparities at the cascade checkpoints. The study will synergize transdisciplinary theory and methodology through integrating a) a sociological theory of health disparities—the stress process model, b) a novel framework for measuring unmet treatment needs–the cascade of care, c) advanced quantitative methods –mediation analysis in structural equation modeling, and d) innovatory qualitative approaches–hybrid thematic analysis with cutting-edge technologies. The specific research aims are to 1) investigate if stress and resources mediate racial/ethnic and sex differences in substance misuse (SM) patterns; 2) test if stress and resources mediate ethnic and sex disparities in referral to SUD screening, diagnosis with SUD, treatment initiation and treatment completion; and 3) qualitatively explore how stress and resources relate to ethnic and sex disparities in SUD services and post-release outcomes. The study employs mediation analysis in structural equation modeling to analyze a statewide longitudinal database of 100,000 JIA from the third largest juvenile justice population in the United States. To uncover deeper insights into the statistical findings, the project conducts and analyzes in-depth interviews and surveys among 60 individuals who experienced SM and incarceration as minors. Hybrid thematic analysis will be employed to fuse the quantitative and qualitative data. These aims serve to fulfil NIDA’s mission to advance science on the etiology of SM, improve SUD prevention and treatment, and advance research on minorities, females, and other populations facing disproportionate consequences of misuse. To complete the research aims, an extensive training plan directed by a network of expert mentors who are leaders in the field will be executed. The training aims are to develop expertise in SUD services delivery in criminal justice systems; mediation analysis in SEM, psychometrics, censored data, and longitudinal design; interviewing methods in health research and analysis with the ATLAS.ti software; stress instrumentation; and implementation and translational science. These training and subsequent research activities are a major step towards developing and testing culturally appropriate, sex-responsive, and trauma-informed SUD risk assessment protocols and disparity reduction interventions that innovate SUD screening and treatment delivery in juvenile justice systems.