Public Housing Relocations: Impact on HIV risk and drug use

描述（由申请人提供）：最近公共住房政策的范式转变正在催化美国历史上最大的计划移民之一。公共住房机构正在将空间集中的综合体的居民重新安置到私人市场上地理上分散的凭证补贴租赁单元。HOPE VI政策体现了这一范式转变，正在将20万个家庭从集中的综合体重新安置到目标城市的租赁单元。希望六移民倾向于搬到更安全、更少贫困、更少毒品的社区（尽管酒精和其他毒品[AOD]滥用者的收益会减弱）;与此同时，移民的社交网络和社会支持会下降。移民的邻里条件、网络和支持可能会在一段时间内发生变化：希望六号开启了50%移民的连续迁移时期。大多数移民是非洲裔美国人，他们都很穷。这些居民在搬家前滥用AOD的比率和艾滋病毒的风险都很高。在拟议的研究中，争论的焦点是HOPE VI搬迁是否以及如何改变移民的邻里条件、网络和社会支持，这些搬迁创造了非裔美国移民的AOD滥用和艾滋病毒风险。拟定的[4]年研究将采用准实验性暴露前/暴露后设计，并设一个未暴露对照组。暴露组将由来自HOPE VI目标的7个亚特兰大住房管理局（AHA）综合体的180名移民组成;未暴露的对照组将由6个未搬迁的AHA综合体的150名居民组成。所有参与者都是非洲裔美国人，我们将在基线AOD滥用状态的样本中寻找变化，以研究AOD滥用如何塑造感兴趣结果的趋势。由一名新的调查员领导的拟议的多层次纵向研究将实现以下目标：目标1：描述在[4]年研究期间HOPE VI移民的居住流动趋势;描述移民居住的人口普查区特征随时间的变化（例如，贫困率）;并了解滥用AOD状况如何影响这些趋势。目标二：描述全样本（N=[330]）中网络和社会支持随时间的变化，并确定HOPE VI状态和AOD滥用状态如何影响这些变化。目标3：描述整个样本中AOD滥用、近端HIV风险因素[和HIV发病率]随时间推移的趋势，并了解这些趋势与HOPE VI状态和AOD滥用状态（其中AOD滥用趋势不是结果）的关系。目标4：分析参与者居住的人口普查区域（目标1）及其网络和支持（目标2）的特征变化与滥用AOD和近端艾滋病毒风险（目标3）趋势的关系。这项研究将建立在NIDA R21研究的基础上，我们正在（1）创建[330]个成员队列;（2）启动数据收集;（3）改进保留方法。研究结果将促进NIDA优先领域的科学知识，包括移民、AOD滥用和艾滋病毒，以及非裔美国人使用AOD和艾滋病毒的决定因素。 公共卫生相关性：拟议的研究将有助于NIDA的几个优先领域。它将加深我们对城市移民对酒精和其他药物（AOD）滥用和艾滋病毒传播的影响的理解，并将促进对非洲裔美国人中AOD滥用和艾滋病毒决定因素的科学知识。

DESCRIPTION (provided by applicant): A recent paradigm shift in public housing policy is catalyzing one of the largest planned migrations in US history. Public housing agencies are relocating residents of spatially concentrated complexes to voucher- subsidized rental units in the private market that are geographically dispersed. The HOPE VI policy embodies this paradigm shift, and is relocating 200,000 households from concentrated complexes to rental units in target cities. HOPE VI migrants tend to move to safer, less poor, and less drug-involved neighborhoods (though gains are attenuated for alcohol and other drug [AOD] abusers); at the same time, migrants' social networks and social supports decline. Migrants' neighborhood conditions, networks, and supports may evolve for some time: HOPE VI inaugurates a period of serial moves for 50% of migrants. Most migrants are African-American and all are poor. Rates of AOD abuse and HIV risk are high among these residents before they move. At issue in the proposed study is whether and how HOPE VI relocations, and the changes in migrants' neighborhood conditions, networks, and social supports that these relocations create, shape African-American migrants' AOD abuse and HIV risk. The proposed [4]-year study will have a quasi-experimental pre-/post-exposure design with an unexposed comparison group. The exposed group will consist of [180] migrants from 7 Atlanta Housing Authority (AHA) complexes targeted by HOPE VI; the unexposed comparison group will consist of 150 residents of 6 AHA complexes that are not relocating. All participants will be African-American, and we will seek variation in the sample in baseline AOD abuse status in order to study how AOD abuse shapes trends in outcomes of interest. The proposed multilevel longitudinal study, led by a new investigator, will achieve the following aims: Aim 1: Characterize trends in residential mobility among HOPE VI migrants during the [4]-year the study period; describe changes in the characteristics of the census tracts where migrants live over time (e.g., poverty rates); and learn how AOD abuse status affects these trends. Aim 2: Characterize changes in network and social supports over time in the full sample (N=[330]), and determine how HOPE VI status and AOD abuse status affect these changes. Aim 3: Describe trends in AOD abuse, proximal HIV risk factors, [and HIV incidence] over time in the full sample, and learn how these trends relate to HOPE VI status and AOD abuse status (where AOD abuse trends are not the outcome). Aim 4: Analyze relationships of changes in the characteristics of the census tracts where participants live (Aim 1), and in their networks and supports (Aim 2), to trends in AOD abuse and proximal HIV risk (Aim 3). This study will build on foundations laid by a NIDA R21 study in which we are (1) creating the [330]-member cohort; (2) initiating data collection; and (3) refining retention methods. Results will advance scientific knowledge in NIDA priority areas on migrations, AOD abuse, and HIV, and on determinants of AOD use and HIV among African-Americans. PUBLIC HEALTH RELEVANCE: The proposed study will contribute to several NIDA priority areas. It will deepen our understanding of the impacts of urban migration on alcohol and other drug (AOD) abuse and HIV transmission, and it will advance scientific knowledge of the determinants of AOD abuse and HIV among African-Americans.