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

描述(由申请人提供)：本申请建议对墨西哥出现和传播的裂缝进行社会流行病学研究。这一应用程序利用了一组独特的资源：1)休斯顿大学毒品和社会政策研究中心在成功地在难以接触到的人群中实施流行病学药物研究方面的科学和方法专业知识，以及2)被认为是墨西哥领先的毒品研究人员的国家心理研究所研究人员。吸食可卡因是墨西哥最近出现的一种现象。治疗入院数据表明，墨西哥DF入院人数从2003年的8%增加到2007年的40%。这一国际研究合作具有重要意义，因为可能会出现一种可能导致艾滋病毒快速传播和其他健康后果的新的裂解流行病。更重要的是，鉴于墨西哥和美国的经济高度一体化和大规模循环移民模式，与裂缝疫情传播相关的风险相关行为可能会对墨西哥和美国产生重大的公共卫生后果。该应用程序建议采访150名成年人，他们在过去30天内自我报告使用可卡因，这些人从墨西哥DF的三个代表团的社区招募。利用人种学方法，我们将实施一种适应性抽样方法，包括实地密集外联、快速反应和评价评估(REARE)和有针对性的受访者驱动的抽样。将使用深入的半结构化人种学访谈和观察收集数据，其中包括生态瞬时评估(EMA)的要素。目的是：1)确定和详细描述目标吸毒人群的特征，包括社会人口学、吸毒和其他吸毒模式和做法以及与健康有关的性和吸毒危险行为；2)描述促成吸毒做法和与健康有关的高危性行为和吸毒行为出现的创新过程。重点将放在知识的获取、对当前药物或做法的满意度、新的新兴药物市场的可获得性、与现有药物亚文化规范的兼容性、复杂性、可试探性和可观察性；3)记录在发展中国家大型和人口稠密的城市的独特背景下导致采用和传播强效使用做法和相关高危性行为和药物使用行为的传播过程。重点将放在开始、使用的进展、社会网络的影响以及对社会和文化背景的理解上；以及4)审查与治疗利用有关的因素以及吸毒者所感知的治疗障碍。创新包括将创新扩散理论应用于发展中国家的毒品流行动态，加强现有的墨西哥毒品监测系统，并将REARE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中使用可卡因的出现和传播进行社会流行病学研究。具体地说，使用创新扩散理论的分析结构和人种学方法论方法，我们将探索与吸毒以及相关的高危性行为和吸毒行为的开始和迅速传播相关的过程。这项研究的发现具有重要的两国公共卫生影响，并将有助于开发基于艾滋病毒和性传播感染的理论，在墨西哥使用高危人群对裂缝进行干预。

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.