Gender differences in perceived costs of safer injection among injection drug use

注射吸毒者对更安全注射的感知成本存在性别差异

• 批准号: 7492584
• 负责人: Karla D. Wagner
• 金额: $ 5.23万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7492584
• 关键词: Accounting; Address; Adult; Adverse effects; Behavior; Behavioral; Blood-Borne Pathogens; California; Cognition; Cognitive; Daily; Data; Development; Disruption; Drug usage; Equation; Equipment; Exhibits; Female; Gender; Gossypium; HIV; Habits; Health behavior; Individual; Infection; Influentials; Injecting drug user; Injection of therapeutic agent; Intervention; Interview; Investigation; Knowledge; Life; Literature; Los Angeles; Measures; Modeling; Motivation; Needle Sharing; Needle-Exchange Programs; Outcome; Participant; Pharmaceutical Preparations; Phase; Play; Predisposition; Prevention intervention; Publishing; Qualitative Methods; Rate; Recruitment Activity; Reporting; Residual state; Risk; Risk Behaviors; Role; Route; Sampling; Self Efficacy; Severities; Sex Characteristics; Shares syringes; Structure; Surveys; Syringes; Testing; Theoretical model; Virus Diseases; Water; Woman; base; concept; cost; design; health belief; male; men; response; social; success; theories; therapy design; transmission process

DESCRIPTION (provided by applicant): High-risk drug injection behavior (e.g., injecting with shared syringes, cookers, cotton, and/or water, or splitting drugs with shared syringes) is a significant route of transmission for human immunodeficiency virus (HIV) among IDUs. Though reductions in HIV risk behavior among IDUs have been observed in recent years, residual injection risk behavior persists. For example, from 2000 to 2003, 38% of California syringe exchange program (SEP) participants reported syringe sharing and up to 62% reported paraphernalia sharing. Significant gender differences exist in HIV risk among IDUs. Among women, injection-related risk is often associated with the social and environmental context in which they use drugs, whereas this influence appears to be less significant among men. Several individual-level, cognitive behavioral theories have been used to explain risky injection practices, employing constructs such as perceived susceptibility, perceived severity, self-efficacy, response efficacy, social norms, and HIV knowledge. To date, theoretically-based studies have had mixed success in explaining injection risk behavior using these constructs. Few studies have examined the association between perceived costs or barriers to safer injection and injection risk, and even fewer have examined gender differences in the explanatory power of these theoretical models. These omissions may partially explain the inconsistent results reported by existing studies. In order to more fully understand the persistence of injection risk behavior, the proposed study will test a theoretical model that integrates both individual-level cognitive and environmental- level factors in the form of perceived costs of safer injection. The model incorporates constructs from several cognitive theoretical models, with a focus on the moderating influence of perceived costs and gender. The proposed study will collect data from 20 semi-structured, qualitative interviews and 200 cross- sectional, quantitative interviews with IDUs recruited from a Los Angeles, California SEP. The sample will be ethnically diverse and 33% female. The study has four specific aims: 1) Identify the perceived costs associated with safer injection behavior via qualitative interviews and develop a measure of perceived costs that will be used in a quantitative survey; 2) Assess the relationship between HIV-related cognitive factors and injection risk behavior; 3) Use Structural Equation Modeling (SEM) to explore the moderating influence of perceived costs on the association between other cognitive variables and injection risk behavior; and 4) Use SEM to explore gender differences in perceived costs and in the strength of associations between cognitive and behavioral variables. Findings from the proposed study could be used to design interventions to mitigate the social and environmental costs of safer injection among IDUs, and specifically to help alleviate barriers to safer injection among female IDUs. If the costs of safer behavior can be minimized, IDUs may be more likely to act upon existing HIV cognitions to reduce their injection-related risk behavior. By identifying those factors that contribute to persistent injection-related risk for HIV among injection drug users, interventions designed to address those factors can be developed. Specifically, this study will identify the perceived costs of safer injection behavior, allowing for the development of HIV prevention interventions designed to mitigate the costs of safer behavior. Additionally, a detailed understanding of how these factors differ by gender will help in the design and implementation of tailored interventions that take into account the social and environmental context of both men and women, and those factors that contribute to elevated risk for HIV among women.

描述（由申请人提供）：高风险药物注射行为（例如，使用共用注射器、炊具、棉花和/或水注射，或使用共用注射器分开药物）是人类免疫缺陷病毒（HIV）的重要传播途径注射吸毒者中。尽管近年来注射吸毒者中艾滋病毒危险行为有所减少，但残留的注射危险行为仍然存在。例如，从 2000 年到 2003 年，38% 的加州注射器交换计划 (SEP) 参与者报告称存在注射器共用情况，高达 62% 的参与者报告称共用用具。注射吸毒者之间的艾滋病毒风险存在显着的性别差异。在女性中，注射相关风险通常与她们吸毒的社会和环境背景有关，而这种影响在男性中似乎不太显着。一些个体层面的认知行为理论已被用来解释危险的注射行为，采用诸如感知易感性、感知严重性、自我效能、反应效能、社会规范和艾滋病毒知识等结构。迄今为止，基于理论的研究在使用这些结构解释注射风险行为方面取得了不同程度的成功。很少有研究探讨感知成本或安全注射障碍与注射风险之间的关联，甚至更少研究探讨这些理论模型解释力的性别差异。这些遗漏可能部分解释了现有研究报告的不一致结果。为了更全面地了解注射风险行为的持续性，拟议的研究将测试一个理论模型，该模型以更安全注射的感知成本的形式整合了个人层面的认知和环境层面的因素。该模型融合了多种认知理论模型的构建，重点关注感知成本和性别的调节影响。拟议的研究将从 20 次半结构化定性访谈和 200 次横断面定量访谈中收集数据，这些访谈对象是从加利福尼亚州洛杉矶 SEP 招募的注射吸毒者。样本来自不同种族，其中 33% 为女性。该研究有四个具体目标：1）通过定性访谈确定与更安全的注射行为相关的感知成本，并制定将在定量调查中使用的感知成本衡量标准； 2）评估HIV相关认知因素与注射危险行为之间的关系； 3）利用结构方程模型（SEM）探讨感知成本对其他认知变量与注射风险行为之间关联的调节影响； 4) 使用 SEM 探索感知成本以及认知和行为变量之间关联强度的性别差异。拟议研究的结果可用于设计干预措施，以减轻注射吸毒者安全注射的社会和环境成本，特别是帮助减轻女性注射吸毒者安全注射的障碍。如果可以将安全行为的成本降至最低，注射吸毒者可能更有可能根据现有的艾滋病毒认知采取行动，以减少与注射相关的危险行为。通过确定导致注射吸毒者持续感染艾滋病毒的注射相关风险的因素，可以制定旨在解决这些因素的干预措施。具体来说，这项研究将确定安全注射行为的感知成本，从而制定旨在减轻安全行为成本的艾滋病毒预防干预措施。此外，详细了解这些因素在性别上的差异将有助于设计和实施量身定制的干预措施，其中考虑到男性和女性的社会和环境背景，以及导致女性艾滋病毒风险升高的因素。