A Self-Assessment Intervention for Young Adult Polydrug Users at Risk for HIV

针对有艾滋病毒风险的年轻成年多吸毒者的自我评估干预措施

• 批准号: 8073629
• 负责人: Steven P Kurtz
• 金额: $ 56.13万
• 依托单位: NOVA SOUTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8073629
• 关键词: Age; Aging; Alcohol or Other Drugs use; Behavior; Behavioral; Cocaine; Dancing; Data; Drug usage; Drug user; Effectiveness; Environmental Risk Factor; Equipment and supply inventories; Evaluation Research; Florida; Freedom; HIV; HIV Infections; Health; Health Status; Heterosexuals; Internet; Intervention; Interviewer; Knowledge; Literature; Measures; Mental Health; Natural History; Outcome; Outcome Measure; Parents; Participant; Pharmaceutical Preparations; Play; Population; Prevalence; Process; Public Health; Qualitative Research; Randomized Clinical Trials; Recording of previous events; Relative (related person); Reporting; Resistance; Risk; Risk Assessment; Risk Behaviors; Risk Reduction; Risk Reduction Behavior; Sampling; Self Administration; Self Assessment; Self Perception; Self-Administered; Sex Behavior; Sexual Partners; Social Problems; Substance abuse problem; Theoretical model; Time; Unsafe Sex; Vulnerable Populations; Woman; alcohol and other drug; arm; authority; base; behavior change; brief intervention; club drug; cost; demographics; design; ecstasy; efficacy testing; follow-up; high risk; high risk sexual behavior; instrument; intervention effect; men; novel; parent grant; peer; programs; public health relevance; response; sex risk; social; young adult

DESCRIPTION (provided by applicant): Drug use is normative in urban club scenes, with MDMA (ecstasy) and cocaine being the most prevalent "club" drugs. The parent grant which this application proposes to continue has documented not only high rates of mental health problems and extensive arrest and abuse histories, but also unexpectedly and alarmingly high rates of undiagnosed HIV infection among a predominately heterosexual young adult sample. The parent grant, now in its fifth year, is an 18-month longitudinal natural history study of 600 club and prescription drug using young adults. A key finding from that study is the extent to which the comprehensive health and social risk assessments induced participants to reduce their substance use and sexual risk behaviors. Over 70% of participants substantially reduced their substance use at the first follow-up assessment after baseline. Qualitative research with study completers showed that participants attributed the strong intervention effect of the baseline assessment to: 1) the friendly, non-judgmental field staff of age-peers; 2) the thorough and detailed assessments; and 3) an emerging self-awareness of substance use-related problems based on their responses to the assessment items. Study completers also reported that risk reduction tended to occur precisely because the study was not framed as an intervention. Within this context, the specific aims of the proposed 5-year renewal project are to: 1) identify the covariates of baseline substance abuse and sexual risks (including demographics, social risk measures, peer norms, abuse history, and mental health status) among a sample of 750 heterosexually active, not-in-treatment, club and prescription drug users ages 18 to 39 in Miami, Florida; 2) evaluate, through random assignment, the relative effectiveness of two intervention conditions and a waitlist control in reducing sex risks and drug use, as measured at 3-, 6- and 12-month follow-ups: Arm 1, an interviewer-administered comprehensive health and social risk assessment intervention (CAPI Intervention) similar to the baseline instrument used in the parent grant; Arm 2, an identical self-administered comprehensive assessment intervention (ACASI Intervention); and Arm 3, a waitlist control condition (Control). Outcome measures, including past 90-day counts of unprotected sex acts and days' drug use, will be obtained from brief risk behavior inventories at baseline and follow-ups; and 3) conduct qualitative process evaluation research with 40 participants in each study arm to contextualize the study findings and intervention outcomes. The proposed project is significant, as it responds to the need for brief interventions for a highly vulnerable, high risk population. The self-assessment intervention, if proven efficacious in reducing HIV risk, could be delivered at low cost and broad scale, and might well be adaptable to other high risk groups who are resistant to public health warnings and/or professional intervention. PUBLIC HEALTH RELEVANCE: Club drug users report high levels of sexual risk behaviors as well as other problems related to substance use. The proposed study is a randomized clinical trial to evaluate the efficacy of a substance use and sexual risk reduction intervention among heterosexually active men and women in the club culture. The self-assessment intervention, if proven efficacious in reducing HIV risk, could be delivered at low cost and broad scale, and might well be adaptable to other high risk groups who are resistant to public health warnings and/or professional intervention.

描述（由申请人提供）：在城市俱乐部场景中使用毒品是规范性的，MDMA（摇头丸）和可卡因是最普遍的“俱乐部”药物。该申请提出的继续的父母赠款不仅记录了高度的精神健康问题和广泛的逮捕和虐待历史，而且出乎意料且令人震惊的是，在主要异性恋年轻人样本中，未诊断的艾滋病毒感染率很高。 父母的赠款现在已进入第五年，是对600个俱乐部和使用年轻人的处方药进行的18个月纵向自然历史研究。该研究的一个关键发现是全面的健康和社会风险评估导致参与者减少其物质使用和性风险行为的程度。在基线后的第一次随访评估中，超过70％的参与者大大降低了其物质使用。与研究完成者的定性研究表明，参与者将基线评估的强大干预效果归因于：1）年龄段的友好，非判断性的现场工作人员； 2）详尽而详细的评估； 3）基于对评估项目的反应，对物质使用相关问题的新自我意识。研究完成者还报告说，降低风险往往是因为该研究不是作为干预措施构建的。 在这种情况下，拟议的5年更新项目的具体目的是：1）在750个异性恋，非活跃，非企业和处方药物的非智能，俱乐部和处方药物的年份中，确定基线药物滥用和性风险的协变量（包括人口统计学，社会风险措施，同伴规范，虐待历史和心理健康状况）。 2）通过随机分配评估两种干预条件的相对有效性以及在减少性风险和吸毒的候补控制下，如3，6和12个月的随访中测量：ARM 1：ARM 1，一种与父母赠款中使用的基线相似的面试官的综合健康和社会风险评估术（CAPI干预措施（CAPI干预））； ARM 2，一种相同的自我管理的综合评估干预措施（ACASI干预）；和手臂3，候补名单控制条件（控制）。结果措施，包括过去90天的无保护性行为和使用毒品的毒品，将从基线和随访中的简短风险行为清单中获得； 3）对每个研究部门的40名参与者进行定性过程评估研究，以将研究结果和干预结果与之相关。 拟议的项目非常重要，因为它回应了对高度脆弱，高风险人群的简短干预措施的需求。如果被证明有效地降低艾滋病毒风险，则可以以低成本和广泛的规模进行自我评估干预措施，并且很可能会适应其他高风险群体，这些高风险群体对公共健康警告和/或专业干预有抵抗力。 公共卫生相关性：俱乐部吸毒者报告了高水平的性风险行为以及与使用物质有关的其他问题。拟议的研究是一项随机临床试验，旨在评估异性活跃的男性和女性在俱乐部文化中使用药物使用和降低性风险干预的功效。如果被证明有效地降低艾滋病毒风险，则可以以低成本和广泛的规模进行自我评估干预措施，并且很可能会适应其他高风险群体，这些高风险群体对公共健康警告和/或专业干预有抵抗力。