Health Promotion Coaching/Vaccine for Homeless Parolees

为无家可归假释者提供健康促进指导/疫苗

• 批准号: 8659556
• 负责人: Adeline M Nyamathi
• 金额: $ 0.7万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8659556
• 关键词: Adult; Aftercare; Alcohol consumption; Alcohol or Other Drugs use; Behavior; Behavioral; California; Car Phone; Case Manager; Cellular Phone; Communicable Diseases; Communication; Communities; Comprehensive Health Care; Coupled; Data; Dose; Drug usage; Education; Effectiveness; Employment; Enrollment; Family; Foundations; Funding; General Population; HBV Vaccination; HIV; Health; Health Policy; Health Promotion; Health Services; Health Services Accessibility; Healthcare; Hepatitis; Hepatitis A; Hepatitis B; Hepatitis B Prevalence; Hepatitis B Vaccines; Hepatitis B Virus; Hepatitis C; Hepatitis C virus; Homeless persons; Homelessness; Housing; Imprisonment; Individual; Infection; Injection of therapeutic agent; Intervention; Knowledge; Lead; Leadership; Link; Measures; Mediating; Mental Health; Mentors; National Institute of Drug Abuse; Needle Sharing; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Policies; Population; Prevention; Prisoner; Prisons; Program Effectiveness; Provider; Randomized; Recording of previous events; Relative (related person); Research Personnel; Residential Treatment; Risk; Risk Behaviors; Risk Reduction; Schedule; Series; Services; Sex Behavior; Social Health Services; Social Work; Subgroup; Substance abuse problem; Technology; Telephone; Time; Unemployment; Urine; Vaccination; Vaccines; Virus; Virus Diseases; Visit; Work; base; compare effectiveness; condoms; coping; cost; design; experience; follow-up; health care service utilization; high risk; housing instability; improved; injection drug use; innovation; intervention program; male; men; novel strategies; offender; parole; parolee; prevent; programs; prospective; rearrest; recidivism; reincarceration; sex risk; skills; social; substance abuse treatment; success; treatment as usual; treatment program

DESCRIPTION (provided by applicant): Homeless parolees are at high risk for Hepatitis B virus (HBV), Hepatitis C virus (HCV) and HIV infection due to high rates of injection drug use and unprotected sexual activity. Although HBV is a vaccine-preventable illness, 12% to 25% of formerly incarcerated individuals are infected with HBV. Homeless parolees pose a particular challenge for successful reentry as they have underlying mental health issues combined with substance use and abuse and must contend with unstable housing situations, disorganized lives, unemployment, and limited access to health care and social services. Generally about 50% of all parolees scheduled to enroll in community-based drug treatment fail to enroll and less than 10% of enrollees actually complete treatment. Not surprisingly, about two-thirds of all individuals on parole are rearrested and return to custody within three years of release from prison. Our recent data also revealed homeless persons least likely to complete a HAV/HBV vaccine series were young (< 40), and were men who had been discharged from prison. Therefore, it is critical to engage paroled adults in comprehensive intervention programs that not only protect them from HBV, but also reduce risky behavior, promote access to health care, social and employment services, and enable positive coping and communication skills. With advice from our community partners who have successfully treated parolees and our experience with hepatitis vaccination work, we propose to conduct a prospective, three-group study that randomly assigns 700 ready-for- discharge parolees, scheduled to enter a community residential drug treatment program, to enter one of three groups: 1) a PCPC (Parolee Comprehensive Care + Phone Coaching Program), which includes nurse case management and specialized hepatitis education sessions and referrals, the HAV/HBV vaccination series (to all eligible) and coach- facilitated mentoring (mostly by cell-phone); 2) a Parolee Brief Hepatitis Education + HBV vaccination + Phone Coaching (PBCP) Program, which includes brief hepatitis/HIV education, the HAV/HBV vaccination and coach-facilitated mentoring; or 3) a Usual Care (UC) control program, which includes brief general health information, and the HAV/HBV vaccine. For the randomized parolees, the primary aims will be to examine: reincarceration (any vs none), number of days to first reincarceration, completion of HAV/HBV vaccination (among those HBV-negative), and completion of six months of the Amity community-based residential drug treatment program. Secondary aims are to examine program- related differences in potential mediating variables, such as reduction in drug and alcohol use and sexual risk behaviors, visit to health care or social service providers, and improved knowledge of Hepatitis/HIV and communication skills, between 6 and 12 months or over the one-year study period, depending on the measure, and to assess the relative costs of the three programs. This study will advance our knowledge about drug treatment and HBV vaccine completion and recidivism among homeless parolees. Findings from this study can inform targeted interventions and lay the groundwork for health policy decisions that may impact hepatitis and HIV risk reduction and recidivism in this group who are a reservoir for these viruses in the general population, and are returning to prison at unprecedented numbers.

描述（由申请人提供）：由于注射吸毒率高和无保护的性活动，无家可归的假释者感染乙型肝炎病毒 (HBV)、丙型肝炎病毒 (HCV) 和艾滋病毒的风险很高。尽管 HBV 是一种疫苗可预防的疾病，但 12% 至 25% 的曾被监禁者感染了 HBV。无家可归的假释者对成功重返社会构成了特殊的挑战，因为他们有潜在的心理健康问题，加上药物滥用和滥用，必须应对不稳定的住房状况、无组织的生活、失业以及获得医疗保健和社会服务的机会有限。一般来说，计划参加社区戒毒治疗的所有假释犯中，约有 50% 未能参加，只有不到 10% 的参加者真正完成治疗。毫不奇怪，大约三分之二的假释者在出狱后三年内再次被捕并重新被拘留。我们最近的数据还显示，最不可能完成 HAV/HBV 疫苗系列的无家可归者是年轻人（< 40 岁），并且是已出狱的男性。因此，让假释成年人参与综合干预计划至关重要，这不仅可以保护他们免受乙肝病毒感染，还可以减少危险行为，促进获得医疗保健、社会和就业服务，并提高积极的应对和沟通技巧。根据成功治疗假释犯的社区合作伙伴的建议以及我们在肝炎疫苗接种工作方面的经验，我们建议进行一项前瞻性三组研究，随机分配 700 名准备出院的假释犯，计划进入社区住宅戒毒治疗计划，进入三组之一：1) PCPC（假释犯综合护理 + 电话辅导计划），其中包括护士病例管理和专门的肝炎教育课程和转介、HAV/HBV 疫苗接种系列（针对所有符合条件的人）以及教练协助指导（主要通过手机）； 2) 假释犯简短肝炎教育 + HBV 疫苗接种 + 电话辅导 (PBCP) 计划，其中包括简短肝炎/HIV 教育、HAV/HBV 疫苗接种和教练辅导；或 3) 常规护理 (UC) 控制计划，其中包括简要的一般健康信息和 HAV/HBV 疫苗。对于随机假释者，主要目标是检查：再监禁（任何与无）、第一次再监禁的天数、完成 HAV/HBV 疫苗接种（其中 HBV 阴性）以及完成六个月的 Amity 社区生活基于住院的戒毒治疗计划。次要目标是检查潜在中介变量中与计划相关的差异，例如减少吸毒和酗酒以及性危险行为、拜访医疗保健或社会服务提供者以及提高肝炎/艾滋病毒知识和沟通技巧，6 至12 个月或一年以上的学习期（具体取决于衡量标准），并评估三个项目的相对成本。这项研究将增进我们对无家可归假释者的药物治疗、乙型肝炎疫苗接种和累犯的认识。这项研究的结果可以为有针对性的干预措施提供信息，并为可能影响肝炎和艾滋病毒风险降低和累犯的健康政策决策奠定基础，这些群体是普通人群中这些病毒的储存库，并且以前所未有的数量返回监狱。

项目成果

Correlates of Heroin and Methamphetamine Use among Homeless Male Ex-Jail and Prison Offenders.

• DOI: 10.3109/16066359.2013.877453
• 发表时间: 2014-12
• 期刊: Addiction research & theory
• 影响因子: 2.9
• 作者: Nyamathi A;Salem BE;Farabee D;Hall E;Zhang S;Marfisee M;Khalilifard F;Musto S;Leake B
• 通讯作者: Leake B

Substance use trends among younger vs. older homeless parolees.

• DOI: 10.1080/10550887.2014.909694
• 发表时间: 2014
• 期刊: Journal of addictive diseases
• 影响因子: 2.3
• 作者: Nyamathi A;Salem B;Marshall L;Idemundia F;Mata R;Khalilifard F;Farabee D;Leake B
• 通讯作者: Leake B

Nursing case management, peer coaching, and hepatitis a and B vaccine completion among homeless men recently released on parole: randomized clinical trial.

• DOI: 10.1097/nnr.0000000000000083
• 发表时间: 2015-05
• 期刊: Nursing research
• 影响因子: 2.5
• 作者: Nyamathi A;Salem BE;Zhang S;Farabee D;Hall B;Khalilifard F;Leake B
• 通讯作者: Leake B

A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis.

针对无家可归假释者健康促进和减少累犯的定制干预措施的随机临床试验：结果和成本分析。

• DOI: 10.1007/s11292-015-9236-9
• 发表时间: 2016
• 期刊: Journal of experimental criminology
• 影响因子: 3
• 作者: Nyamathi,AdelineM;Zhang,Sheldon;Salem,BenissaE;Farabee,David;Hall,Betsy;Marlow,Elizabeth;Faucette,Mark;Bond,Doug;Yadav,Kartik
• 通讯作者: Yadav,Kartik

Drug Use and Multiple Sex Partners Among Homeless Ex-Offenders: Secondary Findings From an Experimental Study.

• DOI: 10.1097/nnr.0000000000000150
• 发表时间: 2016-05
• 期刊: Nursing research
• 影响因子: 2.5
• 作者: Nyamathi AM;Zhang SX;Wall S;Hall EA;Salem BE;Farabee D;Faucette M;Yadav K
• 通讯作者: Yadav K