Assessing the Feasibility of Economic Approaches to Prevention of Substance Abuse among Adolescents

评估预防青少年药物滥用的经济方法的可行性

• 批准号: 10618956
• 负责人: Rachel Brathwaite
• 金额: $ 19.4万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-10 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10618956
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Affect; Africa; Africa South of the Sahara; Age; Alcohol consumption; Alcohols; Attention; Behavior; Bereavement; Biological; Caring; Cessation of life; Clinic; Communities; Coping Skills; Country; Data; Development; Discrimination; Disease; Drug usage; Economics; Enrollment; Environment; Epidemic; Epidemiologic Factors; Epidemiology; Evidence based intervention; Exclusion; Family; Feeling hopeless; Fishes; Goals; Grant; HIV; HIV Seropositivity; HIV risk; HIV/AIDS; Health; Household; Human immunodeficiency virus test; Income; Individual; Infection; Intervention; Knowledge; Learning; Long-Term Effects; Low income; Measures; Mental Depression; Mental Health; Mental Health Associations; Methods; Modeling; Motivation; Patient Self-Report; Personal Satisfaction; Persons; Pharmaceutical Preparations; Play; Population; Poverty; Prevalence; Prevention approach; Psychotropic Drugs; Public Health; Reporting; Resource-limited setting; Resources; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Risk Taking; Role; Sahara; Sampling; Savings; School Drop-Outs; Schools; Stress; Stress and Coping; Student Dropouts; Supervision; Testing; Treatment outcome; Uganda; Unsafe Sex; Urine; Viral; Vulnerable Populations; Youth; adolescent alcohol and drug use; alcohol consequences; alcohol measurement; alcohol misuse; alcohol risk; antiretroviral therapy; binge drinking; care outcomes; chronic pain; cohort; coping mechanism; design; deter alcohol use; drug abuse prevention; drug misuse; empowerment; evidence base; experience; financial literacy; high risk; illicit drug use; improved; innovation; low income country; mortality; poverty reduction; prevent; preventive intervention; protective factors; reduced alcohol use; resilience factor; response; social; social stigma; stressor; substance abuse prevention; substance use; theories; vulnerable adolescent

PROJECT ABSTRACT Adolescent alcohol and drug use (ADU) is a significant public health challenge in sub-Saharan Africa (SSA). About 41.6% of adolescents in SSA reported using at least one psychoactive agent, with alcohol being the most commonly used drug. Uganda, one of the poorest countries in SSA, has the second highest rate of per capita alcohol consumption in SSA (15.1 liters of pure alcohol vs regional average of 6.2 liters of pure alcohol) and over one third of Ugandan adolescents have used alcohol in their lifetime, 22.5 million are current drinkers, and over 50% engage in heavy episodic drinking. These estimates reach even greater magnitudes in the country’s fishing villages – a key HIV vulnerable population- where ADU is normative. A few studies have assessed ADU among AYLHIV, yet AYLHIV are at higher risk for ADU, and ADU impedes adherence to anti-retroviral therapy (ART), retention in care, and viral suppression. Several studies have examined the risk and resilience factors for ADU but few interventions targeting ADU have been tested in SSA. Only 10 ADU interventions have been evaluated in SSA and only a few have been successful. The majority have been implemented in school settings, which may exclude adolescents in fishing communities that have high rates of school dropout. Moreover, none has targeted risk factors such as poverty and mental health, which are rampant among AYLHIV and their families, undermine AYLHIV’s coping skills and resources, and have been associated with increased risk for ADU among adolescents. Family-based economic empowerment (FEE) interventions have the potential to prevent ADU among AYLHIV by reducing poverty and its associated mental health impacts, and also bolstering AYLHIV and their families’ resources to overcome the challenges associated with HIV. Given the lack of evidence-based culturally tailored interventions to prevent ADU in AYLHIV in low-income settings such as Uganda, this study proposes to: Aim 1a. Examine the prevalence and consequences of ADU in a sample of 200 AYLHIV (ages 15- 24) seen at six (6) HIV clinics located in the fishing communities of southwestern Uganda. ADU will be measured using self-report and biological data (i.e. urine). Aim 1b. Using a mixed methods approach, identify the multi- level (individual, interpersonal, community and structural) factors associated with ADU among AYLHIV. Aim 2: Using a subset of the sample, explore the feasibility and short-term effects of a FEE intervention on ADU among AYLHIV. Our intervention focuses on older adolescents and young adults in a high-risk environment (i.e. fishing communities) to elucidate the contextually relevant risk and resilience factors for ADU among AYLHIV undergoing social transitions. Additionally we innovatively target the most commonly occurring risk factors for ADU (i.e. poverty and mental health problems) through the FEE that includes provision of youth development savings accounts, financial literacy sessions and ADU risk reduction sessions. Our findings will inform the design of an R01 grant to examine the long-term effects of a family-based economic empowerment intervention on ADU among AYLHIV.

项目摘要 青少年酗酒和吸毒 (ADU) 是撒哈拉以南非洲地区 (SSA) 面临的重大公共卫生挑战。 SSA 中约 41.6% 的青少年报告至少使用过一种精神活性药物，其中酒精使用最多 乌干达是撒哈拉以南非洲最贫穷的国家之一，人均使用率排名第二。 SSA 的酒精消费量（15.1 升纯酒精，而地区平均水平为 6.2 升纯酒精）及以上 三分之一的乌干达青少年一生中饮酒过，目前有 2250 万人饮酒，超过 50% 的人偶尔酗酒，这一数字在该国的渔业中达到了更高的水平。 村庄——主要的艾滋病毒易感人群——ADU 处于正常水平，一些研究评估了其中的 ADU。 AYLHIV，但 AYLHIV 患 ADU 的风险较高，并且 ADU 妨碍坚持抗逆转录病毒治疗 (ART)， 多项研究探讨了 ADU 的风险和恢复力因素。 但针对 ADU 的干预措施很少在 SSA 中进行过测试，仅评估了 10 种 ADU 干预措施。 在 SSA 中，只有少数取得了成功，大多数已在学校环境中实施。 可能会将辍学率高的渔业社区的青少年排除在外。而且，没有一个这样做。 有针对性的风险因素，如贫困和心理健康，这些因素在 AYLHIV 及其家人中普遍存在， 破坏 AYLHIV 的应对技能和资源，并与 ADU 风险增加相关 以家庭为基础的经济赋权 (FEE) 干预措施有可能预防 ADU。 通过减少贫困及其相关的心理健康影响，以及支持 AYLHIV 和 由于缺乏证据，他们的家庭资源无法克服与艾滋病毒相关的挑战。 这项研究指出，在乌干达等低收入地区，应采取针对文化的干预措施来预防 AYLHIV 感染中的 ADU 建议： 目标 1a. 检查 200 名 AYLHIV 样本（15 岁至 15 岁）中 ADU 的患病率和后果。 24）将在位于乌干达西南部渔业社区的六 (6) 个艾滋病毒诊所进行测量。 使用自我报告和生物数据（即尿液），使用混合方法来识别多因素。 目标 2：AYLHIV 中与 ADU 相关的水平（个人、人际、社区和结构）因素。 使用样本的子集，探讨 FEE 干预对 ADU 的可行性和短期影响 AYLHIV。我们的干预重点是高风险环境（即钓鱼）中的老年青少年和年轻人。 社区）阐明 AYLHIV 中 ADU 的背景相关风险和复原力因素 我们还针对正在经历社会转型的最常见的风险因素。 通过 FEE 解决 ADU（即贫困和心理健康问题），其中包括提供青年发展服务 我们的研究结果将为设计提供信息。 R01 拨款用于研究基于家庭的经济赋权干预措施对 ADU 的长期影响 AYLHIV 中。