Dorian E. Traube, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): Unprotected sexual intercourse between men constitutes 58% of all reported cases of AIDS and 80% of HIV cases 1,2. Rates of HIV infection among 15 to 24 year olds continue to increase with MSM behavior remaining the leading cause of HIV infection among adolescent males 1,2. Over 90% of YMSM have reported having more than one sexual partner in the past 6 months and between 33% and 49% have had unprotected anal intercourse during the same time3. Studies show that use of stimulants, particularly methamphetamine, may influence risky sexual practices and contribute to the most recent wave of HIV and other sexually transmitted infections (STIs)4-6. Systematic development of theory has been identified as a crucial step in efficacious intervention development, but previous conceptual models have focused on a relatively limited array of explanatory constructs. However, Social Action Theory (SAT)7 provides a promising model for examining the risk behavior of YMSM, because it includes individual as well as social and contextual determinants. SAT remains to be tested for use in the field of HIV and with YMSM, because this model was originally conceived as a general health promotion model for the adult population. Using data from the Dr. Kipke's NIDA funded "Healthy Young Men Study" (HYM), this study will conduct multivariate analysis to test this model for use with the YMSM population. The specific aims of this study are to: 1) To empirically validate the chain of relationships depicted in Social Action Theory to determine if the theory addresses the interaction of individual, contextual, and social correlates of sexual and drug risk taking behaviors as they relate to YMSM; and 2) To further validate SAT by testing and incorporating competing theoretical relationships depicted in other behavioral theory models to develop a comprehensive theory of the social, psychosocial and cognitive risk factors for drug use, sexual impulsivity, and HIV among YMSM to guide prevention intervention efforts. . This study will contribute to the objectives of the AIDS-Science Track Award for Research Transition by 1) supporting a New Researcher; 2) addressing the NIDA research objective in the area of HIV, drug abuse, impulsivity, and coping strategies of an at-risk, under represented population; and 3) through refinement of a comprehensive theoretical model, we will provide a platform for developing interventions that address risk behavior related to HIV transmission among YMSM. PUBLIC HEALTH RELEVANCE: This study will contribute to effective HIV interventions for at-risk youth by developing a model to understand how environmental risk factors, impulsivity, and coping strategies converge into drug abuse and sexual risk taking. [unreadable] [unreadable] [unreadable]

Abstract: The child welfare system may be the locus of a vicious circle of intergenerational substance use. In the U.S. some 8.3 million teens dependent on alcohol or otherwise needing treatment for substance use actually reside with substance-abusing parents who were maltreated as children. Maltreated children of parents who abuse substances are more likely to abuse substances in adulthood. Teens involved in CWS have an abundance of risk factors and few protective factors against substance abuse. Given the abundance of risk for CWS involved teens, CWS can serve as an important gateway to substance abuse prevention services. CWS has the potential to serve as a robust non-specialty service sector platform because it can facilitate targeting of high risk youth, sustain both preventive and substance abuse treatment programs, and allows for the capture of teens and their caregivers in a mandated treatment setting. The literature on predictors of substance use initiation and intensity among CWS involved teens is still emerging, as is the literature on prevention and treatment services. Therefore, the overall goal of the proposed research is to conduct analyses of an extant national probability cohort of child welfare involved teens to determine the prevalence and impact of substance use, predictors of substance abuse over the course of adolescent development, and the role that current child welfare services play in ameliorating substance use and abuse. To accomplish this goal, we propose a three year study in response to PAR-10-018, Accelerating the Pace of Drug Abuse Research Using Existing Epidemiology, Prevention, and Treatment Research Data, which highlights: 1) basic science development related to knowledge of risk and resilient trajectories of drug using behaviors among CWS teens; and 2) analyses of the organizational and system contexts that improve the accessibility, utilization, and, effectiveness of substance abuse prevention services within a non-specialty sector. The overall goal will be addressed by the following specific aims: 1) Investigate prevalence and longitudinal trajectories of initiation and intensity of substance use among teens in CWS; 2)Investigate predictors of substance use for teens in CWS; 3) Identify common points for entry into substance abuse services, service utilization patterns, and service utilization outcomes for teens in CWS; and 4) Develop a prevention intervention framework for selecting and fitting evidence based interventions to address substance use among CWS involved teens.