Despite the growing body of evidence linking environmental factors to violence and drug exposure, traditional prevention programs have not targeted environmental factors. Instead, intervention programs have typically focused on individuals or families and their high-risk behavior. The proposed investigation seeks to classify both individual- and community-level distributions and determinants of violence and alcohol and other drug (AOD) exposure by identifying environmental factors associated with increased neighborhood violence and AOD exposure among youth. To achieve these goals, independent objective neighborhood ratings will be conducted on a random sample of two unit blocks within each of 272 ecologically defined city neighborhoods to (a) gather information on the physical environment of the neighborhood; (b) clarify the environmental contexts in which youth live and experience violence and AOD exposure; and (c) provide insight on environmental targets for future intervention efforts. To link community-level factors with individual youth violence and AOD exposure, we will also conduct environmental assessments of neighborhoods among the 316 Baltimore youth participating in the Baltimore Prevention Program (BPP). The BPP data are rich in longitudinal information on both violence and AOD exposure as well as social adaptation and psychological well-being from early childhood thru late adolescence. This work will provide a model approach for assessment and identification of environmental factors linked with increased violence and AOD exposure and guide future community-level environmental preventive interventions. This innovative approach to environmental violence and AOD assessment forms the basis for the next stage of research that involves development and implementation of action plans to target specific environmental indicators. As such this investigation initiates a line of inquiry that will advance the evidence base for strategies in program modeling and improve the comprehensiveness and effectiveness of existing programs.
This proposal seeks to implement a brief screen for alcohol use disorders (AUDs) among the approximate 6,000 participants in the upcoming 2006 National Highway Safety and Traffic Administration (NHSTA) National Roadside Survey (NRS). There is a body of evidence that purports heavy and problem drinkers are overrepresented in the population of DUI offenders and pose a significant threat to highway and traffic safety. A brief AUD screener validated as rapid roadside assessment of AUDs is proposed for inclusion in the upcoming NRS. This project will clarify the extent to which drivers in general, and more specifically drivers with elevated blood alcohol contents as measured by standardized breath tests have current alcohol problems. If successful, this screen will aid policymakers in determining appropriate intervention services for DUI offenders as well as correlate cross-sectional BAC readings with varying types of pathological alcohol use, namely binge drinking, heavy drinking, and alcohol abuse and dependence (potential signals for unmet treatment need). The alcohol screen proposed for use in this large roadside survey is grounded in existing evidence derived from an exploratory program where the screener was refined, piloted and validated as a rapid roadside screening tool. The measurement constructs to be employed are the consumption subscale of the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS). This work is divided into three distinct phases. Phase 1 entails preparation for the 6,000 case fielding of the NRS. Phase 2 is the fielding of the NRS Program and Phase 3 is dedicated to analysis of data and dissemination of findings. The specific aims of this work are: Aim 1: To assess the extent to which persons with alcohol use disorders (AUDs) are present in the nighttime weekend driving population, the period of greatest risk for alcohol-related crash fatalities. Aim 2: To conduct an assessment of the relationship between cross-sectional BAC and active AUD status, including adjustment for active other drug use. Aim 3: To identify characteristics of nighttime weekend drivers that signal unmet treatment need for drug- and alcohol-related prevention or intervention services. Health significance: The significance of this work is best viewed in light of the substantial societal resources being allocated to address the perceived risk posed by AUD drivers who are believed to be chronic DUI offenders as evidenced by the passage of state laws. This nationwide probability sample will enable national prevalence estimates of the extent to which persons with AUDs are represented in the most at-risk for crash, injury and death driving and passenger population.
The proposed project seeks to provide insight on violence, alcohol and other drug (VAOD) activity within Baltimore City by taking pre- and post-municipal alcohol-related intervention measurements of VAOD activity. This proposal seeks to identify promising environmental violence and AOD prevention strategies by providing (a) a comprehensive epidemiologic assessment of municipal alcohol-related intervention effects on communities in Baltimore City, and (b) a systematic and objective contextual analysis of the key alcohol-related environmental precipitators theorized to promote and sustain elevated levels of VAOD exposure. The proposed research will increase understanding of specific environmental factors linked with increased exposure and will lay a foundation for future investigations to test the hypothesis that violence can be prevented and controlled through environmental modifications.
The proposed B-START seeks to pilot test and refine an approach that uses randomized incentives to recruit youth into a preventive intervention geared to increase awareness about the harmfulness of inhalant drug use. Youth ages 12 to 17 will be recruited from local markets and youth "hot spots" via street-intercept surveys, and a brief assessment will be administered. Then youth will be invited to participate in a brief educational intervention on the hazards of inhalants use. Hard refusals will be offered varying incentives assigned at random (ranging from $5 to $25). The goal of this proposed investigation is to estimate the thresholds of incentives needed to induct youth into drug abuse prevention research and identify factors related to a propensity to engage in these types of programs (e.g. gender, age, history of drug involvement). In addition, this work aims to clarify if the propensity to engage in prevention programs is related to response to the intervention (i.e., do youth who are willing to participate at lower incentive thresholds have a more beneficial impact from the intervention). Traditional intervention evaluation uses the "intent-to-treat" approach where all youths assigned to intervention conditions are treated as though they received intervention regardless of intervention dosage. A major shortcoming of that approach is the lack of sensitivity to those youths who never made it to the study because of selection biases, refusals to participate, and so on. This proposed investigation seeks to strengthen the body of evidence on recruitment of youth into preventive interventions as well as provide empirical data on differences in responders and nonresponders regarding levels of drug involvement and intervention response. This line of exploratory/developmental research also should have general significance and applicability in other individualized intervention programs directed toward other drugs and other health risk behaviors.