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.

Agency
National Institute of Health (NIH)
Type
Research Project (R01)
Project #
5R01DA019048-11
Application #
8700357
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Lloyd, Jacqueline
Project Start
Project End
Budget Start
Budget End
Support Year
11
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Nova Southeastern University
Department
None
Type
Schools of Pharmacy
DUNS #
City
Fort Lauderdale
State
FL
Country
United States
Zip Code
33314
Kurtz, Steven P; Surratt, Hilary L; Buttram, Mance E et al. (2013) Interview as intervention: the case of young adult multidrug users in the club scene. J Subst Abuse Treat 44:301-8
Kurtz, Steven P; Surratt, Hilary L; Levi-Minzi, Maria A et al. (2011) Benzodiazepine dependence among multidrug users in the club scene. Drug Alcohol Depend 119:99-105
Ibanez, Gladys E; Kurtz, Steven P; Surratt, Hilary L et al. (2010) Correlates of heterosexual anal intercourse among substance-using club-goers. Arch Sex Behav 39:959-67
Inciardi, James A; Surratt, Hilary L; Cicero, Theodore J et al. (2009) The "black box" of prescription drug diversion. J Addict Dis 28:332-47
Kurtz, Steven P; Inciardi, James A; Pujals, Elisa (2009) Criminal Activity Among Young Adults in the Club Scene. Law Enforc Exec Forum 9:47-59
Inciardi, James A; Surratt, Hilary L; Kurtz, Steven P et al. (2007) Mechanisms of prescription drug diversion among drug-involved club- and street-based populations. Pain Med 8:171-83