Substance abuse is a widely recognized health problem in the US, with devasting impact on individuals and families. Many illnesses are due directly to alcohol abuse, rendering alcoholics among the highest cost users of medical care in the country. Blacks suffer disproportionately from substance use-related health and social problems. The high prevalence of substance use in young urban black males increases their risk of death and disability, often from cardiovascular disease, stroke, and renal disease. Substance use is a modifiable risk factor impacting many health outcomes, including high blood pressure (HBP). The need for substance abuse treatmetn as an integral part of HBP care and control has been demonstrated. However, interventin research has not yet addressed this need in this population. The development and evaluation of practical, cost-effective, and culturally sensitive interventins that address the problem of substance abuse in the high risk, vulnerable population of underserved hypertensive black males is imperative. The proposed dissertation study is designed as a randomized clinical trial with two parallel arms to test the effect of a brief substance abuse intervention on: 1. completion of referral to substance abuse treatment services; 2. substance use patterns; and 3. level of BP. Substance abusing black men with HPB will be randomized to receive either 1. HPB care by a nurse practitioner or 2. the brief intervention for substance abuse in addition to HBP care provided by a nurse practitioner. The brief intervention which is developed to enhance self-efficacy and readiness to change substance use will be developed and tested in a two phase project. The first phase will involve conducting focus groups and pilot testing to refine the brief intervention. In the second phase, the following hypotheses will be tested: 1. Increase self-efficacy and advance along the continuum of readiness to change substance use behaviors. 2. Increase completion of referral to substance abuse treatment services; 3. Increase utilizatoin of substance abuse treatment services; 4. Decrease substance use; and 5. Decrease level of BP. This study is significant because: 1. It specifically targets the vulnerable, underserved population of Black men with substance use-related problems who are at high risk for premature morbidity and mortality; 2. It evaluates a state-of-the-art nursing intervention that the applicant hypothesizes to be effective in improving an important health outcome in this disproportionately affected group; 3. Preliminary work in the parent study confirms the need for the proposed dissertation research, and 4. It takes advantage of the parent grant which provides extraordinary resources for dissertation level research.
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