Health Outcomes by Neighborhood - Baltimore
Condition: Stigma; Activity Space; Social Networks; HIV Status; Drug Abuse/Dependence
MeSH terms: Substance-Related Disorders
Study type: Observational

Summary: 
      Background:

      - Researchers have been studying patterns of mood and drug use in specific neighborhoods.
      This study will look at environmental factors that may affect drug use, addiction, and
      treatment seeking in Baltimore neighborhoods. The results could inform prevention efforts,
      enhance treatment interventions, and improve substance use outcomes.

      Objectives:

      - To better understand why some people start to use drugs, why some people who use drugs
      become addicted, and why some people who become addicted enter treatment.

      Eligibility:

      - Individuals at least 18 years of age who are living in the neighborhoods participating in
      the study.

      Design:

        -  Participants will be screened with a physical exam and medical history. They will be
           separated into one of four groups: (1) people who do not use drugs, (2) people who have
           used drugs in the past, (3) people who are using drugs and want treatment, and (4)
           people who are using drugs and do not want treatment.

        -  This study will include two outpatient visits about 12 months apart. Each visit will
           last about 5 hours. Each study visit may be done in 1 day or in 2 days.

        -  At each study visit, participants will provide blood, breath, urine, and saliva samples.
           They will also have a heart function test and body measurements. They will complete
           questionnaires about personal and family history.

        -  There will be monthly follow-up phone calls between the two visits.
    

Detailed description: 
      Phase B

      Background. The reasons for initiation and continuation of use of illicit substances are
      multifactorial; however, some individuals appear resistant to both. One set of determinants
      lies in the environment. In ongoing studies, we are examining environmental concomitants of
      behavior in individuals in drug treatment. In this study, we will examine environmental
      factors that may impact initiation, addiction, and treatment seeking among the greater
      population at large (nondrug-users, current opioid/stimulant users, and current marijuana
      users).

      Scientific goals. (1) To assess, cross-sectionally at baseline, differences in stress, social
      stability, and mental and physical health among three main neighborhood-matched groups of
      current opioid/stimulant users, current marijuana users, and nondrug users; (2) to assess,
      longitudinally, mediators of 12-month changes in drug-misuse status in the same three groups;
      (3) to provide neighborhood-matched control groups of non-drug-using individuals,
      Unclassified/former drug users, and current opioid/stimulant drug users not seeking treatment
      for our ongoing environmental studies of individuals in drug treatment; (4) to explore the
      possible role of genetics and its interplay with environment in regards to drug use
      initiation, addiction, and treatment seeking among the study groups, (5) to assess EMA
      reports of drug use and psychosocial stress as well as real-time environmental risk exposure
      in a non-treatment seeking and/or nondrug using population and compare to our ongoing
      environmental studies of individuals in drug treatment, (6) to assess the accuracy of stress
      detection in the lab and the field by the Health Tag.

      Participant population. We will enroll 650 participants in Phase B of the study for a total
      enrollment (Phase A + Phase B + Phase C) of 3000 participants. Target enrollment will include
      25% women and 70% minorities (mostly African American).

      Experimental design and methods. This is a three-group observational study with a
      crosssectional component and a longitudinal component: each participant will be assessed in
      two visits spaced approximately 12 months apart. For participants enrolled in Phase B after
      January 26, 2021, the interval between the two visits may be shorter than 12 months. The
      three main groups will be: (1) non-drug-users (NDUs), (2) current opioid/stimulant users
      [(COSUs) comprised of two subgroups: treatment seeking (COSU-TS) and non treatment seeking
      (COSU-NTS)], and current marijuana users (CMUs). All groups will be roughly matched for
      socioeconomic status and neighborhoods of residence. Each participant will attend a 3-5-hour
      initial study visit and a 3-5-hour 12 month visit #2. The study visits will include a
      questionnaire component and a biologicalsample component. Questionnaires will cover substance
      use, stress, social stability (including healthcare access/utilization, and neighborhood
      environment), physical and mental health (including quality of life, HIV, and trauma). The
      biological component will consist of samples of urine (for drugs of abuse and cotinine),
      breath (for alcohol and carbon monoxide). Blood for genetics will be obtained at Visit 1 or
      Visit 2. The primary outcome measures will be lifetime substance-misuse history
      (cross-sectional component) and changes in drug-use status across the 12 months between
      visits (longitudinal component). Secondary outcome measures will include: biological
      assessments of drug use; medical, psychiatric, social determinants of health; and impulsivity
      and decision-making factors. Individuals who choose not to return for a 12-month Visit #2
      will be asked to complete a 45-minute telephone visit #2. For participants enrolled in Phase
      B after January 26, 2021, all participants will be asked to complete their visit #2 by
      telephone only. In the HON EMA/GMA secondary study participants will carry a smartphone for
      up to 4 weeks after completing Visit 1. Event-triggered entries will be initiated by
      participants (1) each time that they use a drug (COSU) or marijuana and/or alcohol (NDU, CMU,
      and Unclassified) and (2) each time they feel overwhelmed, anxious, or stressed more than
      usual. Participants will also make 5 random-signal-triggered recordings per day and one brief
      end of day recording. During this study participants will also complete compliance visits
      once per week. In the Health Tag secondary study, participants will undergo a one-day
      laboratory session followed by a 30-day field study. Benefits to participants and/or society.
      There are no benefits to participants. The knowledge gained may benefit society by providing
      data on the health outcomes of drug-using and non-drugusing individuals and the natural
      history of drug use by neighborhood.

      Risks to participants. This is a minimal-risk study, consisting of standard physical and
      questionnaire-based assessments.
    

Observational model: Ecologic or Community
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        We will enroll 650 participants in Phase B of the study for a total enrollment (Phase A +
        Phase B + Phase C) of 3000 participants. Target enrollment will include 25% women and 70%
        minorities (mostly African-American).
      
Keywords: Drug Abuse; Ecological Momentary Assessment (EMA); Environment; Genetic; Longitudinal; Natural History