Drug Use and Sexual Risk Behaviors Among Emerging Adults in the ER

Study Overview
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Brief Summary
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This project will develop a technology-augmented HIV and substance use risk reduction intervention for delivery in the Emergency Department, a medical setting where at-risk emerging adults who use drugs and engage in HIV-related risk behaviors are likely to present.

Detailed Description
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Research regarding substance use (including illicit drugs and non-medical use of prescription drugs) and HIV-related sexual risk behaviors (HIV SRBs; e.g., inconsistent condom use, multiple partners, sex while intoxicated; and prevention of injection drug use) among emerging adults (EAs; ages 18-25) has generally focused on alcohol use among college students from campus settings; however, substance use and HIV (and other associated Sexually Transmitted Infections) disproportionately occur among young people living in urban, low-resource communities, particularly individuals of racial minorities. The Emergency Department (ED) is a critical venue for accessing at-risk EAs engaging in substance use and HIV risk behaviors. Research shows high rates of substance use and HIV SRBs among EA patients in the ED, yet no intervention exists for EAs in this setting. The ED may be the only opportunity to intervene with these young people because EAs in urban, low-resource settings often lack a primary care provider during the transition from pediatric to adult medicine, may be un-insured or under-insured, and may not be involved in a traditional college campus setting. Further the use of technology (e.g., mobile phones) is relatively ubiquitous among this age group, and most prefer technology-based communication (e.g., text messaging or instant messaging via apps), therefore interventions for EAs may be enhanced by this type of technology. In this phase we will test a tailored intervention for EA patients in the ED focusing on reducing substance use and HIV SRBs, which will be enhanced through the use of mobile app notifications.

Official Title
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Drug Use and Sexual Risk Behaviors Among Emerging Adults in the ER

Conditions
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Drug Use, Sex Behavior

Intervention / Treatment
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* Behavioral: Brief Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Medically stable Mentally and physically able to consent English-speaking Between ages 18-25 Past-month substance use (including illicit drugs and/or non-medical prescription drug use) and inconsistent condom use in the past month Ownership of a smartphone Exclusion Criteria: ED presentation suicidality and/or acute psychosis, being in police custody, or present with psychological distress requiring intensive social work (e.g. sexual assault) Patients with a significant other that they live with who is currently participating in study Actively participating in another study Participated in prospective and intervention development phases of the study Married Do not wish to consent to audio-taping the in-person portion of the ED-based intervention session

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 25 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Brief Intervention<br>ED-based computer-guided intervention for substance use and HIV risk reduction utilizing Motivational Interviewing | Behavioral: Brief Intervention<br>* Intervention for emerging adults (EAs) seeking care in the ED. The intervention will be rooted in motivational interviewing (MI) and will be guided by social cognitive, self-determination, and the trans-theoretical theories. The ED visit presents a teachable moment for intervening to promote health behavior, therefore eligible EAs will receive a  30 minute MI-based session in the ED. In order to capitalize on and potentially extend this moment, participants will receive daily booster notifications delivered through a secure mobile app that they will download to their phone at enrollment.<br>|
| No Intervention: Enhanced Usual Care<br>Substance use and sexual health services information within a brochure provided to participants | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in days substance use | 60-day Timeline Follow-Back (TLFB) will be used to assess total days of any substance use. | 2-months post baseline | 
| Change in quantity of marijuana use | 60-day Timeline Follow-Back (TLFB) will be used to assess quantity of marijuana consumed. | 2-months post baseline | 
| Change in total alcohol consumption | 60-day Timeline Follow-Back (TLFB) will be used to assess quantity of alcohol consumed | 2-months post baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in HIV risk behaviors | 60-day Timeline Follow-Back (TLFB) will be used to assess frequency of unprotected sex. | 2-months post baseline | 
| Change in substance use consequences | Modified Rutgers Alcohol Problems Index adapted for alcohol and drugs will assess total substance related consequences experienced. | 2-months post baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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HIV, Emerging adults, Drugs, Risky Sex Behaviors