Document text
Principal Investigator: Sophia A. Hussen
Organization: EMORY UNIVERSITY
Fiscal Year: 2024
Award: $683,730
Funding agency: National Institute on Drug Abuse
PROJECT SUMMARY
Emerging data demonstrates a rise in methamphetamine (meth) use among Black gay, bisexual and other
men who have sex with men (GBMSM). Meth is associated with myriad physical and social harms, and has the
potential to exacerbate existing health inequities impacting Black GBMSM. Existing meth prevention and
treatment interventions do not address the unique social position of Black GBMSM or the related health
impacts of structural racism and discrimination (SRD). Based on our preliminary studies, we hypothesize that
four forms of SRD are likely to influence meth use among Black GBMSM: housing discrimination, gentrification,
racial and income segregation, and discriminatory LGBT community climate. Additionally, we posit that these
forms of SRD operate through housing instability and inadequate service access to increase risk for meth use
among Black GBMSM. The goal of this project is to generate knowledge that will inform the design of multi-
level, culturally congruent structural approaches to prevent meth use and associate harms among Black
GBMSM. Our study will be based in Atlanta, Georgia – an ideal setting to examine these questions given the
cultural significance for Black Americans, large population of Black GBMSM, and recent SRD-related
demographic shifts. Drawing on the risk environment framework as its theoretical foundation, this study will
pursue three specific aims: (1) to examine the impacts of census-tract level measures of SRD on housing
instability, service access and meth use among Black GBMSM in Atlanta; (2) to elicit narratives of meth use,
housing instability, service access and SRD among Black GBMSM; and (3) to examine systems of structural
influence and develop qualitative causal maps linking various forms of SRD, service access, housing and meth
use among Black GBMSM. For the first aim, we will recruit N=300 Black GBMSM into a longitudinal cohort
study, and conduct serial surveys every 6 months over a two-year follow-up period. Additional location and
meth use data will be obtained monthly using ecological momentary assessment technology. Individual survey
responses will be linked to geolocated census-tract level measures of SRD and service access. For the second
aim, we will conduct a longitudinal qualitative study including in-depth interviews and walking ethnographies
with N=40 cohort participants, to gather insights on their experiences with SRD, housing, service access and
meth use. For the third aim, we will use a community-based system dynamics approach to convene a group
model building workshop with key stakeholders (N=25), which will lead directly to the development of causal
maps that will inform structural interventions. The proposed research is highly significant because of its
potential to inform effective structural strategies for preventing meth use and ameliorating meth-related harms
among Black GBMSM.
Terms: <Access to Care><Active Follow-up><Bi-sexual><Bisexual><Black><Black American><Black Populations><Black group><Black individual><Black people><Black race><Blacks><Censuses><Climate><Cognitive Discrimination><Communities><Crystal Meth><Crystal methamphetamine><Data><Deoxyephedrine><Desoxyephedrine><Destinations><Development><Discrimination><Disparity population><Drugs><Ecological momentary assessment><Economic Income><Economical Income><Economics><Educational workshop><Environment><Epidemic><Ethnography><Exposure to><Foundations><Freedom><Gays><General Population><General Public><Goals><Harm Minimization><Harm Reduction><Health><Health Inequity><Health Services Accessibility><Healthcare><Homelessness><Housing><Income><Individual><Inequalities in Health><Inequities in Health><Intervention><Intervention Strategies><Interview><Knowledge><LGBT><Lead><Lesbian Gay Bi-sexual Transgender><Lesbian Gay Bisexual Transgender><Liberty><Link><Location><Long-term cohort study><Longitudinal cohort study><Longterm cohort study><METH use><MSM><Maps><Measures><Mediating><Mediator><Medication><Mental Health><Mental Hygiene><Meteorological Climate><Methamphetamine><Methamphetamine prevention><Methamphetamine use disorder><Methods><Methylamphetamine><N-Methylamphetamine><NIH><National Institutes of Health><Participant><Pathway interactions><Pb element><Personal Satisfaction><Persons><Pharmaceutical Preparations><Population><Prevention><Psychological Health><Public Health><Race><Races><Reporting><Research><Risk><Science><Services><Social Service><Social Work><Social status><Structural Racism><Survey Instrument><Surveys><System><Technology Assessment><United States><United States National Institutes of Health><Walking><Work><Workshop><access to health services><access to services><access to treatment><accessibility to health services><active followup><availability of services><behavior change><care access><climatic><co-morbid><co-morbidity><cohort><community based organizations><community engaged participatory research><community engaged research><community organizations><community partnered research><community-engaged study><community-partnered study><comorbidity><design><designing><developmental><disadvantaged group><disadvantaged individual><disadvantaged people><disadvantaged population><disadvantaged subgroup><disparate effect><disparate impact><disparate result><disparities across groups><disparity across subgroups><disparity among groups><disparity among subgroups><disparity between groups><disparity between subgroups><drug/agent><dynamic system><dynamical system><economic><ethnographic><examination questions><experience><follow up><follow-up><followed up><followup><group disparity><group inequality><group inequity><health care><health inequalities><health service access><health services availability><heavy metal Pb><heavy metal lead><homeless><homonegativity><housing instability><improved><incomes><inequalities among populations><inequalities between populations><inequalities in populations><inequality across populations><inequality among groups><inequality between groups><inequality in groups><inequitable effect><inequitable impact><inequitable outcome><inequities among populations><inequities between populations><inequities in populations><inequity across groups><inequity across populations><inequity between groups><inequity in groups><innovate><innovation><innovative><insight><instably housed><interventional strategy><men><men having sex with men><men who have sex with men><men who have sex with other men><meth><meth prevention><meth use disorder><methamphetamine use><methamphetamine use prevention><model building><outcome disparities><outcome inequality><outcome inequity><pathway><population inequality><population inequity><prevent><preventing><prospective><racial><racial background><racial origin><recruit><residential segregation><response><segregation><service availability><service providers><social><social position><social standing><social vulnerability><subgroup disparity><substance use treatment><treatment access><unequal effect><unequal group><unequal impact><unequal outcome><unequal population><unhoused><unstable housing><unstably housed><well-being><wellbeing>