AHRQ Series Editorial: Public involvement improves methods development in comparative effectiveness reviews

Exposure to personal and community violence and associated drug use outcomes in African American young adults

BACKGROUND

Exposure to violence (ETV) during one's life has been associated with increased risk for substance abuse. Adolescent ETV is also related to substance abuse into adulthood, and has been shown to have a cumulative effect. This study adds to the understanding of how ETV relates to a range of substance use outcomes by specifying how different types of violence affects substance use behaviors in African American young adults, and examines how this exposure is moderated by other life stressors, and health and social experiences.

METHOD

Factor analysis was conducted to identify unique types of ETV in 638 African American men and women ages 18-25. The resulting factors represent 1) childhood ETV and 2) community ETV as adults. These were regressed upon substance abuse outcomes.

RESULTS

78% of the respondents were exposed to some form of violence during their childhood. Lower childhood ETV were significantly associated with a lower risk of engaging in dangerous substance use behaviors. Adult experiences of community violence had more significant predictors of drug use than childhood ETV. Witnessing gunfire or an assault, witnessing or being a victim of sexual assault, and carrying a weapon were consistent risk factors for dangerous drug behaviors, although specific drug use behaviors differed across genders.

CONCLUSIONS

ETV served as an independent explanatory factor for specific drug use behaviors at different stages of life. Future research is needed to understand how these factors put respondents at risk for drug use behaviors or make them less likely to engage in dangerous use patterns.

A CTSA agenda to advance methods for comparative effectiveness research

Clinical research needs to be more useful to patients, clinicians, and other decision makers. To meet this need, more research should focus on patient-centered outcomes, compare viable alternatives, and be responsive to individual patients' preferences, needs, pathobiology, settings, and values. These features, which make comparative effectiveness research (CER) fundamentally patient-centered, challenge researchers to adopt or develop methods that improve the timeliness, relevance, and practical application of clinical studies. In this paper, we describe 10 priority areas that address 3 critical needs for research on patient-centered outcomes (PCOR): (1) developing and testing trustworthy methods to identify and prioritize important questions for research; (2) improving the design, conduct, and analysis of clinical research studies; and (3) linking the process and outcomes of actual practice to priorities for research on patient-centered outcomes. We argue that the National Institutes of Health, through its clinical and translational research program, should accelerate the development and refinement of methods for CER by linking a program of methods research to the broader portfolio of large, prospective clinical and health system studies it supports. Insights generated by this work should be of enormous value to PCORI and to the broad range of organizations that will be funding and implementing CER.