Understanding the Opioid Epidemic in Rural Ohio: A Mixed-Methods Analysis of Moral Values, Stigma, and Medication for Opioid Use Disorder (MOUD)

了解俄亥俄州农村地区阿片类药物的流行：对阿片类药物使用障碍 (MOUD) 的道德价值观、耻辱和药物的混合方法分析

• 批准号: 10222544
• 负责人: Christine Schalkoff
• 金额: $ 3.81万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222544
• 关键词: Address; Advocate; American; Appalachian Region; Area; Attitude; Automobile Driving; Behavior; Biological Sciences; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Communication; Communities; Country; Crime Victims; Data; Development; Disease; Distress; Drug Addiction; Drug usage; Drug user; Economics; Educational Intervention; Epidemic; Epidemiology; Equation; Evidence based intervention; Evidence based treatment; Factor Analysis; Faculty; Foundations; Funding; Future; Goals; Harm Reduction; Health Personnel; Health behavior; Individual; Interdisciplinary Study; Intervention; Interview; Intuition; Knowledge; Measures; Mediating; Mediation; Mentorship; Methods; Modeling; Morality; Morals; Naltrexone; National Institute of Drug Abuse; Needle-Exchange Programs; Ohio; Opioid; Overdose; Pathway interactions; Pattern; Perception; Pharmaceutical Preparations; Pharmacotherapy; Plant Roots; Policies; Population; Psychology; Public Health; Questionnaires; Recording of previous events; Research; Research Methodology; Research Personnel; Research Training; Rural; Rural Appalachia; Sampling; Shapes; Social Psychology; Stigmatization; Structure; Testing; Translating; United States; Work; addiction; authority; base; career; design; emotional trauma; evidence base; experience; forging; healthcare community; instrument; member; mortality; novel; opioid epidemic; opioid use; opioid use disorder; overdose death; prescription opioid; programs; public health intervention; response; rural area; scale up; service uptake; sexual trauma; skills; social; social stigma; stem; substance use; substance use treatment; theories; tool; trafficking; training opportunity; uptake

Abstract Opioid-related mortality in the U.S continues to rise, particularly in the rural Appalachian region of the country. Increased availability of and access to evidence-based treatment for opioid use disorder, such as medication for opioid use disorder (MOUD) is needed to successfully address the epidemic; however, stigma among healthcare providers and community members as well as internalized stigma among people who use drugs (PWUD) are substantial barriers to MOUD availability and uptake in rural Appalachia. While public health efforts to address opioid use and treatment have often focused on stigma reduction, there is a need for interdisciplinary work to understand the forces underlying this stigma in rural Appalachian communities. In particular, cultural factors such as moral views may have critical consequences for drug- and MOUD-related stigma in these areas. The goal of the proposed research is to understand the relationship between moral views, stigma, and uptake of MOUD among people who use drugs in rural Appalachian Ohio, as well as to explore moral views and perceptions of MOUD among healthcare providers and community stakeholders. An understanding of the moral perceptions underlying or driving stigma in this region is critical for implementing more successful stigma reduction interventions and increasing access to evidence-based care for opioid use. Two theoretical frameworks from the emerging field of moral psychology, Moral Foundations Theory (MFT) and the Theory of Dyadic Morality (TDM), offer explanations for the potential pathway between moral worldview, stigma, and approval of MOUD. Testing these theories in the field of opioid research will strengthen interdisciplinary work between the fields of psychology and public health, contributing novel, valuable knowledge to both areas and forging connections for increased collaborative work in the future. Study aims will be completed within the context of a larger NIDA-funded Rural Opioid Initiative in rural Appalachian Ohio (Implementing a Community-Based Response to the Opioid Epidemic in Rural Ohio, UG3/UH3DA044822). Aim 1 will utilize Confirmatory Factor Analysis testing to assess the validity of instruments associated with MFT and TDM constructs in a rural Appalachian population of PWUD. Aim 2 will utilize structural equation modeling to examine the relationship between moral views and uptake of MOUD among PWUD, and explore potential mediation by internalized stigma. Aim 3 will involve qualitative interviews with treatment providers, PWUD, and other community stakeholders, to further understand moral perceptions and conceptualization of addiction and how these shape attitudes toward drug use and treatment. Through this proposed mixed-methods study, the applicant's background in biological sciences and public health will be strengthened and expanded to include expertise in social and moral psychology. Furthermore, mentorship experience with renowned faculty in health behavior, epidemiology, and moral psychology, as well as training opportunities to expand communication and dissemination skills will prepare the applicant for an independent academic research career.

抽象的 美国与阿片类药物相关的死亡率持续上升，特别是在该国农村阿巴拉契亚地区。 增加的可用性并获得基于循证治疗阿片类药物使用障碍的治疗，例如药物治疗 为了成功解决流行病，需要阿片类药物使用障碍（MOUD）；但是，中间的污名 医疗保健提供者和社区成员以及使用毒品的人的内部污名 （PWUD）是阿巴拉契亚农村地区穆德可用性和吸收的实质性障碍。而公共卫生 解决阿片类药物使用和治疗的努力通常集中在降低污名上，需要 跨学科的工作，以了解阿巴拉契亚农村社区这种污名的力量。在 特别的文化因素（例如道德观点）可能会对药物和穆德相关产生关键的影响 这些地区的污名。拟议的研究的目的是了解道德之间的关系 在俄亥俄州农村使用毒品的人们中，观点，污名和吸收穆德以及 在医疗保健提供者和社区利益相关者中探索道德观点和对MOUD的看法。一个 了解该地区的道德观念或驾驶污名对于实施至关重要 更成功的污名降低干预措施，并增加获得基于循证的治疗阿片类药物的使用。 从道德心理学的新兴领域，道德基础理论（MFT）和 二元道德理论（TDM）为道德世界观之间的潜在途径提供了解释， 污名和穆德的批准。在阿片类药物研究领域测试这些理论将加强 心理学和公共卫生领域之间的跨学科工作，贡献了小说，有价值的 对两个领域的知识和建立联系，以增加协作工作。研究目标将 在阿巴拉契亚农村俄亥俄州农村较大的NIDA资助的农村阿片类药物倡议中完成 （在俄亥俄州农村地区实施基于社区的反应，UG3/UH3DA044822）。 AIM 1将利用确认性因素分析测试来评估与MFT相关的仪器的有效性 和TDM构造的阿巴拉契亚人口居民。 AIM 2将利用结构方程建模 检查道德观点与穆德在PWUD之间的关系之间的关系，并探索潜力 内部污名的调解。 AIM 3将涉及与治疗提供者，PWUD和 其他社区利益相关者，进一步了解成瘾和成瘾的概念化和 这些对吸毒和治疗的形状态度如何。通过这项提出的混合方法研究， 申请人在生物科学和公共卫生方面的背景将得到加强和扩展，包括 社会和道德心理学专业知识。此外，著名的健康教师的指导经验 行为，流行病学和道德心理学，以及培训机会以扩大沟通和 传播技巧将使申请人为独立的学术研究职业做好准备。