Development and Implementation of a Culturally Centered Opioid Prevention Intervention for American Indian/Alaska Native Young Adults in California

为加利福尼亚州美洲印第安人/阿拉斯加原住民年轻人制定和实施以文化为中心的阿片类药物预防干预措施

• 批准号: 10440189
• 负责人: ELIZABETH J. D'AMICO
• 金额: $ 35.93万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10440189
• 关键词: 18 year old; Address; Adolescent and Young Adult; Adult; Affect; Age; Alaska Native; Alcohol consumption; American Indians; Area; Baseline Surveys; California; Cessation of life; Communities; Data; Development; Diagnosis; Discrimination; Dose; Drug usage; Economics; Education; Educational workshop; Elderly; Emotional; Ensure; Evidence based treatment; Focus Groups; Helping to End Addiction Long-term; Hour; Individual; Intervention; Interview; Life; Link; Marijuana; Mediation; Mental Health; Methods; Native-Born; Neurologic; Opioid; Outcome; Overdose; Parents; Patient Recruitments; Peer Pressure; Personal Satisfaction; Pharmaceutical Preparations; Phase; Play; Policy Maker; Population; Poverty; Prevalence; Prevention program; Provider; Public Health; Randomized Controlled Trials; Reporting; Risk; Risk Factors; Role; Rural; Sampling; Social Environment; Social Network; Social support; Spirituality; Structure; Surveys; Technology; Teenagers; Testing; Time; Unemployment; United States; Urban Community; Visualization; Work; Youth; acceptability and feasibility; alcohol and other drug; clinically significant; coping; cost effectiveness; economic evaluation; effectiveness evaluation; emerging adult; emerging adulthood; experience; health care availability; health equity; health inequalities; hedonic; heroin use; informant; innovation; intervention program; marijuana use; motivational enhancement therapy; multidisciplinary; native youth; opioid misuse; opioid overdose; opioid use; opioid use disorder; parent grant; parent project; peer; prescription opioid; prescription opioid misuse; prevent; preventive intervention; programs; protective factors; psychologic; recruit; response; service intervention; social; substance use; substance use treatment; urban Native American; urban area; urban dwelling; young adult

PROJECT SUMMARY/ABSTRACT American Indian/Alaska Native (AI/ANs) individuals experience some of the highest rates of co-occurring mental health and substance use problems in the United States. These disparities reflect broader systemic and community level inequities among urban-dwelling AI/AN individuals. Systemic factors, such as poverty, unemployment, and discrimination are underlying barriers to accessing healthcare and substance use treatment, affecting nearly a quarter of AI/AN people. Emerging adulthood (ages 18-25) is a developmental period often characterized by instability, role transition, and self-exploration. Some evidence suggests that AI/AN emerging adults often experience this key formative life stage while coping with discrimination, social and economic inequities, and rapid cultural change, which all can affect mental health and substance use. However, little is known about risk and protective factors among urban AI/AN emerging adults that may be associated with health inequities. The aims of this supplement are within the scope of the parent grant; however, they substantially expand the parent project by allowing us to analyze our survey baseline data in new ways, as well as combine these survey data with new qualitative data: Aim 1- utilize baseline survey data (n=125) to examine how risk factors (e.g., discrimination, historical loss), and protective factors-- cultural identity and connection (e.g., cultural connection, cultural identity, and participation in traditional practices), and social support (e.g., emotional, tangible, and support from rural or urban network contacts) are associated with opioid, alcohol and cannabis use and mental health outcomes; and Aim 2- conduct in-depth interviews with a subsample of 20 participants recruited from the baseline sample who report different types of experiences (e.g., high rates of discrimination/loss, high rates of cultural engagement, social networks with rural support, social networks with urban support) to better understand urban AI/AN emerging adults’ experiences with discrimination and historical loss, cultural identity and connection, and social support. Findings will support the parent grant by providing new information on how to best address health equity among urban AI/AN emerging adults, given the different risk and protective factors that they experience in their lives. Findings can help build an empirical, culturally grounded rationale for how to enhance opioid and AOD prevention intervention services to ensure equity for this population. This will be the first study to date to take a mixed methods approach to understand specific structural drivers of inequity as well as key protective factors for AOD use and mental health among urban AI/AN emerging adults. Findings can move the field forward in this understudied area by highlighting how providers and policy makers can better address the inequities that AI/AN emerging adults experience.

项目概要/摘要 美洲印第安人/阿拉斯加原住民 (AI/AN) 个体的同时发生率最高 美国的心理健康和药物滥用问题反映了更广泛的系统性和问题。 城市居住的 AI/AN 个体之间的社区层面的不平等 系统性因素，例如贫困、 失业和歧视是获得医疗保健和药物滥用治疗的潜在障碍， 几乎四分之一的 AI/AN 人群受到影响，成年初期（18-25 岁）通常是一个发育时期。 一些证据表明人工智能/AN 正在兴起，其特点是不稳定、角色转换和自我探索。 成年人在应对歧视、社会和经济问题时往往会经历这一关键的人生形成阶段。 不平等和快速的文化变革都会影响心理健康和药物使用，但影响甚微。 了解城市 AI/AN 新兴成年人中可能与健康相关的风险和保护因素 该补充的目的在母基金的范围内，但实质上是这样的； 通过允许我们以新的方式分析我们的调查基线数据以及结合 这些调查数据与新的定性数据：目标 1 - 利用基线调查数据 (n=125) 来检查风险如何 因素（例如，歧视、历史遗失）和保护因素——文化认同和联系（例如， 文化联系、文化认同和参与传统习俗）以及社会支持（例如， 情感上的、有形的以及来自农村或城市网络联系人的支持）与阿片类药物、酒精和 大麻使用和心理健康结果；目标 2-对 20 名子样本进行深入访谈 从基线样本中招募的参与者报告了不同类型的经历（例如，高比例的 歧视/损失、文化参与率高、有农村支持的社交网络、有农村支持的社交网络 城市支持），以更好地了解城市 AI/AN 新兴成年人的歧视经历和 历史损失、文化认同和联系以及社会支持将由家长资助。 鉴于以下情况，提供有关如何最好地解决城市 AI/AN 新兴成年人的健康公平问题的新信息 他们在生活中经历的不同风险和保护因素的研究结果可以帮助建立一个实证的、 关于如何加强阿片类药物和 AOD 预防干预服务的基于文化的理由，以确保 这将是迄今为止第一项采用混合方法来理解的研究。 不平等的具体结构性驱动因素以及 AOD 使用和心理健康的关键保护因素 城市人工智能/AN新兴成年人的研究结果可以通过强调这一研究领域来推动这一领域的发展。 提供者和政策制定者如何更好地解决人工智能/人工智能新兴成年人所经历的不平等问题。