The Impact of Community Infrastructure Reinvestment Programs on Opioid Misuse and Opioid Overdose

社区基础设施再投资计划对阿片类药物滥用和阿片类药物过量的影响

基本信息

批准号：
10771803
负责人：
Elizabeth Nesoff
金额：
$ 73.33万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-30 至 2028-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10771803
关键词：
Address Affect Behavioral Risk Factor Surveillance System Black Populations Black race Cities Communities Crime Data Data Collection Deterioration Development Diagnosis Disease Disparity Distal Drug usage Drug user Economics Emergency Situation Emergency department visit Epidemic Ethnic Origin Fentanyl Government Grant Green space Harm Reduction Health Status Heroin Home Hospitals Housing Infrastructure Intervention Investments Low income Measures Medical Examiners Mental Depression Mental Health Methods Minority Modeling Monitor Naloxone Neighborhoods Not Hispanic or Latino Opioid Outcome Overdose Pharmaceutical Preparations Philadelphia Policies Poverty Prevalence Process Property Public Health Race Racial Segregation Randomized, Controlled Trials Reporting Research Research Proposals Resources Risk Stress Structure Syringes System Time Tourniquets Translations Work community partnership cost effective design fentanyl use gun violence heroin use improved injection drug use innovation opioid misuse opioid overdose opioid use opioid use disorder overdose death overdose prevention overdose risk prevent programs public health intervention remediation repaired social social capital social cohesion social determinants social observations synthetic opioid violent crime wound care

项目摘要

PROJECT SUMMARY/ABSTRACT Discriminatory housing and zoning policies that cause residential racial segregation, concentrated poverty, and lack of economic opportunity often result in neighborhood disinvestment and increased neighborhood disorder. Neighborhood disorder—deterioration of the urban landscape, also known as blight—significantly impacts opioid misuse, including opioid initiation, injection drug use, opioid use disorder development and duration, and risk of opioid-involved overdose. Interventions to improve disorder have shown significant positive impacts on neighborhood crime, gun violence, and mental health. No studies have yet investigated the degree to which neighborhood disorder interventions influence opioid misuse or associated overdose risk. The broad objective of this study is to investigate the impact of community infrastructure reinvestment programs on opioid misuse and opioid overdose. In Philadelphia, government, community, and academic partnerships have resulted in structural interventions (PHS Philadelphia LandCare and Basic Systems Repair Program) to remediate vacant lots, abandoned buildings, and dilapidated homes. These programs are designed to improve neighborhood disorder in resource-deprived, minority-majority neighborhoods with little to no green space and may have distal effects on opioid misuse and associated overdose risk. Previous Philadelphia studies have shown significant reductions in crime and improved stress and depression for residents on blocks with blight remediation. This study will use spatial analysis methods and systematic social observation to address HEAL's RFA DA-23-051 Preventing Opioid Misuse and Co-Occurring Conditions by Intervening on Social Determinants. Specific aims are: (1) Investigate whether street block-level indicators of opioid misuse differ on blocks with blight remediation activities using systematic social observation methods for primary data collection of litter from opioid misuse (e.g., syringes, tourniquets) and harm reduction paraphernalia (e.g., wound care, naloxone); (2) Examine if fatal and nonfatal opioid overdose rates improved with remediation activities using a longitudinal spatial panel approach with fatal overdose data from Philadelphia's medical examiner and nonfatal overdose data from hospital emergency care visits; (3) Explore mechanisms by which remediation activities improve neighborhood indicators of opioid misuse and fatal and nonfatal overdose rates, including improved community mental health (measured by BRFSS data) and improved community social capital and social cohesion (measured by primary data collection of neighborhood structures related to these concepts), using systematic social observation and spatial analysis methods. This study will examine the impact of highly innovative place-based public health interventions on opioid misuse and fatal and nonfatal opioid overdose. Findings will provide support for expanding neighborhood disorder remediation projects in Philadelphia and promote similar public health-based policy and community-level health interventions for opioid misuse and overdose prevention in other cities.

项目概要/摘要歧视性住房和分区政策导致居住种族隔离、集中贫困和缺乏经济机会往往会导致社区投资减少和社区混乱加剧。邻里混乱——城市景观恶化，也称为枯萎病——对阿片类药物产生显着影响滥用，包括阿片类药物开始使用、注射药物使用、阿片类药物使用障碍的发展和持续时间，以及阿片类药物使用障碍的风险改善阿片类药物过量的干预措施已显示出显着的积极影响。尚未有研究调查社区犯罪、枪支暴力和心理健康的程度。邻里混乱干预措施会影响阿片类药物的滥用或相关的用药过量风险。本研究的目的是调查社区基础设施再投资计划对阿片类药物滥用的影响在费城，政府、社区和学术界的合作导致了阿片类药物过量。结构性干预措施（PHS 费城土地护理和基本系统修复计划）以修复空置这些项目旨在改善社区。资源匮乏、少数族裔占多数的社区的混乱，几乎没有绿色空间，并且可能存在远端费城之前的研究表明，该药物对阿片类药物滥用和相关过量风险有显着影响。通过枯萎病修复减少了街区居民的犯罪率并改善了压力和抑郁症。研究将使用空间分析方法和系统的社会观察来解决 HEAL 的 RFA DA-23-051 通过干预社会决定因素来防止阿片类药物滥用和并发病症。是： (1) 调查阿片类药物滥用的街区级指标在进行枯萎病修复的街区是否有所不同使用系统的社会观察方法收集阿片类药物滥用垃圾的主要数据的活动（例如注射器、止血带）和减少伤害用具（例如伤口护理、纳洛酮）； (2) 检查是否致命；通过使用纵向空间面板进行补救活动，非致命性阿片类药物过量率得到改善方法采用费城体检医师提供的致命用药过量数据和来自以下机构的非致命用药过量数据医院紧急护理就诊；(3) 探索改善邻里关系的补救活动机制阿片类药物滥用以及致命和非致命用药过量率的指标，包括改善社区心理健康（通过 BRFSS 数据衡量）并改善社区社会资本和社会凝聚力（通过小学衡量）与这些概念相关的邻里结构的数据收集），使用系统的社会观察和本研究将研究高度创新的基于地点的公共卫生的影响。对阿片类药物滥用以及致命和非致命阿片类药物过量的干预措施将为以下方面提供支持。扩大费城的邻里混乱整治项目并促进类似的基于公共卫生的项目其他城市针对阿片类药物滥用和过量预防的政策和社区一级健康干预措施。