Developing the evidence base for overdose policies: a multilevel analysis of NHBS

开发过量政策的证据基础：NHBS 的多层次分析

• 批准号: 10357754
• 负责人: Hannah LF Cooper
• 金额: $ 59.86万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10357754
• 关键词: Adult; Affect; Age; Area; Behavioral; Cause of Death; Centers for Disease Control and Prevention (U.S.); Characteristics; Code; Collaborations; County; Data; Databases; Development; Environment; Epidemic; Equation; Ethnic Origin; Evidence based intervention; Exposure to; Gender; General Population; HIV; HIV risk; Health; Health Policy; Health Services; Heroin; Individual; Injecting drug user; Intervention; Laws; Learning; Link; Medicaid; Medical Marijuana; Methods; Modeling; Naloxone; National Institute of Drug Abuse; Needle-Exchange Programs; Neighborhoods; Outcome; Overdose; Overdose reduction; Pathway interactions; Patient Self-Report; Pattern; Persons; Pharmaceutical Preparations; Policies; Population; Poverty; Public Health; Race; Research; Risk; Risk Behaviors; Risk Factors; Rupture; Sampling; Substance Use Disorder; Testing; United States Health Resources and Services Administration; United States Substance Abuse and Mental Health Services Administration; Vulnerable Populations; base; combat; design; evidence base; health service use; heroin overdose; innovation; member; metropolitan; mortality; multidisciplinary; multilevel analysis; neglect; opioid epidemic; opioid misuse; opioid overdose; overdose death; overdose risk; prescription monitoring program; prescription opioid; programs; response; substance misuse; surveillance data; theories

Abstract: The overdose (OD) epidemic is one of the worst crises of the 21st century US, and people who inject drugs (PWID) are at its epicenter. ODs are the leading cause of death for PWID, and the number of PWID is rising. We are, though, routinely missing opportunities to develop the evidence base for interventions for PWID:  Many states are enacting laws to combat the opioid epidemic (Prescription Drug Monitoring Programs [PDMPs], Naloxone Access Laws, Good Samaritan Laws), and a high-impact body of research is now analyzing how these laws, and other health policies (Medicaid Expansion, Medical Marijuana Laws [MMLs]), affect ODs in the general population. To date, though, this research has ignored PWID, a highly vulnerable population that may respond differently to these laws than members of the general population.  The growing body of research on place characteristics (e.g., neighborhood poverty rates) and ODs has also neglected PWID. The range and impact of place-based exposures, however, may differ for PWID. NIDA prioritizes generating scientific evidence to guide policy. As policymakers confront this health crisis, however, they are crafting laws with scant evidence about their possible effects on PWID. Likewise, the lack of scientific evidence about the effects of place characteristics on ODs among PWID cuts off whole arenas of place-based interventions, interventions that have proven effective for other health outcomes among PWID. Guided by the Risk Environment Model and Public Health Law Research principles, we will integrate CDC National HIV Behavioral Surveillance (NHBS) data on ~38,800 PWID in 20+ US metropolitan statistical areas (MSAs) in 2009, 2012, 2015, and 2018 with existing data on state laws and on characteristics of the MSAs, counties, and ZIP codes where these PWID live. This rich database will allow us to achieve three aims: Aim 1: Apply multilevel methods to analyze relationships of PDMPs, Medicaid Expansion, and MMLs to self- reported ODs, OD risk factors, and (for PDMPs and Medicaid) substance use disorder treatment among PWID. We will analyze if relationships vary by (a) PWID race/ethnicity, gender, age, and HIV status; and (b) characteristics of the ZIP codes and counties where PWID live. Aim 2. Apply multilevel methods to analyze relationships of Naloxone Access Laws and Good Samaritan Laws to naloxone access and bystander responses to ODs, and learn if relationships vary by (a) PWID race/ethnicity, gender, age, and HIV status; and (b) characteristics of ZIP codes and counties where PWID live. Aim 3. Use multilevel methods to analyze relationships of characteristics of PWID ZIP codes, counties, and MSAs to self-reported ODs, OD risk factors, and substance use disorder treatment; and test if relationships vary by PWID race/ethnicity, gender, age, and HIV status. Each Aim will also use multilevel structural equation models to analyze pathways linking exposures to outcomes. Results will provide some of the first evidence to help develop laws and place-based interven- tions to combat ODs among PWID, a growing and neglected population at the epicenter of the OD epidemic.

摘要：吸毒过量（OD）流行是 21 世纪美国最严重的危机之一，注射吸毒者 吸毒者 (PWID) 处于其震中 OD 是吸毒者死亡的主要原因，吸毒者的数量为 然而，我们经常错过为吸毒者制定干预措施证据基础的机会： 许多州正在制定法律来对抗阿片类药物的流行（处方药监测计划） [PDMP]、纳洛酮使用法、好撒玛利亚人法）以及高影响力的研究机构现已 分析这些法律和其他卫生政策（医疗补助扩展、医用大麻法 [MML]）、 然而，迄今为止，这项研究忽略了吸毒者这一高度脆弱的群体。 对这些法律的反应可能与一般人群不同的人群。  越来越多的关于地方特征（例如，邻里贫困率）和 OD 的研究也已 然而，对于注射吸毒者来说，地点暴露的范围和影响可能有所不同。 在政策制定者面对这场健康危机时，NIDA 优先考虑提供科学证据来指导政策。 然而，他们正在制定法律，但缺乏关于其对吸毒者可能产生的影响的证据。 关于地点特征对吸毒者 OD 影响的科学证据切断了吸毒者的整个领域 基于地点的干预措施，这些干预措施已被证明对吸毒者的其他健康结果有效。 以风险环境模型和公共卫生法研究原则为指导，我们将整合CDC 美国 20 多个大都市统计区域约 38,800 名吸毒者的国家艾滋病毒行为监测 (NHBS) 数据 (MSA) 于 2009 年、2012 年、2015 年和 2018 年利用有关州法律和 MSA 特征的现有数据， 这些丰富的数据库将使我们能够实现三个目标：目标 1： 应用多层次方法分析 PDMP、医疗补助扩展和 MML 与自我保护的关系 报告了吸毒者中的 OD、OD 危险因素以及（针对 PDMP 和医疗补助）物质使用障碍治疗。 我们将分析关系是否因 (a) 吸毒者种族/民族、性别、年龄和艾滋病毒状况而变化； 注射吸毒者居住的邮政编码和县的特征 目标 2. 应用多层次方法进行分析。 纳洛酮获取法和好撒玛利亚人法与纳洛酮获取和旁观者的关系 对 OD 的反应，并了解关系是否因 (a) 吸毒者种族/民族、性别、年龄和艾滋病毒状况而变化；以及 (b) 注射吸毒者居住的邮政编码和县的特征 目标 3. 使用多层次方法进行分析。 PWID 邮政编码、县和 MSA 的特征与自我报告的 OD、OD 风险因素的关系， 药物滥用障碍治疗；并测试关系是否因吸毒者种族/民族、性别、年龄和 每个目标还将使用多级结构方程模型来分析与暴露相关的途径。 结果将提供一些初步证据，以帮助制定法律和基于地点的干预措施。 注射吸毒者是吸毒者中不断增长且被忽视的人口，是吸毒者流行病的中心，因此，我们采取了一些措施来对抗吸毒者中的吸毒者。