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: 10066963
• 负责人: Christine Schalkoff
• 金额: $ 3.75万
• 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/10066963
• 关键词: Address; Advocate; Alcohol or Other Drugs use; 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; Services; 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; sexual trauma; skills; social; social stigma; stem; 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 美国阿片类药物相关死亡率持续上升，特别是在该国阿巴拉契亚农村地区。 增加阿片类药物使用障碍的循证治疗（例如药物治疗）的可用性和可及性 成功应对这一流行病需要阿片类药物使用障碍（MOUD）；然而，其中的耻辱 医疗保健提供者和社区成员以及吸毒者的内在耻辱 (PWUD) 是阿巴拉契亚农村地区 MOUD 可用性和采用的重大障碍。虽然公共卫生 解决阿片类药物使用和治疗问题的努力往往侧重于减少耻辱，因此有必要 跨学科工作，以了解阿巴拉契亚农村社区这种耻辱背后的力量。在 特别是，道德观念等文化因素可能对毒品和 MOUD 相关事件产生严重后果 这些领域的耻辱。本研究的目的是了解道德之间的关系 俄亥俄州阿巴拉契亚农村地区吸毒者对 MOUD 的看法、耻辱和接受程度，以及 探索医疗保健提供者和社区利益相关者对 MOUD 的道德观点和看法。一个 了解该地区潜在或导致耻辱的道德观念对于实施 更成功地减少耻辱干预措施并增加阿片类药物使用循证护理的机会。 道德心理学新兴领域的两个理论框架，道德基础理论（MFT）和 二元道德理论（TDM），为道德世界观、 耻辱和 MOUD 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，贡献新颖、有价值的 对这两个领域的知识并建立联系以加强未来的协作工作。学习目标将 将在 NIDA 资助的俄亥俄州阿巴拉契亚农村地区更大的农村阿片类药物计划的背景下完成 （对俄亥俄州农村地区的阿片类药物流行实施基于社区的应对措施，UG3/UH3DA044822）。 目标 1 将利用验证性因素分析测试来评估与 MFT 相关的工具的有效性 TDM 是在 PWUD 的阿巴拉契亚农村人口中构建的。目标 2 将利用结构方程建模 研究 PWUD 中道德观念与 MOUD 接受程度之间的关系，并探索潜在的潜力 通过内在的耻辱进行调解。目标 3 将涉及与治疗提供者、PWUD 和 其他社区利益相关者，进一步了解成瘾的道德观念和概念化 这些如何影响人们对药物使用和治疗的态度。通过这项拟议的混合方法研究， 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大，包括 社会和道德心理学方面的专业知识。此外，与健康领域著名教师的指导经验 行为、流行病学和道德心理学，以及扩大沟通和交流的培训机会 传播技能将为申请人的独立学术研究生涯做好准备。