Community Wise: An innovative multi-level intervention to reduce alcohol and illegal drug use

社区智慧：减少酒精和非法药物使用的创新多层次干预措施

• 批准号: 9129395
• 负责人: Ellen Benoit
• 金额: $ 53.75万
• 依托单位: UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-16 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9129395
• 关键词: Address; Affect; African American; Alcohols; Attention; Behavior; Behavioral; Cognitive; Communities; Complex; Conscious; Crime; Data; Development; Distress; Drug usage; Employment; Etiology; Evidence based intervention; Experimental Designs; Feasibility Studies; Frequencies; Future; General Population; Goals; HIV/HCV; Health Services Accessibility; Hepatitis C; Homelessness; Housing; Imprisonment; Indigenous; Individual; Inequality; Intervention; Knowledge; Literature; Manuals; Modeling; Outcome; Participant; Performance; Plant Roots; Population; Poverty; Preclinical Drug Evaluation; Principal Investigator; Process; Protocols documentation; Provider; Public Health; Publishing; Quality of life; Randomized; Recommendation; Recording of previous events; Research; Research Methodology; Research Personnel; Resources; Rest; Sampling; Services; Substance Use Disorder; Testing; United States Substance Abuse and Mental Health Services Administration; community based participatory research; community organizations; cost effectiveness; design; effective therapy; empowered; health inequalities; illicit drug use; innovation; member; men; public health relevance; research study; social; social health determinants; social stigma; standard of care; standardize measure; success; theories; wasting

 DESCRIPTION (provided by applicant): Rates of alcohol and illicit drug use (AIDU) among residents of distressed communities with concentrations of African Americans (DCAA- i.e., localities with high rates of poverty and crime) are similar to the general population. Yet AIDU has significantly higher consequences for residents in DCAAs (e.g., higher incarceration and HIV/HCV infection rates), who also have considerably less access to effective treatment of substance use disorders. This project will continue to develop and test Community Wise, an innovative multi-level intervention created in partnership with service providers, residents of DCAAs and individuals with histories of substance use disorders and incarceration, to reduce health inequalities related to AIDU. We used community-based participatory research (CBPR) to develop and pilot test Community Wise, achieving 75% intervention completion rates, despite great participant challenges (such as homelessness, AIDU, and poverty). Note that substance use disorder intervention completion rates in the literature are much lower among populations with fewer challenges (often 30 to 40%). We believe that this success is due to the CBPR model used to develop an intervention that is relevant to participants' needs. Community Wise addresses social determinants of health (e.g., stigma, poverty, lack of treatment access, housing, and meaningful employment) and inequalities related to AIDU at the micro level (e.g., cognitive and behavioral processes), meso level (e.g., relationships with individuals and organizations) and macro level (e.g., political and cultural processes). Community Wise builds on critical consciousness theory, which empowers individuals, organizations, and communities to address social determinants of health while changing individual behaviors (e.g., reducing AIDU). We propose to apply the Multiphase Optimization Strategy (MOST) - an innovative and rigorous framework that employs factorial designs - to optimize Community Wise. Specifically, using MOST we will identify the most efficient, scalable, and sustainable components of Community Wise so that we can refine the intervention protocol by including only components that significantly reduce AIDU. The long-term goal of Community Wise is to reduce health inequalities related to AIDU between men with substance use disorders and a history of incarceration residing in DCAAs and the general population through an intervention that is congruent with DCAA world views and grounded in scientific and indigenous knowledge. Data from this study will culminate in an optimized Community Wise manual; enhanced methodological strategies to develop multi-component scalable interventions using MOST and CBPR; and a better understanding of the application of critical consciousness theory to the field of health inequalities related to AIDU.

 描述（由适用提供）：非洲裔美国人集中的受苦社区居民的酒精和非法吸毒率（AIDU）（DCAA-即具有较高的贫困和犯罪率）与一般人群相似。然而，AIDU对DCAA的居民（例如较高的遗传和HIV/HCV感染率）的后果显着更高，他们也认为较少获得对药物使用障碍的有效治疗的机会。该项目将继续开发和测试社区明智，这是与服务提供商，DCAAS的居民以及具有物质使用障碍史和监禁史的个人合作创建的创新多层次干预措施，以减少与AIDU相关的健康不平等。我们使用基于社区的参与研究（CBPR）来开发和试点测试社区，尽管参与者面临巨大的挑战（例如无家可归，AIDU和贫困），但仍达到了75％的干预完成率。请注意，在挑战较少的人群中，文献中的物质使用障碍干预完成率要低得多（通常为30％至40％）。我们认为，这种成功是由于CBPR模型用于开发与参与者需求相关的干预措施。社区明智的介绍了健康的社会决定者（例如，污名，贫困，缺乏治疗访问，住房和有意义的就业）以及与Micro层面上与AIDU有关的不平等现象（例如认知和行为过程），MESO水平（例如，与个人和组织的关系）和Macro层面（例如，与个人和组织的关系）。社区明智的基础是批判意识理论，这使个人，组织和社区能够解决社会决定者的健康，同时改变个人行为（例如，减少AIDU）。我们建议采用多相优化策略（大多数） - 一种使用阶乘设计的创新且严格的框架来优化社区的明智。具体而言，使用大多数，我们将确定社区明智的最有效，最可持续和可持续的组成部分，以便通过仅包括大大减少AIDU的组件来完善干预方案。社区明智的长期目标是通过与DCAA世界视图一致并以科学和土著知识为基础的干预措施来减少具有物质使用障碍的男性与居住在DCAA和普通人群中的继承史与驻留在DCAA和普通人群中的继承历史的健康不平等。这项研究的数据将在一本优化的社区明智手册中达到顶峰；增强了使用大多数和CBPR开发多组分可扩展干预措施的方法论策略；并更好地理解批判意识理论在与AIDU有关的健康不平等领域中的应用。