Community Randomized Trial in the Cherokee Nation: CONNECT and CMCA for Preventing Drug Misuse among Older Adolescents

摘要 国家公共卫生阿片类药物危机给农村白色人口带来了不成比例的负担， 不成比例地加重了美洲印第安人的负担。因此，切罗基民族（CN）和埃默里 大学公共卫生科学家设计了一项阿片类药物预防试验，将在有风险的农村地区进行。 CN（俄克拉荷马州东北部）的白色和美洲印第安人青少年和年轻人社区。 我们的目标是实施和评估一个以理论为基础的，综合的多层次社区干预， 预防阿片类药物和其他药物滥用的发生和升级。两种不同的干预方法- 社区组织在我们既定的CMCA干预协议中实施，以及普及学校- 根据我们既定的BROECT干预方案实施的简短干预和转诊， 扩大和整合这些方案，以进一步加强其在预防和减少类阿片滥用方面的作用。的 CMCA和ACECT干预措施最初是针对青少年饮酒的，但 然而，对其他药物的使用，包括处方药滥用，显示出显着的有益效果。 拟议的研究将：（1）进一步改进干预措施的设计，更加关注阿片类药物，（2） 在社区随机试验中测试扩展的集成版本，以及（3）设计和测试新系统 在切罗基民族的现有结构内持续实施。建立在现有的 预防科学证据，我们的研究将回应有关阿片类药物滥用预防证据的差距 在美国印第安人和其他农村青年中，有风险的青少年过渡到年轻的成年人。我们 以前的试验，与切罗基民族合作进行，以18岁的年轻人结束; 拟议中的新试验将进一步推进有关吸引年轻人参与的战略的科学， 高中以后的过渡在UG 3规划阶段，我们将（1）扩展和整合基于理论的 青少年后期至青少年关键发展期的多层次预防性干预措施 成年期，（2）制定实施、近端和阿片类药物以及其他药物使用结果指标，以及（3） 为审判的开始做准备。在UH 3试验阶段，我们将（1）实施干预措施， 切罗基民族和测量实施过程和保真度，（2）测量近端和阿片类药物， 来自16所学校的一组10年级学生每6个月进行一次其他药物使用结果的随访 在高中毕业后的三年内，（3）通过社区随机试验测试 综合CMCA-ESCECT干预的实施成本和成本效益分析。 这项试验将扩大我们以前的研究，以大大推进有关以下方面的科学证据： 预防青春期后期关键发育期阿片类药物和其他药物滥用 过渡到年轻的成年。

Abstract The national public health opioid crisis has disproportionately burdened rural white populations, and disproportionately burdened American Indian populations. Therefore, the Cherokee Nation (CN) and Emory University public health scientists have designed an opioid prevention trial to be conducted in at-risk rural communities in the CN (in northeast Oklahoma) with white and American Indian adolescents and young adults. Our goal is to implement and evaluate a theory-based, integrated multi-level community intervention designed to prevent the onset and escalation of opioid and other drug misuse. Two distinct intervention approaches— community organizing as implemented in our established CMCA intervention protocol, and universal school- based brief intervention and referral as implemented in our established CONNECT intervention protocol—will be expanded and integrated to further enhance their effects in preventing and reducing opioid misuse. The CMCA and CONNECT interventions were originally designed to target adolescent alcohol use, but nevertheless showed significant beneficial effects on use of other drugs, including prescription drug misuse. The proposed study will: (1) further improve the design of the interventions with increased focus on opioids, (2) test the expanded, integrated versions in a community randomized trial, and (3) design and test new systems for sustained implementation within existing structures of the Cherokee Nation. Building upon the extant prevention science evidence, our study will respond to a gap in evidence concerning opioid misuse prevention among at-risk adolescents transitioning to young adulthood among American Indian and other rural youth. Our previous trial, conducted in partnership with the Cherokee Nation ended with youth attaining age 18; the proposed new trial will additionally advance the science regarding strategies to engage young adults as they transition beyond high school. During the UG3 planning phase we will (1) expand and integrate a theory-based multi-level preventive intervention package for the critical developmental period of late adolescence to young adulthood, (2) develop implementation, proximal and opioid and other drug use outcome measures, and (3) prepare for the initiation of the trial. During the UH3 trial phase we will (1) implement interventions through Cherokee Nation and measure implementation processes and fidelity, (2) measure proximal and opioid and other drug use outcomes every six months among a cohort of 10th grade students from 16 schools followed over three years through their transition out of high school, (3) test via a community randomized trial the effect of the integrated CMCA-CONNECT intervention, and (4) analyze implementation costs and cost-effectiveness. This trial will expand upon our previous research to substantially advance the scientific evidence regarding prevention of opioid and other drug misuse during the critical developmental period of late adolescent transitions to young adulthood.