Development and Implementation of a Culturally Centered Opioid Prevention Intervention for American Indian/Alaska Native Young Adults in California

摘要/摘要 2015年的数据显示，美国印第安人/阿拉斯加原住民(AI/AN)的阿片类药物诊断率最高 使用障碍(OUD)和药物过量死亡。特别令人关注的是阿片类药物的使用率。 在新兴成年人(18-25岁)中，因为这是一个高度脆弱和关键的发育期 社会、神经和心理发展。本提案响应RFA-DA-19-035，Hear 主动性：通过发展和发展，预防大龄青少年和青年(16-30岁)的OUD 实施以文化为中心的干预措施，解决城市AI/AN新兴成年人中阿片类药物的滥用问题 加利福尼亚州(EAS)：POMANAYA(防止美国土著青年滥用阿片类药物)。这 提案建立在我们过去十年与城市人工智能/人工智能社区密切合作的先前工作的基础上 在加州各地开发适合文化的规划，以解决酒精和其他药物(AOD)的使用问题。 建议的项目还建立在我们团队的工作基础上，确定社交网络如何影响 弱势群体。我们提出了一种多层次的干预方法，包括在 在个人一级(POMANAYA)和在社区一级：健康聚会(WG)。对于UG3阶段，我们 计划与EA、EA的父母、AI/AN提供商和我们的城市老年人咨询委员会一起开展焦点小组 了解如何以最佳方式识别、接触和接触AI/AN EA以访问 解决阿片类药物使用问题的方案，b)调整和加强我们现有的对文化敏感的预防 美国城市原住民青年激励性访谈和文化干预方案(MICUNAY) 人工智能/人工智能企业应对放大(或降低)阿片类药物和AOD使用风险的社交网络因素，以及c)试点 测试POMANAYA以确保计划的可行性和可接受性。对于UH3阶段，我们的目标是1) 比较接受POMANAYA WG的AI/AN EA(n=185)与接受阿片类药物教育的AI/AN EA(n=185) 关于3个月、6个月和12个月的结果，2)探索阿片类药物和AOD减少的潜在机制 通过调解分析利用结果，重点关注社会网络和文化联系的变化， 3)制定和测试战略，以促进POMANAYA在这些社区内的可持续性，方法是 线人访谈和焦点小组，以及4)进行经济评估以量化方案成本 与阿片类药物教育相比，多层次干预方法的成本效益。由此产生的结果 研究可以显著促进AI/AN新兴成年人的科学知识和临床实践。

Summary/Abstract Data from 2015 show that American Indian/Alaska Natives (AI/AN) have the highest rates of diagnosis for opioid use disorders (OUD) and deaths from drug overdose. Of particular concern is the prevalence rate of opioid use among emerging adults (ages 18–25) as this is a developmental period of heightened vulnerability and critical social, neurological, and psychological development. This proposal responds to RFA-DA-19-035, HEAL initiative: Preventing OUD in Older Adolescents and Young Adults (ages 16-30) by developing and implementing a culturally-centered intervention to address opioid misuse among urban AI/AN emerging adults (EAs) in California: POMANAYA (Preventing Opioid Misuse Among Native American Young Adults). This proposal builds on our previous work over the past decade working closely with urban AI/AN communities across California to develop culturally-appropriate programming to address alcohol and other drug (AOD) use. The proposed project also builds off our team’s work identifying how social networks affect risk behaviors among vulnerable populations. We propose a multi-tiered intervention approach that will include intervening at the individual level (POMANAYA) and at the community level: wellness gatherings (WG). For the UG3 Phase, we plan to conduct focus groups with EAs, parents of EAs, AI/AN providers, and our Elder Advisory Board in urban communities throughout California to understand how to a) best identify, reach, and engage AI/AN EAs to access programming addressing opioid use, b) adapt and enhance our existing culturally-sensitive prevention intervention program, Motivational Interviewing and Culture for Urban Native American Youth (MICUNAY), for AI/AN EAs to address social network factors that amplify (or reduce) opioid and AOD use risk, and c) pilot test POMANAYA to ensure feasibility and acceptability of the program. For the UH3 phase, our aims are to 1) Compare AI/AN EAs who receive POMANAYA+WG (n=185) to AI/AN EAs who receive opioid education (n=185) on outcomes at 3, 6, and 12 months, 2) explore potential mechanisms of change for decreases in opioid and AOD use outcomes through mediation analyses, focusing on changes in social networks and cultural connectedness, 3) develop and test strategies to facilitate sustainability of POMANAYA within these communities through key informant interviews and focus groups, and 4) conduct an economic evaluation to quantify programmatic costs and cost-effectiveness of the multi-tiered intervention approach, relative to opioid education. Results from this study could significantly advance scientific knowledge and clinical practice for AI/AN emerging adults.