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，美洲印第安人/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）和药物过量导致的死亡。特别值得关注的是阿片类药物的使用流行率 新兴成年人（18-25 岁）中，因为这是一个高度脆弱和关键的发展时期 社会、神经和心理发展。该提案回应 RFA-DA-19-035，HEAL 倡议：通过发展和预防老年青少年和年轻人（16-30 岁）的 OUD 实施以文化为中心的干预措施，以解决城市 AI/AN 新兴成年人中阿片类药物的滥用问题 (EA) 加利福尼亚州：POMANAYA（防止美国原住民年轻人滥用阿片类药物）。这个 该提案建立在我们过去十年与城市 AI/AN 社区密切合作的先前工作的基础上 加州各地制定适合文化的规划来解决酒精和其他药物 (AOD) 的使用问题。 拟议的项目还建立在我们团队的工作基础上，该工作确定社交网络如何影响人们的风险行为 弱势群体。我们提出了一种多层次的干预方法，其中包括对 个人层面（POMANAYA）和社区层面：健康聚会（WG）。对于UG3阶段，我们 计划与 EA、EA 家长、AI/AN 提供者以及城市老年人咨询委员会进行焦点小组讨论 加州各地的社区了解如何 a) 最好地识别、接触和吸引 AI/AN EA 访问 针对阿片类药物使用的规划，b) 调整和加强我们现有的文化敏感预防措施 干预计划，美国城市原住民青年动机访谈和文化（MICUNAY）， 让 AI/AN EA 解决放大（或减少）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 以确保该程序的可行性和可接受性。对于 UH3 阶段，我们的目标是 1) 将接受 POMANAYA WG (n=185) 的 AI/AN EA 与接受阿片类药物教育的 AI/AN EA (n=185) 进行比较 3、6 和 12 个月的结果，2) 探索阿片类药物和 AOD 减少的潜在变化机制 通过中介分析使用结果，重点关注社交网络和文化联系的变化， 3) 制定和测试战略，通过关键措施促进 POMANAYA 在这些社区内的可持续性 知情者访谈和焦点小组，以及 4) 进行经济评估以量化计划成本 以及多层次干预方法相对于阿片类药物教育的成本效益。结果由此 研究可以显着促进 AI/AN 新兴成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.