Substance Use and Gender-Affirming Care in Oregon's Medicaid Program

项目摘要/摘要 拟议的K01奖项为唐宁博士提供了俄勒冈州健康与卫生学院的新助理教授 理科大学/波特兰州立大学公共卫生学院，拥有所需的培训和技能 实现他们的长期目标，成为一名专注于预防和治疗的独立调查者 在变性人和性别不一致(TRAN)人群中的物质使用障碍(SUD)。运输 人们面临着与SUD预防和治疗相关的独特挑战，包括获得更少的医疗保健 由于医疗保健支付者未能覆盖医疗必要的跨专业护理。唐宁医生的 卫生政策、性别和性少数群体健康方面的背景，以及#年的量化方法 再加上他们作为性别少数民族的生活经历，使他们具有独特的资格 对这一领域做出了重大贡献。有三个方面的额外培训将提高他们的能力 实现他们的长期职业目标：1)资助和提供州医疗补助计划，2) (4)定性与混合法研究。 唐宁博士的培训目标将通过课程作业、定向阅读、一对一 与导师会面，并指导研究活动。K01指导性研究混合方法研究 将在俄勒冈州的医疗补助计划中确定SUD的风险因素和跨性别者的治疗促进者 程序。这项提案的第一个目标是确定跨性别者中肥皂水和过量用药的预测因素。这个 第二个目标是在跨性别者中识别物质使用治疗的预测因素 物质使用障碍。第三个目标是了解筛查和治疗的机制。 因为跨性别者中的sud是通过对跨性别者和提供服务的提供者进行采访而发生的。 病人群体。这项建议具有很高的创新性，因为它：1)提供了第一个具有代表性的估计 在参加医疗补助的跨性别者中进行SUD和治疗的研究，2)采用准实验方法 评估性别肯定护理的保险覆盖面对SUD的影响；以及3)使用混合方法 为调查结果提供背景的方法。这项培训将扩大候选人进行研究的能力 这具体满足了NIDA的三个关键目标：确定吸毒的行为和社会原因以及 制定新的和改进的干预措施，以防止吸毒及其后果； 评估政策对SUD的影响。

PROJECT SUMMARY/ABSTRACT The proposed K01 award provides Dr. Downing, a new Assistant Professor in the Oregon Health & Science University/Portland State University School of Public Health, with the training and skills needed to achieve their long-term goal of becoming an independent investigator focused on the prevention and treatment of substance use disorders (SUD) among transgender and gender non-conforming (trans) people. Trans people face unique challenges related to SUD prevention and treatment, including lower healthcare access resulting from the failure of healthcare payers to cover medically necessary, trans-specific care. Dr. Downing’s background in health policy, gender and sexual minority population health, and quantitative methods in addition to their lived experience as a gender minority person makes them uniquely qualified to make significant contributions to this field. There are three areas where additional training will improve their ability to achieve their long-term career goals: 1) the financing and care delivery of state Medicaid programs, 2) the epidemiology and treatment of SUD, and 4) qualitative and mixed methods research. Dr. Downing’s training goals will be achieved through coursework, directed readings, one-on-one meetings with mentors, and mentored research activities. The K01 mentored research mixed-methods study will identify risk factors for SUD and facilitators of treatment among trans people in Oregon’s Medicaid program. The first aim of this proposal is to identify predictors of SUDs and overdose among trans people. The second aim is to identify predictors of substance use treatment among trans people with a history of a substance use disorder. The third aim proposes to understand mechanisms by which screening and treatment for SUD among trans people occur by conducting interviews with trans people and providers who serve this patient population. This proposal is highly innovative because it: 1) provides the first representative estimates of SUD and treatment among trans people enrolled in Medicaid, 2) employs a quasi-experimental approach to evaluate the impact of insurance coverage of gender-affirming care on SUD; and 3) uses a mixed methods approach to provide context for findings. This training will expand the candidate’s ability to conduct research that specifically meets three NIDA key goals: identifying the behavioral and social causes of drug use and addiction, developing new and improved interventions to prevent drug use and its consequences, and assessing the impact of polices on SUD.