Optimized Interventions to Prevent Opioid Use Disorder among Adolescents and Young Adults in the Emergency Department

项目摘要 全国药物使用与健康调查(NSDUH)数据显示，过去一年处方阿片类药物的使用 2019年，年龄较大的青少年和年轻人(AYA)的止痛药比例：19.7%(16-17岁)，24.8% (18-25岁)和28.2%(26-29岁)，而过去一年的阿片类药物滥用(处方+非法)比率为：3.4% 5.3%(18-25岁)和5.8%(26-29岁)。因此，AYA(16-30岁)使用阿片类药物是一种 公共卫生问题需要可扩展和可持续的战略来防止阿片类药物滥用和阿片类药物使用 在卫生系统中实施的疾病和预防方法有可能改变风险 轨迹。在本补编中，“阿片类药物”滥用包括处方类阿片类药物(没有处方，超过 使用非法阿片类药物(如海洛因、芬太尼类似物)。这 补充请求通过请求支持来直接响应NS-21-025以增加参与者多样性 并纳入我们正在进行的由Hear预防计划资助的随机对照试验(RCT)，以 技术驱动的预防干预措施。NSDUH的数据显示，过去一年处方阿片类药物的使用和 在黑人/非裔美国人协会中，滥用比率令人担忧。此外，黑人/非裔美国人 在预防研究和临床试验中，历史上代表性不足，但考虑到美国的种族差异 在获得治疗机会的情况下，让这些人口充分参与至关重要。因此，我们提出了两个与我们的 RCT：1)在允许的情况下，增加外联活动，以加强纳入自认为是黑人/非裔美国人的AYA 对版主进行有意义的分析(招募~N=110个额外的AYA)，以及2)提高我们的 通过对黑人/非裔美国人参与者进行深入访谈(IDI)来实现实施目标 采取后续行动(N=20)，以确定：a)今后实施这一分项目干预措施的障碍/促进者 人口，以及b)参与者认为的招募/干预交付的各个方面 引人入胜和/或有帮助的建议或修改建议，以增加吸引力和帮助。因此， 黑人/非裔美国人AYA更多地参与这一RCT将增强普遍性和文化性 干预措施与有计划的传播的相关性。定性方法将为患者提供小插曲 以他们的经历为特征的旅程(从急诊部的接触点到干预 交付)和成果，以便在卫生与健康组织会议上和在我们的执行工具包中传播。通过 作为对目前努力的补充，我们准备在阿片滥用和滥用问题上产生更大的影响。 通过加强对任职人数偏低的个人的吸纳，增强了对妇女和儿童权利的认识。我们使用电子健康记录- 促进招聘和IDI为我们的实施工具包提供信息是支持未来的关键创新 将我们的技术驱动的预防干预措施整合到医疗保健系统中。

Project Summary National Survey on Drug Use and Health (NSDUH) data show that past-year prescription opioid use (i.e., pain relievers) in 2019 for older adolescents and young adults (AYAs) was: 19.7% (ages 16-17), 24.8% (ages 18-25), and 28.2% (ages 26-29), whereas past-year opioid misuse (prescription+illicit) rates were: 3.4% (ages 16-17), 5.3% (ages 18-25), and 5.8% (ages 26-29). Thus, use of opioids by AYAs (ages 16-30) is a public health concern requiring scalable and sustainable strategies to prevent opioid misuse and opioid use disorders (OUDs), and prevention approaches implemented in health systems have the potential to alter risk trajectories. In this supplement, “opioid” misuse includes prescription opioids (without a prescription, more than prescribed, or for reasons other than prescribed) and use of illicit opioids (e.g., heroin, fentanyl analogs). This supplement request is directly responsive to NS-21-025 by requesting support to increase participant diversity and inclusion in our ongoing HEAL Prevention Initiative-funded randomized controlled trial (RCT) to technology-driven prevention interventions. The NSDUH data show that past-year prescription opioid use and misuse rates are concerning among Black/African American AYAs. Further, Black/African Americans are historically under-represented in prevention research and clinical trials, but, given racial disparities in OUD treatment access, it is critical to fully engage these populations. Thus, we propose two aims related to our RCT: 1) Increase outreach to enhance inclusion of AYAs who identify as Black/African American, permitting meaningful analyses of moderators (enrolling ~N = 110 additional AYAs), and 2) Enhance inclusion in our implementation aim by conducting in-depth interviews (IDIs) with Black/African American participants after follow-up (N =20) to identify: a) barriers/facilitators to future implementation of interventions for this sub- population, and b) aspects of the recruitment/intervention delivery that were perceived by participants as engaging and/or helpful or recommendations for modifications to increase appeal and helpfulness. Thus, greater involvement of Black/African American AYAs in this RCT will enhance the generalizability and cultural relevance of the interventions for planned dissemination. Qualitative methods will inform vignettes of patient journeys that characterize their experiences (from the Emergency Department touchpoint through intervention delivery) and outcomes for dissemination at HEAL meetings and in our implementation toolkit. By supplementing current efforts, we are poised to have a greater impact on the problem of opioid misuse and OUD through enhanced inclusion of under-represented individuals. Our use of electronic health record- facilitated recruitment and IDIs to inform our implementation toolkit are key innovations that support future integration of our technology-driven prevention interventions in healthcare systems.