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

为加利福尼亚州美洲印第安人/阿拉斯加原住民年轻人制定和实施以文化为中心的阿片类药物预防干预措施

• 批准号: 10440189
• 负责人: ELIZABETH J. D'AMICO
• 金额: $ 35.93万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10440189
• 关键词: 18 year old; Address; Adolescent and Young Adult; Adult; Affect; Age; Alaska Native; Alcohol consumption; American Indians; Area; Baseline Surveys; California; Cessation of life; Communities; Data; Development; Diagnosis; Discrimination; Dose; Drug usage; Economics; Education; Educational workshop; Elderly; Emotional; Ensure; Evidence based treatment; Focus Groups; Helping to End Addiction Long-term; Hour; Individual; Intervention; Interview; Life; Link; Marijuana; Mediation; Mental Health; Methods; Native-Born; Neurologic; Opioid; Outcome; Overdose; Parents; Patient Recruitments; Peer Pressure; Personal Satisfaction; Pharmaceutical Preparations; Phase; Play; Policy Maker; Population; Poverty; Prevalence; Prevention program; Provider; Public Health; Randomized Controlled Trials; Reporting; Risk; Risk Factors; Role; Rural; Sampling; Social Environment; Social Network; Social support; Spirituality; Structure; Surveys; Technology; Teenagers; Testing; Time; Unemployment; United States; Urban Community; Visualization; Work; Youth; acceptability and feasibility; alcohol and other drug; clinically significant; coping; cost effectiveness; economic evaluation; effectiveness evaluation; emerging adult; emerging adulthood; experience; health care availability; health equity; health inequalities; hedonic; heroin use; informant; innovation; intervention program; marijuana use; motivational enhancement therapy; multidisciplinary; native youth; opioid misuse; opioid overdose; opioid use; opioid use disorder; parent grant; parent project; peer; prescription opioid; prescription opioid misuse; prevent; preventive intervention; programs; protective factors; psychologic; recruit; response; service intervention; social; substance use; substance use treatment; urban Native American; urban area; urban dwelling; young adult

PROJECT SUMMARY/ABSTRACT American Indian/Alaska Native (AI/ANs) individuals experience some of the highest rates of co-occurring mental health and substance use problems in the United States. These disparities reflect broader systemic and community level inequities among urban-dwelling AI/AN individuals. Systemic factors, such as poverty, unemployment, and discrimination are underlying barriers to accessing healthcare and substance use treatment, affecting nearly a quarter of AI/AN people. Emerging adulthood (ages 18-25) is a developmental period often characterized by instability, role transition, and self-exploration. Some evidence suggests that AI/AN emerging adults often experience this key formative life stage while coping with discrimination, social and economic inequities, and rapid cultural change, which all can affect mental health and substance use. However, little is known about risk and protective factors among urban AI/AN emerging adults that may be associated with health inequities. The aims of this supplement are within the scope of the parent grant; however, they substantially expand the parent project by allowing us to analyze our survey baseline data in new ways, as well as combine these survey data with new qualitative data: Aim 1- utilize baseline survey data (n=125) to examine how risk factors (e.g., discrimination, historical loss), and protective factors-- cultural identity and connection (e.g., cultural connection, cultural identity, and participation in traditional practices), and social support (e.g., emotional, tangible, and support from rural or urban network contacts) are associated with opioid, alcohol and cannabis use and mental health outcomes; and Aim 2- conduct in-depth interviews with a subsample of 20 participants recruited from the baseline sample who report different types of experiences (e.g., high rates of discrimination/loss, high rates of cultural engagement, social networks with rural support, social networks with urban support) to better understand urban AI/AN emerging adults’ experiences with discrimination and historical loss, cultural identity and connection, and social support. Findings will support the parent grant by providing new information on how to best address health equity among urban AI/AN emerging adults, given the different risk and protective factors that they experience in their lives. Findings can help build an empirical, culturally grounded rationale for how to enhance opioid and AOD prevention intervention services to ensure equity for this population. This will be the first study to date to take a mixed methods approach to understand specific structural drivers of inequity as well as key protective factors for AOD use and mental health among urban AI/AN emerging adults. Findings can move the field forward in this understudied area by highlighting how providers and policy makers can better address the inequities that AI/AN emerging adults experience.

项目摘要/摘要 美国印第安人/阿拉斯加原住民(AI/ANS)的共生率最高 美国的精神健康和药物使用问题。这些差距反映了更广泛的系统性和 居住在城市的人工智能/人工智能个人之间的社区层面的不平等。系统性因素，如贫困， 失业和歧视是获得医疗保健和药物使用治疗的根本障碍， 影响到近四分之一的人工智能/AN人。成年初期(18-25岁)通常是一个发育阶段。 以不稳定、角色转换和自我探索为特征的。一些证据表明，人工智能/一个新兴的 成年人经常在应对社会和经济歧视的同时经历这一关键的人生形成阶段 不平等和快速的文化变革，所有这些都会影响精神健康和物质使用。然而，几乎没有什么是 已知城市AI/AN新兴成人中可能与健康相关的风险和保护因素 不平等。本补编的目的是在父母资助的范围内；然而，他们实质上 通过允许我们以新的方式分析我们的调查基线数据以及组合 这些带有新的定性数据的调查数据：目标1--利用基线调查数据(n=125)检查风险如何 因素(例如，歧视、历史损失)和保护性因素--文化认同和联系(例如， 文化联系、文化认同和对传统习俗的参与)和社会支持(例如， 来自农村或城市网络联系人的情感、有形和支持)与阿片类药物、酒精和 大麻使用和精神健康结果；和目标2--对20个小样本进行深入访谈 从基线样本招募的参与者，他们报告了不同类型的经历(例如，高比率 歧视/丧失、高文化参与率、有农村支持的社交网络、 城市支持)以更好地理解城市AI/AN新兴成年人的歧视和 历史遗失、文化认同和联系以及社会支持。调查结果将通过以下方式支持家长赠款 提供关于如何最好地解决城市人工智能/人工智能新兴成年人健康公平问题的新信息，鉴于 他们在生活中经历的不同的风险和保护因素。研究结果有助于建立一种经验性的、 关于如何加强阿片类药物和AOD预防干预服务以确保 对这一群体的公平。这将是迄今为止第一项采用混合方法来理解 不平等的特定结构性驱动因素以及AOD使用和精神健康的关键保护因素 城市人工智能/新兴成人。这些发现可以通过强调以下内容来推动这一未被研究的领域的发展 提供者和政策制定者如何更好地解决人工智能/新兴成年人经历的不平等问题。