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

项目概要/摘要 美国印第安人/阿拉斯加原住民（AI/AN）的共同发生率最高 精神健康和物质使用问题。这些差异反映了更广泛的系统性和 城市居住AI/AN个体之间的社区水平不平等。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潜在障碍， 影响了近四分之一的AI/AN人群。成年初显期（18-25岁）是一个发育期， 其特点是不稳定、角色转换和自我探索。一些证据表明，AI/AN正在出现 成年人在应对歧视、社会和经济歧视的同时， 不平等和快速的文化变革，这些都可能影响心理健康和药物使用。然而， 了解城市AI/AN新兴成年人中可能与健康相关的风险和保护因素 不平等这项补助金的目的在父母补助金的范围之内;但是， 通过允许我们以新的方式分析我们的调查基线数据，以及将联合收割机 这些调查数据与新的定性数据：目标1-利用基线调查数据（n=125），以检查风险 因素（例如，歧视，历史损失），和保护因素-文化认同和联系（例如， 文化联系、文化认同和参与传统习俗）和社会支持（例如， 情感，有形的，来自农村或城市网络联系人的支持）与阿片类药物，酒精和 大麻使用和心理健康结果;以及目标2-对20个子样本进行深入访谈 从基线样本中招募的报告不同类型经历的参与者（例如，率高 歧视/损失，文化参与率高，农村支持的社交网络， 城市支持），以更好地了解城市AI/AN新兴成年人的歧视经历， 历史损失、文化认同和联系以及社会支持。调查结果将支持父母补助金， 提供关于如何最好地解决城市AI/AN新兴成年人健康公平问题的新信息， 他们在生活中经历的不同风险和保护因素。研究结果可以帮助建立一个经验， 如何加强阿片类药物和AOD预防干预服务，以确保 公平对待这个群体。这将是迄今为止第一项采用混合方法来了解 不平等的具体结构性驱动因素以及使用AOD和心理健康的关键保护因素， 城市AI/AN新兴成年人。研究结果可以通过突出强调这一未充分研究的领域， 提供者和政策制定者如何更好地解决AI/AN新兴成年人所经历的不平等问题。

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.