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）和药物过量死亡。特别令人担忧的是阿片类药物使用的流行率 由于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。本提案响应RFA-DA-19-035，HEAL 倡议：通过制定和实施预防青少年和青年（16-30岁）OUD的措施， 实施以文化为中心的干预措施，以解决城市AI/AN新兴成年人中的阿片类药物滥用问题 (EAs)在加州：POMANAYA（防止美洲土著年轻人滥用阿片类药物）。这 该提案建立在我们过去十年与城市AI/AN社区密切合作的基础上 在整个加州，制定文化适当的节目，以解决酒精和其他药物（AOD）的使用。 该项目还建立了我们团队的工作，确定社交网络如何影响风险行为， 弱势群体。我们提出了一种多层次的干预方法，其中包括在 个人层面（POMANAYA）和社区层面：健康聚会（WG）。对于UG 3阶段，我们 我计划与幼儿园、幼儿园家长、人工智能/人工智能提供者和我们在市区的长者顾问委员会进行焦点小组讨论。 整个加州的社区，以了解如何a）最好地识别，接触和参与AI/AN EA，以访问 制定解决阿片类药物使用问题的方案，B）调整和加强我们现有的文化敏感预防措施 干预方案，动机访谈和文化的城市土著美国青年（MICUNAY）， AI/AN EA解决扩大（或减少）阿片类药物和AOD使用风险的社会网络因素，以及c）试点 测试POMANAYA，以确保该计划的可行性和可接受性。对于UH 3阶段，我们的目标是：1） 将接受POMANAYA+WG的AI/AN EA（n=185）与接受阿片类药物教育的AI/AN EA（n=185）进行比较 关于3个月、6个月和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 通过调解分析利用成果，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在这些社区的可持续性 访谈知情人和焦点小组，以及4）进行经济评估，以量化方案成本 与类阿片教育相比，多层次干预方法的成本效益。结果从这个 这项研究可以大大提高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.