Developing a public health measure of built environment to assess risk of nonmedical opioid use and related mortality in urban and non-urban areas in New Jersey

摘要 非医用阿片类药物（NMO）使用（滥用处方阿片类药物或海洛因）和相关过量， 死亡率是迅速增长的公共卫生问题。特别是有相当多的证据表明 流行病在主要城市中心和城市地区之外增长特别快（即，在郊区和 农村地区）。虽然有大量的经验证据表明， 社会环境，结合在一起（即，使用构建环境框架）代表以下方面的强预测因素 药物使用和精神健康结果在城市环境中，缺乏研究评估的建设 非城市环境特征，以预测NMO结果的风险。 拟议的研究将汇编来自新泽西566个城市的二级数据源的数据， 弥补这一差距。选择新泽西是因为其流行病学相关性和NMO的可用性 过量数据。近年来，NMO过量急诊室入院率最高的是 发生在由郊区和农村地区组成的县。这项拟议的研究将是第一个 系统地测量物理和社会环境特征，即，非城市的建筑环境 理论上和经验上与动校正使用相关的领域， 一个环境框架，可以估计非城市地区使用和过量使用NMO的危险水平 设置. 本研究将针对以下具体目标：目标1。1a.制定衡量战略， 扩展了建筑环境框架的使用，以描述建筑物的物理和社会环境的特征。 理论上与NMO使用和过量相关的非城市地区。1b.构建空间数据 建筑环境数据基础设施，用于地理信息系统， 在城市和非城市中检验这种新的建筑环境措施的可行性和有效性 社区.目标2.通过检查目标1中制定的措施与以下方面的关系，评估目标1中制定的措施的有效性 各种社会和环境建设。我们将部分评估新措施的预测有效性， 通过检查其预测市政一级过量风险较高地区的能力（城市和城市之间）， 非城市地区）。我们还将评估新措施与其他市政级别的相关性 变量，以建立并发，收敛和判别效度。 这种新的建筑环境措施和相应的空间数据基础设施的发展， 复制，从而使公共卫生部门和其他服务组织能够确定具体领域， NMO发病率和死亡率的风险最大。反过来，这将使他们能够战略性地分配 资源，并设计和（或）修改其预防和干预工作，以解决这些领域的问题。 我们的目标是更直接、更有效地针对高危人群。

ABSTRACT Nonmedical opioid (NMO) use (misuse of either prescription opioids or heroin) and related overdose and mortality are rapidly growing public health problems. In particular, there is quite a bit of evidence that the NMO epidemic is growing particularly rapidly outside of major city centers and urban areas (i.e., in suburban and rural areas). While there has been a great deal of empirical evidence suggesting that features of physical and social environments, taken together (i.e., using a built environment framework) represent strong predictors of drug use and mental health outcomes in urban settings, there is a dearth of research assessing the built environmental features of non-urban settings in order to predict risk for NMO outcomes. The proposed study will compile data from secondary data sources for 566 municipalities in New Jersey to address this gap. New Jersey was chosen for its epidemiological relevance and its availability of NMO overdose data. In recent years, the highest rates of NMO overdose emergency room admissions have occurred in counties comprised of suburban and rural areas. The proposed study will be the first to systematically measure physical and social environmental features, i.e., the built environments, of non-urban areas which are theoretically and empirically related to NMO use, in the service of developing a built environment framework that can estimate municipality-level risk of NMO use and overdose in non-urban settings. This study will address the following specific aims: Aim 1. 1a. To develop a measurement strategy that extends use of the built environment framework to describe features of the physical and social environments of non-urban areas which are theoretically relevant for NMO use and overdose. 1b.To construct a spatial data infrastructure of built environment data to be utilized in a Geographic Information System (GIS) with which to test the feasibility and validity of this new built environment measure among both urban and non-urban communities. Aim 2. To assess the validity of the measure produced in Aim 1 by examining its relationship to various social and environmental constructs. We will assess the predictive validity of the new measure in part by examining its ability to predict areas at higher risk for overdose at the municipality level (among both urban and non-urban areas). We will also assess correlations of the new measure with other municipality level variables in order to establish concurrent, convergent, and discriminant validity. The development of this new built environment measure and corresponding spatial data infrastructure can be replicated, thereby allowing public health departments and other service organizations to identify specific areas with greatest risk for NMO morbidity and mortality. This, in turn, will allow them to strategically allocate resources to these areas and to design and/or modify their prevention and intervention efforts to address area vulnerabilities and to more directly and efficiently target high-risk populations.