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 非医疗类阿片(NMO)的使用(处方类阿片或海洛因的滥用)和相关的过量使用 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，国家气象局 在主要城市中心和城区以外(即郊区和郊区)，疫情增长尤其迅速 农村地区)。虽然有大量的经验证据表明，身体和身体的特征 社会环境结合在一起(即，使用构建的环境框架)代表着强烈的预测因素 在城市环境中，药物使用和心理健康结果，缺乏评估建筑的研究 非城市环境的环境特征，以便预测国家气象组织结果的风险。 拟议的研究将汇编新泽西州566个城市的二级数据来源的数据，以 弥补这一差距。新泽西州被选中是因为它的流行病学相关性和NMO的可用性 服药过量数据。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 系统地衡量非城市的自然和社会环境特征，即建成环境 理论上和经验上与NMO使用相关的领域，为开发一个已建成的 能够评估非城市地区使用和过量使用NMO的市级风险的环境框架 设置。 这项研究将涉及以下具体目标：目标1.1a。要制定一种衡量战略， 扩展了构建环境框架的使用，以描述物理和社会环境的特征 理论上与NMO使用和过量有关的非城市地区。1b.构建空间数据 要在地理信息系统(GIS)中使用的已建成环境数据的基础设施 在城市和非城市中测试这一新的建成环境措施的可行性和有效性 社区。目标2.评估目标1中提出的措施的有效性，方法是检查其与 各种社会和环境结构。我们将在一定程度上评估新指标的预测有效性 通过检查其在市政一级(在城市和城市之间)预测吸毒过量风险较高地区的能力 和非城市地区)。我们还将评估新措施与其他市级的相关性。 变量，以建立同时效度、收敛效度和判别效度。 这种新的建筑环境措施和相应的空间数据基础设施的开发可以 复制，从而允许公共卫生部门和其他服务组织确定特定领域 具有最大的NMO发病率和死亡率风险。反过来，这将使它们能够战略性地分配 向这些地区提供资源，并设计和/或修改其预防和干预工作，以解决这些地区 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.