An Integrated Geospatial and Community-based Model to Prevent Opioid Overdose among Black Americans

项目摘要 阿片类药物过量死亡（OOD）率在美国黑人个体中一直有增无减， 2015年，以2比1的速度超过了白色个体。OOD增长率的种族差异 至少有23个州有记录在案，包括密苏里州，该州的OOD率在美国排名第二。 黑人：每10万人中有44人（全国每10万人中有16人）。迫切需要查明和 减轻健康的社会决定因素（SDOH），这些决定因素导致OOD和阿片类药物使用中的种族不平等日益增加 疾病治疗利用率。解决SDOH问题的一个策略是， 治疗和高邻里剥夺-是以社区为基础的推广，派遣同行， 社区卫生工作者提供减少伤害的工具，并将其与循证治疗联系起来。虽然 外展工作改善了心理教育和获得治疗的黑人谁使用阿片类药物，现有的 由于缺乏数据驱动的目标，这些努力受到限制。因此，迫切需要查明和传播 黑人个体中OOD的地理和结构驱动因素，以提高现有外展的效率 干预措施，从而改善治疗的可及性。当前的K 08提案通过以下方式满足了这一需求 整合地理空间信息系统（GIS）技术和社区参与式研究， 创建一个数字工具，旨在1）确定当前SDOH是黑人个体OOD的基础，2） 提供数据驱动的目标，以提高基于社区的外联干预措施的效力。项目 目标和职业发展计划将同时支持银行博士过渡到一个独立的临床 调查人员重点关注技术和社区参与的整合，以改善药物使用 少数种族/族裔群体的待遇。该项目的具体目标是：（1）开发和评估 一个基于GIS的指数（“过量种族公平指数”）对OOD风险模型的预测有效性 根据社区专家确定和评级的SDOH，在黑人个体中， 过量种族公平指数的可接受性和实用性，以指导黑人OOD的外展干预， 与同龄人和社区卫生工作者的焦点小组。促进的目标和相关培训机会 密苏里大学圣路易斯分校和另外两所研究机构丰富的学术环境 将支持班克斯博士的培训目标，以获得数字/移动的健康疗法、阿片类药物 用乱治乱，实施科学。结果包括确定SDOH， OOD在美国黑人和其他地区的研究和可复制的实施模式，以确定 政策和干预目标，以减少不成比例的负担OOD在美国黑人。的 研究将为R 01应用程序提供必要的培训和数据，以测试 移动的版本的过量种族公平指数，以改善基于社区的预防成果。

PROJECT SUMMARY Opioid overdose death (OOD) rates in the among Black individuals in the U.S. have increased unabated since 2015, outpacing those of White individuals at a rate of two to one. Racial disparities in the growth rate of OOD have been documented in at least 23 states, including Missouri, which has second highest rate of OOD among Black individuals: 44 per 100,000 (relative to 16 per 100,000 nationally). There is a critical need to identify and mitigate social determinants of health (SDOH) that drive increasing racial inequities in OOD and opioid use disorder treatment utilization. One strategy that addresses SDOH—such as low geographic access to treatment and high neighborhood deprivation—is community-based outreach, which dispatches peers and community health workers to provide harm reduction tools and linkages to evidence-based treatment. Although outreach efforts improve psychoeducation and access to treatment for Black people who use opioids, existing efforts are limited by a lack of data-driven targets. Thus, there is an urgent need to identify and disseminate geographic and structural drivers of OOD among Black individuals to improve the efficacy of existing outreach interventions and in turn, improve treatment access. The current K08 proposal addresses this need by integrating geospatial information systems (GIS) technology and community based participatory research to create a digital tool designed to 1) identify current SDOH that underlie OOD among Black individuals and 2) provide data-driven targets to improve the efficacy of community-based outreach interventions. The project aims and career development plan will concurrently support Dr. Banks’ transition to an independent clinical investigator focused on the integration of technology and community engagement to improve substance use treatment among minoritized racial/ethnic groups. Specific aims of the project are to 1) develop and evaluate the predictive validity of a GIS-enabled index (the “Overdose Racial Equity Index”) to model risk for OOD among Black individuals based on SDOH identified and rated by community experts and 2) demonstrate initial acceptability and utility of the Overdose Racial Equity Index to guide outreach interventions for Black OOD via focus groups with peers and community health workers. Aims and related training opportunities facilitated by the rich intellectual environment of the University of Missouri—St. Louis and the two other research institutions in St. Louis will support Dr. Banks’ training goals to gain expertise in digital/mobile health therapeutics, opioid use disorder treatment, and implementation science. Outcomes include the identification of SDOH that underlie OOD among Black Americans and a research and replicable implementation model for other regions to identify policy and intervention targets that reduce the disproportionate burden of OOD among Black Americans. The research will provide the training and data necessary for an R01 application that tests the effectiveness of a mobile version of the Overdose Racial Equity Index to improve community-based prevention outcomes.