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

项目总结 自那以来，美国黑人中阿片类药物过量死亡(OOD)的比率有增无减 2015年，超过白人的比例为2：1。OOD增长率中的种族差异 至少在23个州有记录，包括密苏里州，该州的OOD发生率在 黑人：每10万人中有44人(相比之下，全国每10万人中有16人)。迫切需要确定和确定 缓解社会健康决定因素(SDOH)，这些因素导致OOD和阿片类药物使用中日益加剧的种族不平等 精神障碍的治疗利用。一种解决SDOH的战略-例如低地理位置访问 治疗和高度社区剥夺-是以社区为基础的外展，派遣同龄人和 社区卫生工作者提供减少伤害的工具和与循证治疗的联系。虽然 外展工作改善了使用阿片类药物的黑人的心理教育和获得治疗的机会，现有 由于缺乏数据驱动的目标，这些努力受到了限制。因此，迫切需要确定和传播 黑人个体中OOD的地理和结构驱动因素，以提高现有外联的有效性 干预措施，进而改善获得治疗的机会。当前的K08提案通过以下方式满足了这一需求 将地理空间信息系统(GIS)技术与基于社区的参与性研究相结合 创建一个数字工具，旨在1)确定黑人个人的OOD基础上的当前SDOH和2) 提供以数据为导向的目标，以提高以社区为基础的外联干预措施的效力。该项目 AIMS和职业发展计划将同时支持班克斯博士向独立临床医生的过渡 调查员侧重于将技术与社区参与相结合，以改善物质使用 在少数族裔群体中的待遇。该项目的具体目标是：1)开发和评估 地理信息系统支持的指数(“过量种族公平指数”)对OOD风险建模的预测有效性 基于社区专家识别和评级的SDOH的黑人个人和2)展示了最初的 过量种族公平指数用于指导黑人OOD外展干预的可接受性和实用性 与同龄人和社区卫生工作者组成焦点小组。目标和相关培训机会由 密苏里大学圣路易斯分校和其他两个研究机构丰富的知识环境 将支持班克斯博士的培训目标，以获得数字/移动健康疗法、阿片类药物方面的专业知识 使用障碍治疗，并实施科学。结果包括确定作为基础的SDOH 美国黑人的OOD和一种研究和可复制的实施模式，供其他地区识别 政策和干预目标，以减少美国黑人中不成比例的OOD负担。这个 研究将为R01应用程序提供必要的培训和数据，以测试 移动版本的过量种族公平指数，以改善基于社区的预防结果。

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.