HEALing Communities Study Health Equity Research

项目摘要/摘要 阿片类药物过量危机在美国持续存在，给发病率和死亡率带来了沉重的负担。 减少阿片类药物过量有强有力的证据基础，包括过量教育和纳洛酮 阿片类药物分配(OEND)、阿片使用障碍药物(MOUD)以及更安全的阿片类药物处方和处置。 然而，在社区层面采用这些循证实践(EBP)在医疗保健、行为 卫生和刑事法律制度是次优的。 康复社区研究(HCS)设计了康复社区(Cth)干预措施以帮助 增加EBPs的采用，并最终减少美国四个社区67个社区的阿片类药物过量死亡。 州：肯塔基州、马萨诸塞州、纽约州和俄亥俄州。Cth是联盟领导的、数据驱动的干预 这包括三个组成部分：(1)社区参与；(2)持续减少阿片类药物过量 护理方法(ORCCA)，这是EBP的菜单；以及(3)一套沟通活动，以减少 耻辱和推动对EBPS的需求。 在HCS的过程中，美国面临着明显的种族、民族和社会经济差异 新冠肺炎结果与乔治·弗洛伊德在警方拘留期间被杀的8分钟可怕视频一起发布。 这些事件引起了人们对我国体制中普遍存在的不平等现象的关注。作为回应，HCS的研究人员 改进了Cth对等待名单社区的干预措施，将更明确的重点放在卫生公平上。 作为数据协调中心(DCC)，RTI将与研究站点合作探索实施 Cth干预措施与股权有关的增强措施的结果。在这项补充下，我们将进行 评估联盟成员对成员多样性的满意程度的新分析(目标1)； 联盟成员对种族和民族的培训、资源和量身定制的战略的需求 小规模群体和其他服务不足群体(目标2)；联盟讨论的频率和重点 种族平等(目标3)；在多大程度上执行的《新德里战略》和《穆德战略》反映了 第二波社区的社会人口特征(目标4)；以及社区一级之间的联系 对污名和健康的社会决定因素的衡量，通过旨在 覆盖特殊人群，EBP覆盖第二波社区(目标5)。 DCC有能力与HCS研究站点合作实现这些目标。多个主体 调查人员Emmanuel Oga博士、LaShawn Glasgow博士和Gary Zarkin博士是MultiSite的经验丰富的领导人 在药物滥用、社区参与、实施科学和健康方面具有专业知识的研究 公平。更广泛的团队包括支持De Novo开发的分析师和一名协调员 建议分析的数据来源，分析人员具有进行其他实施的相关经验- 在母公司HCS下进行定向分析。实现以公平为重点的新目标和传播 研究结果将有助于为社区参与公平解决问题的方法建立基于实践的证据 阿片类药物过量危机。

Project Summary/Abstract The opioid overdose crisis persists in the United States, exacting a heavy burden of morbidity and mortality. There is a robust evidence base for reducing opioid overdose, including overdose education and naloxone distribution (OEND), medication for opioid use disorder (MOUD), and safer opioid prescribing and disposal. However, community-level adoption of these evidence-based practices (EBPs) in healthcare, behavioral health, and criminal legal systems is suboptimal. The HEALing Communities Study (HCS) designed the Communities That HEAL (CTH) intervention to help increase adoption of EBPs and ultimately reduce opioid overdose deaths in 67 communities across four U.S. states: Kentucky, Massachusetts, New York, and Ohio. The CTH is a coalition-led and data-driven intervention that includes three components: (1) community engagement; (2) the Opioid-overdose Reduction Continuum of Care Approach (ORCCA), which is a menu of EBPs; and (3) a set of communication campaigns to reduce stigma and drive demand for EBPs. Over the course of the HCS, the United States faced stark racial, ethnic, and socioeconomic differences in COVID-19 outcomes alongside the horrific eight-minute video of George Floyd’s killing in police custody. These events called attention to pervasive inequities in our nation’s systems. In response, HCS researchers refined the CTH intervention for wait-listed communities to include a more explicit focus on health equity. As the Data Coordination Center (DCC), RTI will work with research sites to explore implementation outcomes for equity-related enhancements to the CTH intervention. Under this supplement, we will conduct new analyses to assess coalition members’ level of satisfaction with the diversity of membership (Aim 1); coalition members’ perceived need for training, resources, and tailored strategies for racial and ethnic minoritized and other underserved groups (Aim 2); the frequency and focus of coalitions’ discussions about racial equity (Aim 3); the extent to which the reach of implemented OEND and MOUD strategies reflect the sociodemographic characteristics of Wave 2 communities (Aim 4); and associations among community-level measures of stigma and social determinants of health, the adoption of OEND and MOUD strategies intended to reach special populations, and EBP reach in Wave 2 communities (Aim 5). The DCC is equipped to collaborate with HCS research sites to achieve these aims. Multiple Principal Investigators, Drs. Emmanuel Oga, LaShawn Glasgow, and Gary Zarkin, are experienced leaders of multisite studies with expertise in substance abuse, community engagement, implementation science, and health equity. The broader team includes analysts and a coordinator who have supported the development of de novo data sources for proposed analyses, and analysts have relevant experience conducting other implementation- oriented analyses under the parent HCS. Achievement of the new equity-focused aims and dissemination of findings will help build practice-based evidence for community-engaged approaches to equitably addressing the opioid overdose crisis.