HEALing Communities Study Health Equity Research

项目概要/摘要 阿片类药物过量危机在美国持续存在，造成发病率和死亡率的沉重负担。 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 分配（OEND）、阿片类药物使用障碍（MOUD）药物以及更安全的阿片类药物处方和处置。 然而，社区层面在医疗保健、行为方面采用这些循证实践 (EBP) 卫生和刑事法律体系欠佳。 治愈社区研究 (HCS) 设计了治愈社区 (CTH) 干预措施，以帮助 增加 EBP 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 是一项联盟主导、数据驱动的干预措施 其中包括三个组成部分：（1）社区参与； (2) 阿片类药物过量减少连续性 Care Approach (ORCCA)，这是一个 EBP 菜单； (3) 一系列沟通活动，以减少 耻辱并推动对 EBP 的需求。 在 HCS 的过程中，美国在种族、民族和社会经济方面面临着明显的差异。 COVID-19 的结果与乔治·弗洛伊德 (George Floyd) 在警方拘留期间被杀的可怕的八分钟视频一起出现。 这些事件引起了人们对我们国家制度中普遍存在的不平等现象的关注。对此，HCS 研究人员 完善了对等候名单社区的 CTH 干预措施，更加明确地关注健康公平。 作为数据协调中心（DCC），RTI 将与研究机构合作探索实施方案 CTH 干预措施与公平相关的增强结果。根据本补充规定，我们将进行 新的分析来评估联盟成员对成员多样性的满意度（目标 1）； 联盟成员对针对种族和族裔的培训、资源和定制战略的感知需求 少数群体和其他服务不足的群体（目标 2）；联盟讨论的频率和重点 种族平等（目标 3）；实施的 OEND 和 MOUD 战略的影响范围反映了 第二波社区的社会人口特征（目标 4）；以及社区层面的协会 耻辱和健康问题社会决定因素的措施，旨在采用 OEND 和 MOUD 战略 覆盖特殊人群，EBP 覆盖第 2 波社区（目标 5）。 DCC 有能力与 HCS 研究中心合作来实现这些目标。多重校长 研究人员，博士。 Emmanuel Oga、LaShawn Glasgow 和 Gary Zarkin 是经验丰富的多站点领导者 具有药物滥用、社区参与、实施科学和健康方面专业知识的研究 股权。更广泛的团队包括支持 de novo 开发的分析师和协调员 用于拟议分析的数据源，并且分析师具有进行其他实施的相关经验 - 母体 HCS 下的定向分析。实现以公平为中心的新目标并传播 研究结果将有助于为社区参与的方法建立基于实践的证据，以公平地解决问题 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.