HEALing Communities Study Health Equity Research

项目总结/文摘

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.