Community Wise: An innovative multi-level intervention to reduce alcohol and illegal drug use

社区智慧：减少酒精和非法药物使用的创新多层次干预措施

• 批准号: 9581302
• 负责人: Ellen Benoit
• 金额: $ 16.18万
• 依托单位: UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-16 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9581302
• 关键词: Address; Affect; African American; Alcohols; Attention; Behavior; Behavioral; Cognitive; Communities; Complex; Conscious; Crime; Data; Development; Distress; Drug Screening; Drug usage; Employment; Etiology; Evidence based intervention; Experimental Designs; Feasibility Studies; Frequencies; Future; General Population; Goals; HIV/HCV; Health Services Accessibility; Hepatitis C; Homelessness; Housing; Imprisonment; Indigenous; Individual; Inequality; Intervention; Knowledge; Literature; Manuals; Methodology; Modeling; Outcome; Participant; Performance; Plant Roots; Politics; Population; Poverty; Principal Investigator; Process; Protocols documentation; Public Health; Publishing; Quality of life; Randomized; Recommendation; Recording of previous events; Research; Research Methodology; Research Personnel; Resources; Rest; Sampling; Substance Use Disorder; Testing; United States Substance Abuse and Mental Health Services Administration; community based participatory research; cost effectiveness; design; effective therapy; experimental study; health inequalities; illicit drug use; innovation; member; men; public health relevance; research study; service providers; social health determinants; social stigma; standard of care; standardize measure; success; theories; wasting

 DESCRIPTION (provided by applicant): Rates of alcohol and illicit drug use (AIDU) among residents of distressed communities with concentrations of African Americans (DCAA- i.e., localities with high rates of poverty and crime) are similar to the general population. Yet AIDU has significantly higher consequences for residents in DCAAs (e.g., higher incarceration and HIV/HCV infection rates), who also have considerably less access to effective treatment of substance use disorders. This project will continue to develop and test Community Wise, an innovative multi-level intervention created in partnership with service providers, residents of DCAAs and individuals with histories of substance use disorders and incarceration, to reduce health inequalities related to AIDU. We used community-based participatory research (CBPR) to develop and pilot test Community Wise, achieving 75% intervention completion rates, despite great participant challenges (such as homelessness, AIDU, and poverty). Note that substance use disorder intervention completion rates in the literature are much lower among populations with fewer challenges (often 30 to 40%). We believe that this success is due to the CBPR model used to develop an intervention that is relevant to participants' needs. Community Wise addresses social determinants of health (e.g., stigma, poverty, lack of treatment access, housing, and meaningful employment) and inequalities related to AIDU at the micro level (e.g., cognitive and behavioral processes), meso level (e.g., relationships with individuals and organizations) and macro level (e.g., political and cultural processes). Community Wise builds on critical consciousness theory, which empowers individuals, organizations, and communities to address social determinants of health while changing individual behaviors (e.g., reducing AIDU). We propose to apply the Multiphase Optimization Strategy (MOST) - an innovative and rigorous framework that employs factorial designs - to optimize Community Wise. Specifically, using MOST we will identify the most efficient, scalable, and sustainable components of Community Wise so that we can refine the intervention protocol by including only components that significantly reduce AIDU. The long-term goal of Community Wise is to reduce health inequalities related to AIDU between men with substance use disorders and a history of incarceration residing in DCAAs and the general population through an intervention that is congruent with DCAA world views and grounded in scientific and indigenous knowledge. Data from this study will culminate in an optimized Community Wise manual; enhanced methodological strategies to develop multi-component scalable interventions using MOST and CBPR; and a better understanding of the application of critical consciousness theory to the field of health inequalities related to AIDU.

 描述（由申请人提供）：非裔美国人集中的贫困社区居民的酒精和非法药物使用率（AIDU）（DCAA-即，贫困率和犯罪率高的地区）与一般人口相似。然而，AIDU对DCAAs的居民有更高的影响（例如，这些人的监禁率和艾滋病毒/丙型肝炎病毒感染率较高，他们获得药物使用障碍有效治疗的机会也少得多。该项目将继续开发和测试Community Wise，这是与服务提供者，DCAAs居民和有药物使用障碍和监禁史的个人合作创建的一种创新的多层次干预措施，以减少与AIDU有关的健康不平等。我们使用基于社区的参与式研究（CBPR）来开发和试点测试社区智慧，实现了75%的干预完成率，尽管参与者面临巨大的挑战（如无家可归，AIDU和贫困）。请注意，文献中的物质使用障碍干预完成率在挑战较少的人群中要低得多（通常为30%至40%）。我们认为，这一成功是由于CBPR模型用于开发与参与者需求相关的干预措施。社区智慧解决健康的社会决定因素（例如，耻辱、贫困、缺乏治疗机会、住房和有意义的就业）以及微观层面上与艾滋病吸毒有关的不平等（例如，认知和行为过程），中间水平（例如，与个人和组织的关系）和宏观水平（例如，政治和文化进程）。社区智慧建立在批判意识理论的基础上，该理论赋予个人、组织和社区权力，在改变个人行为的同时解决健康的社会决定因素（例如，减少AIDU）。我们建议应用多阶段优化策略（MOST）-一个创新和严格的框架，采用析因设计-优化社区明智的。具体来说，使用MOST，我们将确定Community Wise最有效，可扩展和可持续的组件，以便我们可以通过仅包括显着减少AIDU的组件来改进干预方案。Community Wise的长期目标是通过与DCAA世界观一致并以科学和本土知识为基础的干预措施，减少患有药物使用障碍和有监禁史的男性与DCAA和普通人群之间与AIDU相关的健康不平等。这项研究的数据将最终优化社区智慧手册;增强方法战略，利用MOST和CBPR制定多组件可扩展的干预措施;更好地理解批判意识理论在与AIDU相关的健康不平等领域的应用。