Neighborhoods, Mental Health, and the Prevention of Opioid Overdose: A Mixed Methods Approach

项目摘要/摘要 美国越来越多的阿片类药物使用导致与阿片类药物相关的致命和非致命过量急剧增加 (OD)，有精神健康障碍的成年人，包括焦虑和情绪障碍，明显更多 可能会使用非处方类阿片类药物。心理健康和相关药物的使用直接和显著地 受社区环境的影响，但很少有研究考察可改变的影响 关于吸食过量风险的社区特征。这项研究的主要目标是调查可修改的邻里 影响精神健康和可能导致阿片类药物过量的因素。拟议的研究将实现 使用具有致命OD数据的混合定量/定性方法的下列相互关联的具体目标 来自纽约、芝加哥和西雅图，以及对吸毒者的原创深度采访：(1) 调查可改变的物理和社会邻近因素与阿片类药物过量之间的关系；(2) 检查关键的心理健康指标作为可改变的邻里因素之间关系的中介 和阿片类OD之间的关系；(3)对比研究了可改变的邻里因素、心理因素 健康指标和阿片类药物过量，比较使用阿片类药物的人与 他们吸毒过量的地点。对吸毒者的深入采访将为 量化结果，确定社区影响药物使用和相关OD风险的机制 并为预防吸毒提供新的战略。本K01指导型研究科学家发展方案 将提供在药物使用研究中过渡到研究独立所需的培训和专业知识。五 将纳入特定的培训领域以实现这些研究目标：(1)在以下领域获得高级技能 结构方程建模和贝叶斯建模方法，因果推理理论和方法；(2) 发展混合定量和定性方法的专业知识，研究理论、设计和分析，并建立 收集和分析定性数据的能力；(3)培养精神病学领域的专业知识 流行病学和相关的药物使用危险因素，特别是严重抑郁症、一般焦虑症、 和精神疾病的诊断标准；(4)在研究的道德行为方面获得额外的培训 在被边缘化和被污名化的人群中；(5)为成功的研究生涯建立专业技能，如 领导多学科团队建立新知识和应对重大挑战的独立科学家 在吸毒和滥用方面。这些培训目标将通过教学课程的组合来实现， 来自跨学科专家团队的专业研讨会、实践研究和指导。这 研究和培训将导致随后的R01提案，该提案正式测试实施战略和 邻里层面预防吸毒干预的有效性。

PROJECT SUMMARY/ABSTRACT Increasing opioid use in the U.S. has led to a dramatic increase in opioid-related fatal and non-fatal overdoses (OD), and adults with mental health disorders, including anxiety and mood disorders, are significantly more likely to use nonprescription opioids. Mental health and associated drug use are directly and significantly impacted by the neighborhood environment, but few studies have examined the impact of modifiable neighborhood features on OD risk. The broad objective of this study is to investigate modifiable neighborhood factors which impact mental health and which may contribute to opioid OD. The proposed research will achieve the following interconnected specific aims using mixed quantitative/qualitative approaches with fatal OD data from New York City, Chicago, and Seattle and original in-depth interviews with people who use drugs: (1) investigate the associations between modifiable physical and social neighborhood factors and opioid OD; (2) examine key mental health indicators as mediators of the relationship between modifiable neighborhood factors and opioid OD; (3) comparatively investigate the associations between modifiable neighborhood factors, mental health indicators, and opioid OD, comparing the locations where people who use opioids lived versus the locations where they overdosed. In-depth interviews with people who use drugs will provide context for quantitative results, identifying mechanisms by which neighborhood impacts drug using and associated OD risk and informing novel strategies for OD prevention. This K01 mentored research scientist development proposal will provide the training and expertise needed to transition to research independence in drug use research. Five specific training areas will be incorporated to carry out these research goals: (1) obtain advanced skills in structural equation modeling and Bayesian modeling methods, and causal inference theory and methods; (2) develop expertise in mixed quantitative and qualitative methods research theory, design, and analysis, and build capacity in collecting and analyzing qualitative data; (3) develop subject matter expertise in psychiatric epidemiology and associated drug use risk factors, in particular, major depression, general anxiety disorders, and diagnostic criteria for psychiatric disorders; (4) obtain additional training in the ethical conduct of research among marginalized and stigmatized populations; (5) build professional skills for a successful research career as an independent scientist leading multidisciplinary teams to build new knowledge and address major challenges in drug use and abuse. These training goals will be achieved through a combination of didactic courses, specialized workshops, hands-on research, and mentoring from an interdisciplinary team of experts. This research and training will lead to a subsequent R01 proposal that formally tests implementation strategies and effectiveness of neighborhood-level interventions for OD prevention.