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

项目概要/摘要 美国阿片类药物使用的增加导致阿片类药物相关的致命和非致命过量急剧增加 (OD)，而患有精神健康障碍（包括焦虑和情绪障碍）的成年人， 可能使用非处方阿片类药物。精神健康和相关的药物使用是直接和显著的 受邻里环境的影响，但很少有研究探讨了可修改的影响， 邻里特征对OD风险的影响本研究的主要目的是研究可修改邻域 影响心理健康和可能导致阿片类药物OD的因素。这项研究将实现 使用混合定量/定性方法和致命OD数据，实现以下相互关联的具体目标 来自纽约市、芝加哥和西雅图以及对吸毒者的原始深度访谈：（1） 探讨可改变的物理和社会邻里因素与阿片类药物OD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 （3）比较研究可改变的邻里因素、心理因素和阿片类药物之间的关系 健康指标和阿片类药物OD，比较使用阿片类药物的人居住的地点与 吸毒过量的地方对吸毒者的深入采访将为以下方面提供背景： 定量结果，确定邻里影响药物使用和相关OD风险的机制 并为预防吸毒过量提供新的策略。此K 01指导了研究科学家的发展建议 将提供必要的培训和专门知识，以过渡到药物使用研究的独立性。五 具体的培训领域将纳入执行这些研究目标：（1）获得先进的技能， 结构方程建模和贝叶斯建模方法，以及因果推理理论和方法;（2） 发展混合定量和定性方法研究理论，设计和分析的专业知识，并建立 收集和分析定性数据的能力;（3）发展精神病学的主题专业知识 流行病学和相关的药物使用风险因素，特别是重度抑郁症，广泛性焦虑症， 和精神疾病的诊断标准;（4）在研究的伦理行为方面获得额外的培训 （5）为成功的研究事业培养专业技能， 一位独立的科学家，领导多学科团队，建立新知识，应对重大挑战 毒品使用和滥用这些培训目标将通过教学课程， 专业研讨会，动手研究，并从一个跨学科的专家团队指导。这 研究和培训将导致随后的R 01提案，正式测试实施战略， 社区一级预防吸毒过量干预措施的有效性。

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.