Research Project 3

项目摘要 在2010年的所有社会人口群体中，土著人民处方类阿片滥用率最高。 United States（US）.阿片类药物滥用率上升导致注射吸毒流行率上升 (IDU)以及伴随的过量和传染病发病率和死亡率。传染病的不平等 部分原因是没有足够的无菌注射设备。IDU相关的危害是许多驱动因素之一 在所有种族和族裔群体中，土著人民的预期寿命最低。尽管持续健康 由于土著人民之间的不平等，美国很少有联邦政府承认的部落实施注射器 服务项目（SSP）。这种稀缺的部分原因是，反映减少危害的SSP 通常，对抗疗法的“西方”健康和福祉的方法-必须与传统的 本土的治疗方法。虽然这三种方法并非不兼容，但它们的整合可能是 挑战性了解有助于成功执行以土著人民为中心的小岛屿发展中国家方案的因素 整合减少伤害、对抗疗法“西方”和传统土著方法值得探索 因为这些方案对于减轻与注射吸毒有关的危害至关重要。我们将以社区为基础， 与土著社区进行的参与性研究，成功实施了将多种 健康和福祉的方法。通过这个项目，我们将确定文化因素、社区 背景和政策，在实施整合多种方法的SSP期间（即，减少伤害， 对抗疗法“西方”和传统的土著）的健康和福祉在三个不同的土著 通过与在实施过程中发挥作用的人进行关键的知情人访谈，对社区进行评估（目标1）。 我们还将确定文化，社会和结构因素影响的背景和机制 对土著SSP中整合多种方法的SSP利用的态度和信念 客户和土著非客户（目标2）。最后，我们将研究知识和态度的模式 关于健康和福祉的多种方法以及整合它们的SSP与以下方面相关： 社会文化因素（例如，文化认同，污名），通过受众细分研究， 公共卫生和保健工作队伍中的土著服务人员（目标3）。该项目的结果 将最终形成一个强大的证据基础，以扭转现状的惯性，消除物质使用 对原住民社区的伤害。该项目与NIDA种族平等的目标直接一致 鉴于土著人民在卫生方面长期存在不平等现象，该项目具有很强的创新性，因为它 将是美国第一个全面审查SSP在土著地区实施过程的机构。 社区.

PROJECT SUMMARY Indigenous Peoples have the highest rate of prescription opioid misuse of any sociodemographic group in the United States (US). Increasing rates of opioid misuse have led to increased prevalence of injection drug use (IDU) and concomitant overdose and infectious disease morbidity and mortality. Infectious disease inequities are driven in part by inadequate access to sterile injection equipment. IDU-associated harms are one of many drivers of Indigenous Peoples having the lowest life expectancy of all racial and ethnic groups. Despite sustained health inequities among Indigenous Peoples, very few Federally recognized tribes in the US have implemented syringe services programs (SSPs). This scarcity is driven in part by the fact that SSPs – which reflect harm reduction and, often, allopathic “western” approaches to health and well-being – must be integrated with traditional Indigenous approaches for healing. While these three approaches are not incompatible, their integration can be challenging. Understanding factors that facilitated the successful implementation of Indigenous-centered SSPs that integrate harm reduction, allopathic “western,” and traditional Indigenous approaches warrants exploration since these programs are essential for mitigating IDU-associated harms. We will conduct community-based participatory research with Indigenous communities that successfully implemented SSPs that integrate multiple approaches to health and well-being. Through this Project, we will identify the roles of cultural factors, community contexts, and policy during the implementation of SSPs that integrate multiple approaches (i.e., harm reduction, allopathic “western,” and traditional Indigenous) to health and well-being in three diverse Indigenous communities through key informant interviews with persons who played a role during implementation (Aim 1). We will also determine the contexts and mechanisms by which cultural, social, and structural factors affect attitudes and beliefs about the utilization of SSPs that integrate multiple approaches among Indigenous-SSP clients and Indigenous non-clients (Aim 2). Finally, we will examine how patterns of knowledge and attitudes about multiple approaches to health and well-being and SSPs that integrate them are associated with sociocultural factors (e.g., cultural identification, stigma) through audience segmentation research among Indigenous-serving members of the public health and healthcare workforce (Aim 3). The results of this Project will culminate in a robust evidence base for reversing the inertia of the status quo and eliminating substance use harms in Indigenous communities. This Project is directly aligned with the goals of the NIDA Racial Equity Initiative given that Indigenous Peoples have persistent health inequities. This Project is highly innovative as it will be the first in the US to comprehensively examine SSP implementation processes in Indigenous communities.