Understanding the Opioid Epidemic in Rural Ohio: A Mixed-Methods Analysis of Moral Values, Stigma, and Medication for Opioid Use Disorder (MOUD)

摘要 美国与阿片类药物有关的死亡率继续上升，特别是在该国的阿巴拉契亚农村地区。 增加类阿片使用障碍循证治疗的提供和获得，如药物治疗 阿片类药物使用障碍（MOUD）需要成功地解决流行病;然而， 医疗保健提供者和社区成员以及吸毒者的内在耻辱感 （PWUD）是阿巴拉契亚农村MOUD可用性和吸收的重大障碍。虽然公共卫生 解决阿片类药物使用和治疗问题的努力往往侧重于减少耻辱感，因此有必要 跨学科的工作，以了解在农村阿巴拉契亚社区这种耻辱的力量。在 特别是，文化因素，如道德观点，可能会对毒品和MOUD相关的 在这些领域的耻辱。这项研究的目的是为了了解道德与道德之间的关系， 观点，耻辱，以及在阿巴拉契亚俄亥俄州农村使用药物的人对MOUD的吸收，以及 探讨医疗服务提供者和社区利益相关者对MOUD的道德观点和看法。一个 了解该地区污名化背后或驱动污名化的道德观念，对于实施 更成功的减少污名干预措施和增加对阿片类药物使用的循证护理。 道德心理学的两个新兴领域的理论框架，道德基础理论（MFT）和 二元道德理论（TDM），提供了对道德世界观， 耻辱和MOUD的批准。在阿片研究领域测试这些理论将加强 心理学和公共卫生领域之间的跨学科工作，贡献新颖，有价值 知识，并建立联系，以增加未来的合作工作。研究目的将 在俄亥俄州阿巴拉契亚农村地区，在一个更大的由NIDA资助的农村阿片类药物倡议的背景下完成 （实施以社区为基础的应对阿片类药物流行在农村俄亥俄州，UG 3/UH 3DA 044822）。 目标1将利用验证性因素分析测试来评估与MFT相关的工具的有效性 和TDM结构在农村阿巴拉契亚人口的PWUD。目标2将利用结构方程模型 研究PWUD的道德观与MOUD的接受之间的关系，并探索潜在的 通过内化的污名进行调解。目标3将涉及与治疗提供者、PWUD和 其他社区利益攸关方，以进一步了解道德观念和成瘾的概念化， 这些影响了人们对药物使用和治疗态度。通过这种混合方法的研究， 申请人在生物科学和公共卫生的背景将得到加强和扩大，包括 社会和道德心理学的专业知识。此外，与健康领域著名教师的指导经验 行为，流行病学和道德心理学，以及培训机会，以扩大沟通和 传播技能将为申请人的独立学术研究生涯做好准备。

Abstract Opioid-related mortality in the U.S continues to rise, particularly in the rural Appalachian region of the country. Increased availability of and access to evidence-based treatment for opioid use disorder, such as medication for opioid use disorder (MOUD) is needed to successfully address the epidemic; however, stigma among healthcare providers and community members as well as internalized stigma among people who use drugs (PWUD) are substantial barriers to MOUD availability and uptake in rural Appalachia. While public health efforts to address opioid use and treatment have often focused on stigma reduction, there is a need for interdisciplinary work to understand the forces underlying this stigma in rural Appalachian communities. In particular, cultural factors such as moral views may have critical consequences for drug- and MOUD-related stigma in these areas. The goal of the proposed research is to understand the relationship between moral views, stigma, and uptake of MOUD among people who use drugs in rural Appalachian Ohio, as well as to explore moral views and perceptions of MOUD among healthcare providers and community stakeholders. An understanding of the moral perceptions underlying or driving stigma in this region is critical for implementing more successful stigma reduction interventions and increasing access to evidence-based care for opioid use. Two theoretical frameworks from the emerging field of moral psychology, Moral Foundations Theory (MFT) and the Theory of Dyadic Morality (TDM), offer explanations for the potential pathway between moral worldview, stigma, and approval of MOUD. Testing these theories in the field of opioid research will strengthen interdisciplinary work between the fields of psychology and public health, contributing novel, valuable knowledge to both areas and forging connections for increased collaborative work in the future. Study aims will be completed within the context of a larger NIDA-funded Rural Opioid Initiative in rural Appalachian Ohio (Implementing a Community-Based Response to the Opioid Epidemic in Rural Ohio, UG3/UH3DA044822). Aim 1 will utilize Confirmatory Factor Analysis testing to assess the validity of instruments associated with MFT and TDM constructs in a rural Appalachian population of PWUD. Aim 2 will utilize structural equation modeling to examine the relationship between moral views and uptake of MOUD among PWUD, and explore potential mediation by internalized stigma. Aim 3 will involve qualitative interviews with treatment providers, PWUD, and other community stakeholders, to further understand moral perceptions and conceptualization of addiction and how these shape attitudes toward drug use and treatment. Through this proposed mixed-methods study, the applicant's background in biological sciences and public health will be strengthened and expanded to include expertise in social and moral psychology. Furthermore, mentorship experience with renowned faculty in health behavior, epidemiology, and moral psychology, as well as training opportunities to expand communication and dissemination skills will prepare the applicant for an independent academic research career.