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

 描述(由申请人提供)：非裔美国人集中的贫困社区(DCAA--即贫困和犯罪率高的地区)居民的酒精和非法药物使用率(AIDU)与一般人口相似。然而，AIDU对DCaaS的居民的后果要高得多(例如，更高的监禁和艾滋病毒/丙型肝炎感染率)，他们获得有效治疗药物使用障碍的机会也要少得多。该项目将继续开发和测试社区智慧，这是一种与服务提供商、DCaaS居民和有药物使用障碍和监禁史的个人合作创建的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性研究(CBPR)来开发和试点测试社区智慧，尽管参与者面临着巨大的挑战(如无家可归、艾滋病和贫困)，但干预完成率达到了75%。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，这一成功归功于用于制定与参与者需求相关的干预措施的CBPR模式。“社区智慧”在微观层面(如认知和行为过程)、中观层面(如与个人和组织的关系)和宏观层面(如政治和文化进程)处理健康的社会决定因素(如耻辱、贫困、缺乏治疗机会、住房和有意义的就业)和与艾滋病成瘾有关的不平等现象。社区智慧建立在批判意识理论的基础上，该理论使个人、组织和社区能够在改变个人行为(例如，减少AIDU)的同时解决健康的社会决定因素。我们建议应用多阶段优化策略(MOST)-一种采用析因设计的创新和严格的框架-来优化Community Wise。具体地说，使用MOST，我们将确定最有效、可扩展和可持续的社区智慧组件，以便我们可以通过仅包括显著降低AIDU的组件来完善干预方案。社区智慧的长期目标是通过符合DCAA世界观并以科学和土著知识为基础的干预措施，减少居住在DCAA的有药物使用障碍和监禁史的男子与普通民众之间与AIDU有关的健康不平等。这项研究的数据将最终形成一份优化的社区智慧手册；使用MOST和CBPR开发多成分可扩展干预措施的改进方法战略；以及更好地理解关键意识理论在与艾滋病相关的健康不平等领域的应用。

 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.