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

摘要 在美国，与阿片类药物相关的死亡率继续上升，特别是在该国阿巴拉契亚农村地区。 增加对阿片类药物使用障碍的循证治疗，如药物治疗 对于阿片类药物使用障碍(Moud)，需要成功地解决这一流行病；然而， 医疗保健提供者和社区成员以及吸毒者的内在化污名 (PWUD)是阿巴拉契亚农村地区获得和吸收Moud的重大障碍。虽然公共卫生 解决阿片类药物使用和治疗的努力往往侧重于减少耻辱，有必要 跨学科工作，以了解阿巴拉契亚农村社区这种耻辱背后的力量。在……里面 特别是，道德观点等文化因素可能会对与毒品和穆德有关的人产生关键影响 这些地区的耻辱。这项研究的目的是了解道德与道德之间的关系 在阿巴拉契亚俄亥俄州农村吸毒者中对Moud的看法、污名和吸收，以及 探索医疗保健提供者和社区利益相关者对Moud的道德观点和看法。一个 理解这一地区潜在的或推动耻辱的道德观念对于实施 更成功的减少污名干预措施和更多地获得阿片类药物使用的循证护理。 来自新兴道德心理学领域的两个理论框架，道德基础理论(MFT)和 二元道德理论(TDM)解释了道德世界观和道德世界观之间的潜在路径， 耻辱和对穆德的认可。在阿片类药物研究领域检验这些理论将加强 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 了解这两个领域的知识，并为未来更多的协作工作建立联系。研究目标将 将在俄亥俄州阿巴拉契亚农村地区由NIDA资助的更大规模的农村阿片类药物倡议范围内完成 (对俄亥俄州农村阿片类药物流行实施基于社区的反应，UG3/UH3DA044822)。 目标1将使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构建在阿巴拉契亚农村人口的PWUD。目标2将利用结构方程建模 探讨残障儿童的道德观念与Moud的关系，并挖掘其潜能 通过内化污名进行调解。目标3将包括与治疗提供者、PWUD和 其他社区利益相关者，以进一步了解成瘾的道德观念和概念化 这些因素如何塑造人们对药物使用和治疗的态度。通过这项拟议的混合方法研究， 申请人在生物科学和公共卫生方面的背景将得到加强和扩大，以包括 社会心理学和道德心理学方面的专业知识。此外，与健康领域知名教师的指导经验 行为学、流行病学和道德心理学，以及扩大沟通和 传播技能将使申请者为独立的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.