Building an innovative Ethno-Geographic Information System (EGIS) to address opioid overdose disparities in Inland So Ca

项目总结 在美国，药物过量是伤害相关死亡的主要原因。在全国范围内，关于 阿片类药物过量作为一场以白人为主的郊区危机只讲述了部分故事，使 在边缘化和服务不足人群中产生过量用药差距的地方地理社会背景的重要性 社区。例如，河滨县是加利福尼亚州人口第三大县，代表着 社会经济、种族和地理上不同的区域，其特点是普遍的健康差距 以及医疗保健提供者的短缺。服药过量的比率十多年来一直在上升；近一半的人 所有吸毒过量都发生在非白人人群中，黑人的死亡人数增加了30%，原住民 美国人增加了47%，拉美人增加了52%，而5年来平均过量服药率是几年来最高的 主要是少数族裔和农村社区，超出了该县的城市中心，河滨市。我们 将Riverside县视为“风险环境”，定义为社会和物理空间，其中上下文 各种因素相互作用，在弱势群体中造成聚集性危害。然而，城市的空间特征 由于目前的空间模型缺乏人种学，过量用药的风险环境没有得到很好的描述 结构因素如何塑造阿片类药物使用的生活体验的粒度。因此，我们问：我们如何才能更好地 表征阿片类药物过量的差异，以增强我们在不同社会地理位置的反应？ 该项目的总体目标是开发一个创新的民族地理信息系统 (Egis)，将人种学与空间分析相结合，以确定阿片类药物过量的特征并指导研究 和资源分配，以减少服务不足社区的过量用药差距。《公约》的具体目标 项目是：1)开发与阿片类药物过量流行病学指标相关的空间显式模型(即， 过量服药死亡率)与空间背景变量有关，这些变量假设会影响过量服药的风险。 这些模型将结合在一起创建河滨县的“风险表面”地图，并确定哪些方面 通过使用正式的空间分析，空间背景与阿片类药物过量差异有关 方法：研究方法。2)检查不同样本人群中吸毒过量的结构、社会和空间背景 通过人种学方法(观察、深入访谈和人种学绘图)使用阿片类药物的人。 这项工作将建立在目标1中使用On-the-1开发的风险曲面图的基础上，并对其进行情景分析和重新考虑 地面数据，以解释观察到的阿片类药物过量差异。3)整合地理空间数据和人种学数据 从目标1和目标2开发以阿片类药物为特征的民族地理信息系统(EGIS) 指导资源分配的药物过量差异，未来的研究工作侧重于减少差异。 我们的研究将提供一种创新的新方法--EGIS，作为开发和测试的基础 在随后的R01赠款提案中采取社区一级干预措施以减少过量用药发生率和死亡率， 并将提供一种新的工具，供全国各地的社区使用，以解决阿片类药物过量的差距。

PROJECT SUMMARY In the United States, drug overdose is the leading cause of injury-related death. Nationally, narratives of opioid overdose as a predominantly White suburban crisis tell only a partial story, overshadowing the importance of local geosocial contexts in producing overdose disparities in marginalized and underserved communities. As one example, Riverside County is California’s third-largest in population, representing a socioeconomically, racially, and geographically diverse region characterized by widespread health disparities and a shortage of healthcare providers. Overdose rates have been rising for more than a decade; nearly half of all overdoses are among non-White populations, and deaths have increased among Blacks by 30%, Native Americans by 47%, and Latinos by 52%, while 5-year average overdose rates are highest in several predominantly minority and rural communities beyond the county’s urban hub, the City of Riverside. We consider Riverside County as a “risk environment,” defined as the social and physical spaces where contextual factors interact to cluster harms among disadvantaged populations. However, the spatial characteristics of overdose risk environments are not well characterized because current spatial models lack ethnographic granularity on how structural factors shape lived experiences of opioid use. Thus, we ask: how do we better characterize opioid overdose disparities to enhance our response across diverse social geographies? The overall goal of this project is to develop an innovative Ethno-Geographic Information System (EGIS) that combines ethnography with spatial analytics to characterize opioid overdose and guide research and resource allocation to reduce overdose disparities in underserved communities. The specific aims of the project are to: 1) Develop spatially-explicit models relating epidemiologic indicators of opioid overdose (i.e., overdose mortality, EMS calls) to spatial contextual variables hypothesized to influence the risk of overdose. These models will combine to create a “risk surface” map of Riverside County and identify which aspects of spatial context are associated with opioid overdose disparities through the use of formal spatial analytical methods. 2) Examine the structural, social, and spatial contexts of overdose among a diverse sample of people who use opioids via ethnographic methods (observations, in-depth interviews, and ethnographic mapping). This work will build upon, contextualize, and reconsider the risk surface map developed in Aim 1 using on-the- ground data to explain observed opioid overdose disparities. 3) Integrate the geospatial and ethnographic data from Aims 1 and 2 to develop an Ethno-Geographic Information System (EGIS) that characterizes opioid overdose disparities to guide resource allocation and future research efforts focused on reducing disparities. Our research will provide an innovative new method, EGIS, to serve as a foundation for developing and testing community-level interventions to reduce overdose incidence and mortality in subsequent R01 grant proposals, and will provide a new tool for use by communities around the country to address opioid overdose disparities.