The Impact of Community Infrastructure Reinvestment Programs on Opioid Misuse and Opioid Overdose

项目总结/摘要 歧视性住房和分区政策，造成居住种族隔离，集中贫困， 缺乏经济机会往往导致邻里撤资和邻里混乱加剧。 邻里障碍-城市景观的恶化，也被称为枯萎病-显着影响阿片类药物 滥用，包括阿片类药物启动、注射药物使用、阿片类药物使用障碍的发展和持续时间，以及 阿片类药物过量改善失调的干预措施显示出显著的积极影响， 邻里犯罪枪支暴力和心理健康目前还没有研究调查 邻里障碍干预影响阿片类药物滥用或相关的过量风险。其广泛目标 本研究的目的是调查社区基础设施再投资计划对阿片类药物滥用的影响 和阿片类药物过量在费城，政府、社区和学术界的合作伙伴关系导致了 结构性干预措施（PHS费城土地养护和基本系统修复方案），以补救空置 废弃的建筑物和破旧的房屋。这些项目旨在改善邻里关系 在资源匮乏，少数民族占多数的社区，几乎没有绿色空间，并可能有远端的混乱 对阿片类药物滥用和相关过量风险的影响。之前的费城研究显示， 减少犯罪，改善枯萎病修复街区居民的压力和抑郁。这 研究将使用空间分析方法和系统的社会观察来解决HEAL的RFA DA-23-051 通过干预社会决定因素预防阿片类药物滥用和共患条件。具体目标 （1）调查阿片类药物滥用的街区级指标是否与枯萎病整治的街区不同 使用系统社会观察方法收集类阿片滥用所致垃圾原始数据的活动 (e.g.,注射器、止血带）和减少伤害的用具（例如，伤口护理，纳洛酮）;（2）检查是否致命 使用纵向空间面板， 方法与致命过量数据从费城的法医和非致命过量数据从 医院急诊护理访问;（3）探索补救活动改善邻里关系的机制 阿片类药物滥用以及致命和非致命过量率的指标，包括社区心理健康的改善 （按BRFSS数据衡量）和改善社区社会资本和社会凝聚力（按小学 与这些概念相关的邻里结构的数据收集），使用系统的社会观察和 空间分析方法这项研究将审查高度创新的地方公共卫生的影响 对阿片类药物滥用以及致命性和非致命性阿片类药物过量采取干预措施。调查结果将支持 扩大费城的邻里秩序整治项目，并促进类似的公共卫生为基础的 在其他城市采取政策和社区一级的卫生干预措施，防止类阿片滥用和过量使用。

PROJECT SUMMARY/ABSTRACT Discriminatory housing and zoning policies that cause residential racial segregation, concentrated poverty, and lack of economic opportunity often result in neighborhood disinvestment and increased neighborhood disorder. Neighborhood disorder—deterioration of the urban landscape, also known as blight—significantly impacts opioid misuse, including opioid initiation, injection drug use, opioid use disorder development and duration, and risk of opioid-involved overdose. Interventions to improve disorder have shown significant positive impacts on neighborhood crime, gun violence, and mental health. No studies have yet investigated the degree to which neighborhood disorder interventions influence opioid misuse or associated overdose risk. The broad objective of this study is to investigate the impact of community infrastructure reinvestment programs on opioid misuse and opioid overdose. In Philadelphia, government, community, and academic partnerships have resulted in structural interventions (PHS Philadelphia LandCare and Basic Systems Repair Program) to remediate vacant lots, abandoned buildings, and dilapidated homes. These programs are designed to improve neighborhood disorder in resource-deprived, minority-majority neighborhoods with little to no green space and may have distal effects on opioid misuse and associated overdose risk. Previous Philadelphia studies have shown significant reductions in crime and improved stress and depression for residents on blocks with blight remediation. This study will use spatial analysis methods and systematic social observation to address HEAL's RFA DA-23-051 Preventing Opioid Misuse and Co-Occurring Conditions by Intervening on Social Determinants. Specific aims are: (1) Investigate whether street block-level indicators of opioid misuse differ on blocks with blight remediation activities using systematic social observation methods for primary data collection of litter from opioid misuse (e.g., syringes, tourniquets) and harm reduction paraphernalia (e.g., wound care, naloxone); (2) Examine if fatal and nonfatal opioid overdose rates improved with remediation activities using a longitudinal spatial panel approach with fatal overdose data from Philadelphia's medical examiner and nonfatal overdose data from hospital emergency care visits; (3) Explore mechanisms by which remediation activities improve neighborhood indicators of opioid misuse and fatal and nonfatal overdose rates, including improved community mental health (measured by BRFSS data) and improved community social capital and social cohesion (measured by primary data collection of neighborhood structures related to these concepts), using systematic social observation and spatial analysis methods. This study will examine the impact of highly innovative place-based public health interventions on opioid misuse and fatal and nonfatal opioid overdose. Findings will provide support for expanding neighborhood disorder remediation projects in Philadelphia and promote similar public health-based policy and community-level health interventions for opioid misuse and overdose prevention in other cities.