Research Project 3

项目总结 土著人民的处方阿片类药物滥用比率是#年所有社会人口群体中最高的。 美国(美国)。阿片类药物滥用比率的增加导致注射毒品使用的流行率增加。 (IDU)及伴随的过量用药和传染病发病率和死亡率。传染病的不平等是 部分原因是无法获得无菌注射设备。与IDU相关的危害是众多驱动因素之一 在所有种族和族裔群体中，预期寿命最低的土著人民。尽管身体持续健康 土著人民之间的不平等，美国联邦承认的部落中很少有人使用注射器 服务计划(SSP)。这种稀缺性的部分原因是，反映减少危害的SSP 而且，通常，对抗疗法的“西方”健康和幸福方法--必须与传统的 本土化的治愈方法。虽然这三种方法不是不兼容的，但它们的集成可能是 很有挑战性。了解促进成功执行以土著为中心的战略文件的因素 将减少伤害、对抗性的“西方”和传统的土著方法结合在一起，值得探索 因为这些计划对于减轻IDU相关的伤害是必不可少的。我们将开展以社区为基础的 与土著社区一起进行参与性研究，成功地实施了将多个 健康和幸福的方法。通过这个项目，我们将确定文化因素、社区 在实施整合多种方法的SSP期间的上下文和政策(即，减少危害， 在三个不同的土著中对抗疗法(西方和传统土著)对健康和福祉的影响 通过与在执行过程中发挥作用的人进行的关键线人访谈，向社区提供援助(目标1)。 我们还将确定文化、社会和结构性因素影响的背景和机制 土著--SSP对综合多种方法的SSP利用的态度和信念 客户和土著非客户(目标2)。最后，我们将考察知识和态度的模式是如何 关于健康和福祉的多种方法以及将它们整合在一起的SSP与 社会文化因素(例如，文化认同、耻辱)通过受众细分研究 公共卫生和保健工作人员中的土著服务人员(目标3)。本项目的成果 最终将为扭转现状的惰性和消除物质使用提供强有力的证据基础 土著社区的危害。该项目直接与NIDA种族平等的目标相一致 鉴于土著人民在健康方面长期存在不平等现象，这是一项新的倡议。这个项目具有很高的创新性，因为它 将是美国第一个全面审查土著地区SSP实施过程的机构 社区。

PROJECT SUMMARY Indigenous Peoples have the highest rate of prescription opioid misuse of any sociodemographic group in the United States (US). Increasing rates of opioid misuse have led to increased prevalence of injection drug use (IDU) and concomitant overdose and infectious disease morbidity and mortality. Infectious disease inequities are driven in part by inadequate access to sterile injection equipment. IDU-associated harms are one of many drivers of Indigenous Peoples having the lowest life expectancy of all racial and ethnic groups. Despite sustained health inequities among Indigenous Peoples, very few Federally recognized tribes in the US have implemented syringe services programs (SSPs). This scarcity is driven in part by the fact that SSPs – which reflect harm reduction and, often, allopathic “western” approaches to health and well-being – must be integrated with traditional Indigenous approaches for healing. While these three approaches are not incompatible, their integration can be challenging. Understanding factors that facilitated the successful implementation of Indigenous-centered SSPs that integrate harm reduction, allopathic “western,” and traditional Indigenous approaches warrants exploration since these programs are essential for mitigating IDU-associated harms. We will conduct community-based participatory research with Indigenous communities that successfully implemented SSPs that integrate multiple approaches to health and well-being. Through this Project, we will identify the roles of cultural factors, community contexts, and policy during the implementation of SSPs that integrate multiple approaches (i.e., harm reduction, allopathic “western,” and traditional Indigenous) to health and well-being in three diverse Indigenous communities through key informant interviews with persons who played a role during implementation (Aim 1). We will also determine the contexts and mechanisms by which cultural, social, and structural factors affect attitudes and beliefs about the utilization of SSPs that integrate multiple approaches among Indigenous-SSP clients and Indigenous non-clients (Aim 2). Finally, we will examine how patterns of knowledge and attitudes about multiple approaches to health and well-being and SSPs that integrate them are associated with sociocultural factors (e.g., cultural identification, stigma) through audience segmentation research among Indigenous-serving members of the public health and healthcare workforce (Aim 3). The results of this Project will culminate in a robust evidence base for reversing the inertia of the status quo and eliminating substance use harms in Indigenous communities. This Project is directly aligned with the goals of the NIDA Racial Equity Initiative given that Indigenous Peoples have persistent health inequities. This Project is highly innovative as it will be the first in the US to comprehensively examine SSP implementation processes in Indigenous communities.