Funded Projects

Non-punishment, support-based preventive interventions in schools are needed to reduce misuse of opioids and other substances among youth. This project will test an intervention to improve school climate by introducing a learning approach that encourages behavior that is supportive and respectful in middle schools. ISLA reduces the use of exclusionary and discipline practices, such as suspensions and expulsions, that can be racially discriminating. The research aims to improve inclusive teaching practices, student engagement, student-teacher relationships, and school climate, while reducing student misuse of opioids and other substances.

Multiple social determinants affect the health of youth experiencing homelessness. These include a lack of stable safe housing, income, education, food security, restricted access to services, as well as discrimination, victimization, and social isolation. This project will test the use of prevention efforts to address the factors that may be embedded within systems that serve this population, such as drop-in centers. The research will gather generalizable information about helping these youth along with cost estimates to inform future implementation efforts.

Providing housing and prevention services (often referred to as “housing first”) has great potential to prevent opioid use disorder, continued homelessness, and other problem behaviors among youth experiencing homelessness. However, implementation of these services is challenging because criminal justice system involvement (which is common in this population) often prevents or delays access to housing. This project will explore interactions between criminal justice system involvement and the housing first intervention, toward reducing risks for opioid use and death among justice-involved youth experiencing homelessness

The emergency department is an ideal venue to reach and intervene with adolescents and young adults at risk for opioid misuse, particularly as young adults may disconnect from primary care when transitioning out of care in pediatric settings. This study will evaluate the efficacy of interventions of varying type and intensity to prevent or reduce opioid misuse or opioid use disorder. The research leverages technology that is appealing to youth to facilitate intervention delivery by health coaches. In this study, adolescents and young adults in the emergency department screening positive for opioid use or misuse will be randomly assigned to one of four intervention conditions with outcomes measured at 4, 8, and 12 months. Technology-driven, scalable interventions delivered via health coaches allow for real-time tailoring to the rapidly changing opioid epidemic, with the potential to prevent an increase in opioid misuse among adolescents and young adults.  Black/African American youth are at increased risk for opioid and other substance use, but they often do not participate in research studies. As a result, it is not known how well prevention interventions work with Black/African American people. This supplement will focus on increasing participant diversity and inclusion by recruiting additional Black/African American participants for this ongoing randomized controlled study of technology-driven prevention interventions.

The parent project’s Housing First initiative can be divided into two interconnected goals: (1) to reduce the likelihood of substance misuse and the development of an opioid use disorder and (2) to provide youth with housing stability and opioid and related risk prevention services that will assist them in exiting homelessness. The proposed supplement project complements the goals of the parent grant project by exploring two additional components that are related to exiting homelessness and reducing substance misuse or the development of opioid use disorder: (1) to further investigate youth’s interactions with social service providers, via qualitative methods, with the goal of cultivating a detail understanding actionable practices as it relates to fostering successful interactions between substance using homeless youth and service providers and (2) to evaluate, via quantitative methods, the extent to which ethnic identity protects youth from the negative effects of discrimination, substance misuse, and the development of a opioid use disorder.

American Native (AN) communities experience high rates of trauma that compromise the mental health of parents and caregivers that in turn increases their children?s risk for suicide and substance use during adolescence and young adulthood. Without intervention, this intergenerational cycle may repeat. The goal of this study is to understand opioid use, suicide, and the social network characteristics of Fort Peck Assiniboine and Sioux parents and caregivers to determine how the social network of parents/adult caregivers are related to both risk for and protection from suicide and opioid use. This supplement will examine the effectiveness of a community health worker delivered, culturally tailored prevention intervention called Wa?Kan Ye?Zah on caregiver and child behavioral and mental health outcomes and assess the benefits of culturally enhancing the intervention for caregivers? well-being.

American Indian and Alaska Native (AI/AN) youth and young adults experience disproportionately high rates of suicide, mental health disorders, traumatic life events, and substance use disorder. More effective, culturally informed interventions are needed that are tailored to the specific needs of this population. This supplement will examine how a person?s social network contributes to their behavioral health (suicide risk, mental health, substance use) status and how this network can be leveraged to improve the uptake of prevention interventions. The long-term goal is to disseminate and translate the lessons learned into practical policy, organizational changes, and preventive innovations that optimize patient-centered health outcomes and ultimately reduce or eliminate the dramatic and tragic suicide-related health disparities among urban AI/AN YYAs.

Fatal opioid overdose rates are higher among American Indian/Alaska Native populations than among Hispanics, African Americans, and Asian Americans, and are just below non-Hispanic Whites. AI/AN opioid overdose rates vary significantly by state and county; however, tribe-level differences are difficult to ascertain due to decentralized data systems that divide state health data and Indian Health Service data. This study will conduct a two-phase research project that leverages Center for Disease Control funding awarded to the Albuquerque Area Southwest Tribal Epidemiology Center for improving data quality in opioid overdose surveillance in New Mexico. In the first phase, geocoding and data linkages will be studied to address the need in New Mexico for tribe-specific data and analyses on opioid use disorder and opioid overdose. After disseminating analyses to tribal communities and Indian Health Service, Tribal and Urban Indian health facilities, the second phase of the study will establish a collaboration with interested tribes and facilities in a community-based participatory intervention research project to develop and test a culturally centered implementation program for providing medication for opioid use disorders to American Indian people.

Risk for opioid use disorder (OUD) often begins in adolescence and young adulthood. Engaging and retaining adolescents and young adults (collectively, “youth”) in early, effective treatment is critical for improving the life course trajectory of addiction. For adults with OUD, office-based opioid treatment (OBOT) with a collaborative care approach that includes behavioral therapy optimizes patient engagement and retention in care. Collaborative care OBOT is especially promising for youth, who can receive treatment from a trusted primary care provider in the same familiar setting they receive their usual medical care. To date, however, OBOT has not been formally adapted for treating youth. The central objective of this project is to develop and pilot an enhanced OBOT model for youth that is developmentally appropriate and family centered. The multidisciplinary nature of our team, which includes expertise in advanced biostatistical analysis, qualitative research, intervention development, developmental psychology, and implementation and improvement science, will maximize the chances of filling an important gap in the provision of youth specific evidence-based OUD interventions.

Despite psychopathology robustly increasing the risk for later substance use disorders (SUD), remarkably few studies have examined the impact of treating psychopathology on reducing rates of opioid use disorder (OUD), nicotine, and SUD. The main aims of this study are to implement a pragmatic set of office-based instrumentation using patient related outcome measures linked to electronic health records (EPIC) for intake and follow-up assessments to evaluate psychopathology, OUD, nicotine use disorder, and other SUDs in young people aged 16-30 years old who are receiving psychopathology treatment as part of routine outpatient clinical care. The study will also examine similar age patients with non-opioid SUD in outpatient SUD treatment settings to examine the impact of treatment in mitigating the development of OUD. Data derived from this study will help inform clinical guidelines and public health policy and provide important secondary outcomes for further work on the prevention of OUD, nicotine use disorder, and other SUDs in relation to early-onset psychopathology.

Quality implementation of evidence-based programs (EBPs) in community settings for youth is critical for reducing the burden of alcohol, tobacco and other drug (ATOD) use and its consequences. EBPs delivered in schools are an efficient way to reach large populations of young people, including those underserved by other settings, and reduce and prevent ATOD use. Yet youth rarely receive EBPs as intended in community settings, including schools. This training and research plan will prepare the investigator to become an independent scholar in the implementation of theories and frameworks to better understand factors related to program delivery—approaches to enhancing ATOD programs for youth in community settings. More specifically, the training will allow him to expand the application of Consolidated Framework for Implementation Research (CFIR) to inform approaches to enhancing effective EBP delivery. The proposed training and research plan extends current implementation research to focus applying implementation theories, frameworks and strategies in other community settings (schools) and on economic evaluation of implementation strategies. The results are expected to improve current efforts to deliver EBPs in diverse community settings and aid in applying evidence-based implementation strategies in the school context to ultimately reduce and prevent ATOD use among youth.

The opioid epidemic continues unabated in the United States, and despite the rapid expansion of this crisis, the nature of the risk factors that contribute to opioid misuse remain poorly understood compared with other substances of abuse. The goal of this project is to examine cannabis use and cannabis identification measures as risk factors for opioid misuse while also developing and evaluating novel implicit measures of opioid associations as risk factors for opioid misuse among an at-risk sample of adolescents. Findings from the proposed research are intended to improve the prediction of opioid misuse among adolescents and to potentially identify novel targets for prevention and intervention strategies that aim to combat the opioid epidemic.