Funded Projects

Justice-involved young adults are one of the highest-risk populations for the development of opioid use disorder (OUD) and other significant public health problems, but they usually lack access to evidence-based practices that could potentially prevent this trajectory. The risk of unintentional death and other deleterious outcomes and long-term costs for opioid misuse for young adults, their communities and society (costs estimated at more than $115 billion annually) make this a priority, with rural areas in need of the most attention and assistance. The overriding purpose of the proposed pilot study is to prevent the onset of OUD by improving young adult offenders’ access to evidence-based risk reduction interventions, like contingency management (CM), by testing whether officers in the adult probation and parole setting can deliver such an intervention to their young adult substance using probationers who have not yet developed OUD. The primary motivation for this pilot is the clear public health need for improving and expanding delivery of substance use risk reduction interventions for young adults in the justice system. The ultimate outcome would be prevention of OUD in this high-risk population.

Four out of five youth in the juvenile justice (JJ) system show evidence of being under the influence during their offenses, and more than half test positive for substances at the time of their arrest. Preventive intervention approaches that can be easily implemented within JJ settings may offer greater access to substance use care as well as increase families’ motivation to comply with court referrals to seek further services. It is especially important to evaluate interventions for court-involved, non-incarcerated (CINI) juveniles, as these youth account for two-thirds of those arrested; however, the bulk of extant research has been conducted with detained or incarcerated youth. In this application for supplemental funding, we capitalize on our parent grant (Brief Individual and Parent Interventions for Marijuana Misuse in Truant Adolescents) by proposing to develop an adjunctive, targeted preventive intervention for marijuana-using, JJ youth who are at elevated risk for illicit opioid use. The goal will be to develop a protocol for a single-session, parent-adolescent preventive intervention to decrease the likelihood of illicit opioid use in CINI adolescents. This formative work will culminate in a draft intervention manual.

The U.S. is in the midst of an opioid crisis, and efforts to tackle the complex and dynamic nature of this public health challenge must comprehensively consider a multitude of contributing factors. In response, states have implemented a wide range of policies and initiatives. However, the dynamic nature of the crisis and the speed with which different policy approaches are being implemented pose numerous challenges for researchers evaluating the effects of such efforts. These challenges stem in part from limited information regarding policy implementation; insufficient information about policy characteristics that may influence effectiveness; little consideration of how the chosen analytic method may influence findings, given simultaneous or concurrent implementation of multiple policies; and limited training on how to best communicate findings to policymakers. To address these challenges, the proposed Center for Opioid Policy Research (COPR) will serve as a national resource, fostering innovative and high-quality research in the opioid policy arena and developing and disseminating methods, tools and information to the research community, policymakers and the public.

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.

The emergency department (ED) 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 pediatric medicine. This study will evaluate the efficacy of interventions of varying type/intensity to prevent/reduce opioid misuse or opioid use disorder (OUD). 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 ED 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 coach allow for real-time tailoring to the rapidly changing opioid epidemic, with the potential for a sustainable impact on preventing escalation of opioid misuse among adolescents and young adults. While we know that Black/African American youth are at increased risk for opioid and other substance use, they often do not participate in research studies. As a result, we do not know how well prevention interventions work with Black/African American individuals. This supplement will focus on increasing participant diversity and inclusion by recruiting additional Black/African American participants for this ongoing randomized controlled trial to study technology-driven prevention interventions.

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.

Social determinants of health are individual and environmental factors that affect health, the ability to function, and quality of life. This project will study the impact of the family-focused Families Actively Improving Relationships (FAIR) prevention intervention currently offered in rural Oregon counties to parents experiencing substance use and mental health challenges. Through the FAIR program, participants receive substance use treatment services; mental health treatment services; parent management training; and support to access employment, housing, education or to mitigate exposure to violence and discrimination. This research will examine how the FAIR intervention affects substance use and societal determinants of health, toward informing payors and decision makers about the cost and value of FAIR prevention services in rural communities.

Urban neighborhood deterioration (also known as blight) can affect individual and community health. Interventions have shown positive effects on neighborhood crime, gun violence, and mental health. In Philadelphia, government and community partnerships have remediated vacant lots and abandoned buildings to improve living conditions. This project will investigate the degree to which neighborhood improvement interventions in Philadelphia affect opioid misuse and overdose risk for residents. Results from this research could inform similar public health-based policy and community-level health interventions in other cities.

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.