TY - JOUR
AU - A. Davis
AU - H. K. Knudsen
AU - D. M. Walker
AU - D. Chassler
AU - K. Lunze
AU - P. M. Westgate
AU - E. Oga
AU - S. Rodriguez
AU - S. Tan
AU - J. Holloway
AU - S. L. Walsh
AU - C. B. Oser
AU - R. C. Lefebvre
AU - L. C. Fanucchi
AU - L. Glasgow
AU - A. S. McAlearney
AU - H. L. Surratt
AU - M. W. Konstan
AU - T. T. Huang
AU - P. LeBaron
AU - J. Nakayima
AU - M. D. Stein
AU - M. Rudorf
AU - M. Nouvong
AU - E. N. Kinnard
AU - N. El-Bassel
AU - J. Tilley
AU - A. Macoubray
AU - C. Savitzky
AU - A. Farmer
AU - D. Beers
AU - P. Salsberry
AU - T. R. Huerta
A1 - 
AB - BACKGROUND: Community stigma against people with opioid use disorder (OUD) and intervention stigma (e.g., toward naloxone) exacerbate the opioid overdose crisis. We examined the effects of the Communities that HEAL (CTH) intervention on perceived opioid-related community stigma by stakeholders in the HEALing Communities Study (HCS). METHODS: We collected three surveys from community coalition members in 66 communities across four states participating in HCS. Communities were randomized into Intervention (Wave 1) or Wait-list Control (Wave 2) arms. We conducted multilevel linear mixed models to compare changes in primary outcomes of community stigma toward people treated for OUD, naloxone, and medication for opioid use disorder (MOUD) by arm from time 1 (before the start of the intervention) to time 3 (end of the intervention period in the Intervention arm). FINDINGS: Intervention stakeholders reported a larger decrease in perceived community stigma toward people treated for OUD (adjusted mean change (AMC) -3.20 [95% C.I. -4.43, -1.98]) and toward MOUD (AMC -0.33 [95% C.I. -0.56, -0.09]) than stakeholders in Wait-list Control communities (AMC -0.18 [95% C.I. -1.38, 1.02], p = 0.0007 and AMC 0.11 [95% C.I. -0.09, 0.31], p = 0.0066). The relationship between intervention status and change in stigma toward MOUD was moderated by rural-urban status (urban AMC -0.59 [95% CI, -0.87, -0.32], rural AMC not sig.) and state. The difference in stigma toward naloxone between Intervention and Wait-list Control stakeholders was not statistically significant (p = 0.18). INTERPRETATION: The CTH intervention decreased stakeholder perceptions of community stigma toward people treated for OUD and stigma toward MOUD. Implementing the CTH intervention in other communities could decrease OUD stigma across diverse settings nationally. FUNDING: US National Institute on Drug Abuse.
AD - Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.; Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA.; CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 4000, Columbus, OH, 43202, USA.; Department of Family and Community Medicine, College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 5000, Columbus, OH, 43202, USA.; Boston University School of Social Work, 264-270 Bay State Road, Boston, MA, 02215, USA.; Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Department of Medicine, 801 Massachusetts Ave., Boston, MA, 02118, USA.; Department of Biostatistics, College of Public Health, University of Kentucky, 760 Press Avenue, Lexington, KY, 40536, USA.; RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA.; Department of Sociology, Center on Drug and Alcohol Research, Center for Health Equity Transformation, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY, 40506, USA.; Department of Medicine, Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA.; Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.; Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health & Health Policy, City University of New York, 55 W. 125 Street, Room 803, New York, NY, 10027, USA.; Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.; Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA.; New England Drug Users Union, 36 Bedford Terrace, Suite 2, Northampton, MA, 01060, USA.; Boston Medical Center, Section of Infectious Diseases, 801 Massachusetts Ave., Boston, MA, 02118, USA.; The Ohio State University College of Medicine, HEALing Communities Research, 530 W. Spring St., Suite 275, Columbus, OH, 43215, USA.; The Ohio State University College of Public Health, 1841 Neil Ave., Columbus, OH, 43210, USA.; Department of Biomedical Informatics, College of Medicine, The Ohio State University, 1585 Neil Ave, Columbus, OH, 43210, USA.
AN - 38510790
BT - Lancet Reg Health Am
C5 - Opioids & Substance Use
DA - Apr
DO - 10.1016/j.lana.2024.100710
DP - NLM
ET - 20240312
JF - Lancet Reg Health Am
LA - eng
N2 - BACKGROUND: Community stigma against people with opioid use disorder (OUD) and intervention stigma (e.g., toward naloxone) exacerbate the opioid overdose crisis. We examined the effects of the Communities that HEAL (CTH) intervention on perceived opioid-related community stigma by stakeholders in the HEALing Communities Study (HCS). METHODS: We collected three surveys from community coalition members in 66 communities across four states participating in HCS. Communities were randomized into Intervention (Wave 1) or Wait-list Control (Wave 2) arms. We conducted multilevel linear mixed models to compare changes in primary outcomes of community stigma toward people treated for OUD, naloxone, and medication for opioid use disorder (MOUD) by arm from time 1 (before the start of the intervention) to time 3 (end of the intervention period in the Intervention arm). FINDINGS: Intervention stakeholders reported a larger decrease in perceived community stigma toward people treated for OUD (adjusted mean change (AMC) -3.20 [95% C.I. -4.43, -1.98]) and toward MOUD (AMC -0.33 [95% C.I. -0.56, -0.09]) than stakeholders in Wait-list Control communities (AMC -0.18 [95% C.I. -1.38, 1.02], p = 0.0007 and AMC 0.11 [95% C.I. -0.09, 0.31], p = 0.0066). The relationship between intervention status and change in stigma toward MOUD was moderated by rural-urban status (urban AMC -0.59 [95% CI, -0.87, -0.32], rural AMC not sig.) and state. The difference in stigma toward naloxone between Intervention and Wait-list Control stakeholders was not statistically significant (p = 0.18). INTERPRETATION: The CTH intervention decreased stakeholder perceptions of community stigma toward people treated for OUD and stigma toward MOUD. Implementing the CTH intervention in other communities could decrease OUD stigma across diverse settings nationally. FUNDING: US National Institute on Drug Abuse.
PY - 2024
SN - 2667-193x
SP - 100710
ST - Effects of the Communities that Heal (CTH) intervention on perceived opioid-related community stigma in the HEALing Communities Study: results of a multi-site, community-level, cluster-randomized trial
T1 - Effects of the Communities that Heal (CTH) intervention on perceived opioid-related community stigma in the HEALing Communities Study: results of a multi-site, community-level, cluster-randomized trial
T2 - Lancet Reg Health Am
TI - Effects of the Communities that Heal (CTH) intervention on perceived opioid-related community stigma in the HEALing Communities Study: results of a multi-site, community-level, cluster-randomized trial
U1 - Opioids & Substance Use
U3 - 10.1016/j.lana.2024.100710
VL - 32
VO - 2667-193x
Y1 - 2024
ER -