The Lancet Regional Health. Americas (Apr 2024)
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 trialResearch in context
- Alissa Davis,
- Hannah K. Knudsen,
- Daniel M. Walker,
- Deborah Chassler,
- Karsten Lunze,
- Philip M. Westgate,
- Emmanuel Oga,
- Sandra Rodriguez,
- Sylvia Tan,
- JaNae Holloway,
- Sharon L. Walsh,
- Carrie B. Oser,
- R. Craig Lefebvre,
- Laura C. Fanucchi,
- LaShawn Glasgow,
- Ann Scheck McAlearney,
- Hilary L. Surratt,
- Michael W. Konstan,
- Terry T.-K. Huang,
- Patricia LeBaron,
- Julie Nakayima,
- Michael D. Stein,
- Maria Rudorf,
- Monica Nouvong,
- Elizabeth N. Kinnard,
- Nabila El-Bassel,
- Jess Tilley,
- Aaron Macoubray,
- Caroline Savitzky,
- Amy Farmer,
- Donna Beers,
- Pamela Salsberry,
- Timothy R. Huerta
Affiliations
- Alissa Davis
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA; Corresponding author. Columbia University School of Social Work, 1255 Amsterdam Avenue, Rm. 706, New York, NY, 10027, USA.
- Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
- Daniel M. Walker
- 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
- Deborah Chassler
- Boston University School of Social Work, 264-270 Bay State Road, Boston, MA, 02215, USA
- Karsten Lunze
- Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Department of Medicine, 801 Massachusetts Ave., Boston, MA, 02118, USA
- Philip M. Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, 760 Press Avenue, Lexington, KY, 40536, USA
- Emmanuel Oga
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
- Sandra Rodriguez
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
- Sylvia Tan
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
- JaNae Holloway
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
- Sharon L. Walsh
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
- Carrie B. Oser
- 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
- R. Craig Lefebvre
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
- Laura C. Fanucchi
- Department of Medicine, Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
- LaShawn Glasgow
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
- Ann Scheck McAlearney
- 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
- Hilary L. Surratt
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
- Michael W. Konstan
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
- Terry T.-K. Huang
- 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
- Patricia LeBaron
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
- Julie Nakayima
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
- Michael D. Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
- Maria Rudorf
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA
- Monica Nouvong
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA
- Elizabeth N. Kinnard
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA
- Nabila El-Bassel
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
- Jess Tilley
- New England Drug Users Union, 36 Bedford Terrace, Suite 2, Northampton, MA, 01060, USA
- Aaron Macoubray
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
- Caroline Savitzky
- Boston Medical Center, Section of Infectious Diseases, 801 Massachusetts Ave., Boston, MA, 02118, USA
- Amy Farmer
- The Ohio State University College of Medicine, HEALing Communities Research, 530 W. Spring St., Suite 275, Columbus, OH, 43215, USA
- Donna Beers
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA
- Pamela Salsberry
- The Ohio State University College of Public Health, 1841 Neil Ave., Columbus, OH, 43210, USA
- Timothy R. Huerta
- 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; Department of Biomedical Informatics, College of Medicine, The Ohio State University, 1585 Neil Ave, Columbus, OH, 43210, USA
- Journal volume & issue
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Vol. 32
p. 100710
Abstract
Summary: 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.
