Optimizing a community-engaged multi-level group intervention to reduce substance use: an application of the...

Area of Science:

• Public Health
• Health Disparities Research
• Behavioral Health Interventions

Background:

• Alcohol and illicit drug use (AIDU) rates are similar across racial groups, but consequences are higher in distressed African American communities with less treatment access.
• Substance use disorders (SUD) disproportionately affect marginalized populations in high-poverty, high-crime areas.
• Community Wise is an intervention developed with community input to address health inequalities in AIDU.

Purpose of the Study:

• To optimize the Community Wise intervention for effectiveness, efficiency, and scalability.
• To reduce health inequalities related to AIDU in marginalized communities.
• To develop a cost-effective (under $250/person) intervention.

Main Methods:

• A 2x2x2x2 factorial design using the multiphase optimization strategy (MOST) and community-based participatory research (CBPR).
• 528 men with histories of SUD and incarceration in Newark, NJ, were recruited via diverse community strategies.
• Participants were randomized to 16 conditions testing combinations of peer/licensed facilitators, group dialogue, personal goal development, and community organizing, plus a core critical-thinking component.

Main Results:

• The study protocol is described, detailing the optimization of a multi-component intervention.
• Data collection includes baseline and five monthly follow-ups.
• The optimized intervention will be compared to the standard of care in a future trial.

Conclusions:

• This is the first study using CBPR and MOST to optimize a SUD intervention for a marginalized population.
• Expected outcomes include an optimized Community Wise manual and enhanced methods for scalable intervention development.
• The study will advance understanding of critical consciousness theory in addressing health inequalities related to AIDU.