A community-based systems science approach to assess risk and protective factors and improve the efficacy and equity of intervention strategies for stimulant use, use disorder, and overdose

项目摘要/摘要 自2014年以来，与兴奋剂有关的致命过量迅速增加；涉及精神刺激剂的死亡， 主要是甲基苯丙胺，增加了四倍，而与可卡因有关的致命过量增加了两倍。黑色, 拉丁裔和美洲原住民越来越多地使用兴奋剂，并死于过量，尽管使用率较低。 收入白人男性仍然是使用兴奋剂(PWUS)并死于过量服药的最大群体。这个 拟议的研究目标RFA-CE-21-002目标2：“[评估]非法行为的风险和保护因素 兴奋剂使用、使用障碍和过量用药可促进干预措施的发展或适应 战略。“我们的目标是确定可以开发或调整的干预策略，以减少 兴奋剂的使用(SU)和改善SU的健康结果(SU障碍、康复和过量)。我们将进行 我们在两个有不同SU危机的州进行的研究：马萨诸塞州(MA)，可卡因和芬太尼过量 正在上升，包括在黑人和拉丁裔个人中，以及南达科他州(SD)，那里的 甲基苯丙胺的使用和过量对美洲原住民的影响不成比例。 我们的成瘾和系统科学专家团队将评估多级别风险和保护因素如何 SU和SU健康结果动态互动，重点关注与以下社会决定因素相关的差异 健康，MA和SD(目标1)。我们将对影响SU的多层次因素进行生动系统的回顾 和SU健康结果以及可以协同减少SU和SU的多层次干预策略 改善SU健康结果(目标1.1)。我们还将与MA和SD的社区合作伙伴联系，网址为 半结构化的兴奋剂使用背后的多个层次的系统(PWUS、提供者和决策者) 定性访谈，以制定描述风险和防护的统一原因环图(CLD) 各因素动态地相互作用(目标1.2)。接下来，我们将确定减少SU和改善SU的干预策略 SU健康结果，包括适用于所有人口的一般性战略和调整战略，以减少 代表人数不足人群的健康差距(目标2)。我们将开发一个系统动力学仿真 模型，使用CLD和生活系统回顾，解释MA和MA的SU和SU健康结局趋势 SD(目标2.1)。然后，我们将利用该模型来探索和确定具有 最有潜力减少SU并改善MA和SD的SU健康结果，同时还产生洞察力 这适用于全国(目标2.2)。 拟议的研究将通过以下方式解决SU、SU紊乱和过量服药的公共卫生问题 确定有效和公平的干预战略。我们与社区合作伙伴的接触 使用系统建模方法将使我们能够立即向决策者提供可翻译的见解 Ma和SD。从长远来看，我们的发现将为减少SU和改善SU的干预策略提供参考 所有弱势群体以及代表不足的人群以及农村和城市地区的健康结果。

PROJECT SUMMARY/ABSTRACT Stimulant-involved fatal overdoses have increased rapidly since 2014; deaths involving psychostimulants, primarily methamphetamine, have quadrupled, while fatal overdoses involving cocaine have tripled. Black, Latino, and Native American people are increasingly using stimulants and dying from overdoses, though low- income White men remain the largest group of people who use stimulants (PWUS) and die of overdose. The proposed research targets RFA-CE-21-002 Objective 2: “[to] assess risk and protective factors for illicit stimulant use, use disorder, and overdose that can contribute to the development or adaptation of intervention strategies.” Our goal is to identify intervention strategies that could be developed or adapted to reduce stimulant use (SU) and improve SU health outcomes (SU disorder, recovery, and overdoses). We will conduct our research in two states with distinct SU crises: Massachusetts (MA), where cocaine and fentanyl overdoses are rising, including among Black and Latino individuals, and South Dakota (SD), where rapid increases in methamphetamine use and overdose have disproportionately affected Native Americans. Our team of addiction and systems science experts will assess how multi-level risk and protective factors for SU and SU health outcomes interact dynamically, with a focus on disparities related to social determinants of health, in MA and SD (Aim 1). We will conduct a living systematic review of multi-level factors influencing SU and SU health outcomes and of multi-level intervention strategies that could synergistically reduce SU and improve SU health outcomes (Aim 1.1). We will also engage community partners across MA and SD at multiple levels of the system underlying stimulant use (PWUS, providers, and policymakers) in semi-structured qualitative interviews to develop a unified causal loop diagram (CLD) that depicts how risk and protective factors interact dynamically (Aim 1.2). Next, we will identify intervention strategies to reduce SU and improve SU health outcomes, including generalizable strategies for all populations and adapted strategies to reduce health disparities in underrepresented populations (Aim 2). We will develop a system dynamics simulation model, using the CLD and the living systematic review, to explain SU and SU health outcome trends in MA and SD (Aim 2.1). We will then utilize the model to explore and identify intervention strategies that have the greatest potential to reduce SU and improve SU health outcomes in MA and SD, while also generating insight that is applicable nationally (Aim 2.2). The proposed research will address the public health problems of SU, SU disorder, and overdose through the identification of efficacious and equitable intervention strategies. Our engagement with community partners using a systems modeling approach will allow us to provide immediately translatable insight to policymakers in MA and SD. In the long term, our findings will inform intervention strategies for reducing SU and improving SU health outcomes for all PWUS as well as underrepresented populations, and across rural and urban areas.