Disrupting Social Determinants of Health to Improve Substance Use and Mental Health Outcomes for Parents in Rural Regions

破坏健康的社会决定因素，改善农村地区父母的药物使用和心理健康结果

• 批准号: 10892474
• 负责人: Lisa Saldana
• 金额: $ 221.85万
• 依托单位: CHESTNUT HEALTH SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10892474
• 关键词: Disrupting; Social; Determinants; Health; Improve

PROJECT SUMMARY/ABSTRACT This has not changed from the original submission. Although social determinants of health (SDOH) have long been recognized as significant contributors to the quality of life and long-term outcomes for individuals, only recently have preventive intervention efforts begun to target poor SDOH directly as a method for achieving improved health outcomes. Little remains known about interventions that disrupt the ongoing negative effect of poor SDOH or how to intervene on malleable SDOH (e.g., employment) in the context of non-malleable SDOH (e.g., rural region). This application, Disrupting Social Determinants of Health to Improve Substance Use and Mental Health Outcomes for Parents in Rural Regions, is directly responsive to NIDA RFA DA-22-036 and seeks to test the multi-level, multi-component Families Actively Improving Relationships (FAIR) intervention to prevent “opioid use disorder, and comorbid conditions by intervening on social determinants of health (SDOH).” Leveraging a naturally occurring roll out of FAIR across five rural Oregon counties, parents (N = 250) who are referred to FAIR will be recruited to participate. Oregon is the ideal setting for this project—data released in January 2022 ranks the state as leading the nation in opioid and methamphetamine use, mental health disorders and suicide. Participating counties, though all rural, are distinct in their county health metrics, providing the opportunity to examine the influence of outside structural conditions on intervention targets and subsequent prevention outcomes. Consenting parents will report weekly on their SDOH needs for 18 months, regardless of whether they are engaged in services. When engaged, their FAIR clinician also will be probed weekly for a report of intervention strategies used to address SDOH. Interventions will not be manipulated but will be observed as they naturally occur. Parents will be assessed for opioid and methamphetamine use, including IV drug use, and mental health symptoms, including suicide (ideation, intention, attempt) at Baseline, 9-months, and 18-months. To assess longer-term prevention of IV drug use and suicide, administrative health data will be collected from the time of consent to 24-42 months post-Baseline. The intensive, longitudinal, sequencing design will allow an analysis of how FAIR components (Aim 1) disrupt individual and systemic SDOH and escalation of opioid and/or methamphetamine use and mental health disorders; (Aim 2) are impacted by external, structural SDOH; and (Aim 3) can influence the relationship between SDOH and individual and systemic outcomes on costs, from the perspective of provider clinics delivering FAIR. Outcomes will (a) inform the future scale-up of FAIR by providing an empirical basis for targeting and sequencing of parent SDOH throughout the course of treatment, and the impact of these clinical decisions on outcomes and clinic-borne costs and (b) provide generalizable knowledge of the consequences of targeting, or not, poor SDOH in the treatment of comorbid opioid and methamphetamine use and mental health disorders. The disruption of a parent’s poor SDOH has the potential for a cascade of positive outcomes across generations, and drive a significant improvement of public health.

项目摘要/摘要 这与最初提交的文件没有变化。 尽管健康的社会决定因素(SDOH)长期以来一直被认为是 个人的生活质量和长期结果，只是最近才开始预防性干预努力 直接以贫困的SDOH为目标，作为改善健康结果的一种方法。人们对此知之甚少 干扰不良SDOH的持续负面影响的干预措施或如何干预可延展性SDOH (例如，就业)在不可延展的SDOH(例如，农村地区)的背景下。此应用程序，中断 改善农村父母物质使用和心理健康结局的健康社会决定因素 直接响应NIDA RFA DA-22-036，并寻求测试多级别、多组件 积极改善家庭关系(公平)干预，预防阿片类药物使用障碍和共病 通过干预健康的社会决定因素(SDOH)来改善健康状况。利用自然发生的推出 在俄勒冈州的五个农村县，被推荐到博览会的父母(N=250)将被招募到 参与进来。俄勒冈州是这个项目的理想地点-2022年1月发布的数据显示，该州 在阿片类药物和甲基苯丙胺的使用、精神健康障碍和自杀方面处于全国领先地位。参与 县，虽然都是农村，但在县健康指标上是不同的，提供了检查 外部结构条件对干预目标和后续预防结果的影响。 同意的父母将在18个月内每周报告他们的SDOH需求，无论他们是否 从事服务业。当受聘时，他们的公正的临床医生也将每周接受调查，以获得一份干预报告。 用于解决SDOH的策略。干预措施不会被操纵，而是会被自然地观察到 发生。父母将接受阿片类药物和甲基苯丙胺使用情况的评估，包括静脉注射药物的使用，以及精神疾病 健康症状，包括基线、9个月和18个月的自杀(意念、意图、企图)。至 评估长期预防静脉注射药物使用和自杀，行政卫生数据将从 同意时间为基线后24-42个月。密集的纵向定序设计将允许 分析公平成分(目标1)如何扰乱个人和全身SDOH以及阿片类药物的升级 和/或甲基苯丙胺的使用和精神健康障碍；(目标2)受到外部结构性SDOH的影响； 和(目标3)可以影响SDOH与个人和系统成本结果之间的关系， 从提供者诊所提供公平的角度来看。成果将(A)为广交会未来的扩大提供信息，具体方式为 为亲本SDOH在整个治疗过程中的靶向和测序提供了经验基础， 以及这些临床决定对结果和临床负担费用的影响，以及(B)提供可推广的 了解靶向或不靶向SDOH在治疗阿片类药物和阿片类药物合并症中的后果 甲基苯丙胺的使用与精神健康障碍。父母糟糕的SDOH的破坏具有潜在的 一系列代代相传的积极成果，并推动公共卫生的显著改善。