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.

项目总结/摘要 这一点与最初提交的文件相比没有变化。 虽然健康的社会决定因素（SDOH）长期以来一直被认为是健康的重要贡献者， 个人的生活质量和长期结果，直到最近才开始进行预防性干预 直接针对贫困的SDOH作为实现改善健康结果的方法。关于这一点我们所知甚少 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的SDOH (e.g.,就业）在非延展性SDOH的情况下（例如，农村地区）。这个应用程序，破坏 改善农村父母物质使用和心理健康结果的社会健康决定因素 区域，直接响应NIDA RFA DA-22-036，并寻求测试多层次，多组件 家庭积极改善关系（FAIR）干预，以预防“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，将招募被推荐到FAIR的父母（N = 250）， 参加俄勒冈州是该项目的理想环境-2022年1月发布的数据将该州列为 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领先全国。参与 县，虽然都是农村，在他们的县健康指标是不同的，提供了检查的机会， 外部结构条件对干预目标和随后的预防结果的影响。 在接下来的18个月里，无论父母是否 从事服务业。当参与时，他们的FAIR临床医生也将每周进行一次干预报告的调查 用于解决SDOH的策略。干预措施不会被操纵，但会被观察到，因为他们自然 发生.父母将被评估阿片类药物和甲基苯丙胺的使用，包括静脉吸毒，以及精神疾病。 健康症状，包括基线、9个月和18个月时的自杀（意念、意图、企图）。到 评估静脉药物使用和自杀的长期预防，将从 知情同意时间至基线后24-42个月。密集的、纵向的、测序设计将允许 分析FAIR组分（目的1）如何破坏个体和全身SDOH以及阿片类药物的递增 和/或甲基苯丙胺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）通过以下方式为未来扩大FAIR提供信息 提供了在整个治疗过程中靶向和测序母体SDOH的经验基础， 以及这些临床决策对结果和临床负担成本的影响，以及（B）提供可推广的 了解在治疗阿片类共病时靶向或不靶向不良SDOH的后果， 甲基苯丙胺的使用和精神疾病。父母糟糕的SDOH的破坏有可能 在几代人之间产生一系列积极成果，并推动公共卫生的显著改善。