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.

项目概要/摘要 这与最初提交的内容相比没有改变。 尽管健康的社会决定因素 (SDOH) 长期以来一直被认为是导致健康问题的重要因素。 个人的生活质量和长期结果，直到最近才开始预防性干预工作 直接针对贫困的 SDOH 作为实现改善健康结果的方法。至今知之甚少 破坏不良 SDOH 持续负面影响的干预措施或如何干预可塑性 SDOH （例如，就业）在不可延展的 SDOH 背景下（例如，农村地区）。这个应用程序，扰乱 改善农村父母药物使用和心理健康结果的健康社会决定因素 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）来改善状况。”利用自然发生的推出 FAIR 遍及俄勒冈州五个农村县，被推荐参加 FAIR 的家长 (N = 250) 将被招募到 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 县虽然都是农村县，但其县健康指标各不相同，这提供了检查县健康状况的机会 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。当参与时，他们的 FAIR 临床医生还将每周接受调查以获取干预报告 用于解决 SDOH 问题的策略。干预措施不会被操纵，而是会自然地被观察到 发生。将对父母进行阿片类药物和甲基苯丙胺使用情况评估，包括静脉注射药物使用情况和精神状况 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 评估静脉注射药物使用和自杀的长期预防，将从以下机构收集行政健康数据 同意时间为基线后 24-42 个月。密集的、纵向的、排序的设计将允许 分析 FAIR 组件（目标 1）如何破坏个体和系统 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； （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 FAIR 的提供者诊所的角度来看。结果将 (a) 为未来扩大 FAIR 提供信息： 为整个治疗过程中母体 SDOH 的靶向和测序提供经验基础， 以及这些临床决策对结果和临床承担的成本的影响，并且（b）提供可概括的 了解治疗阿片类药物共病时是否针对不良 SDOH 的后果 甲基苯丙胺的使用和精神健康障碍。父母糟糕的 SDOH 可能会受到破坏 为几代人带来一系列积极成果，并推动公共卫生的显着改善。