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: 10582989
• 负责人: Lisa Saldana
• 金额: $ 27.7万
• 依托单位: OREGON SOCIAL LEARNING CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10582989
• 关键词: Address; Age; Ambulatory Care; Area; Child; Child Rearing; Child Welfare; Clinic; Clinical; Cohort Effect; Communities; Community Health Education; Consent; County; Data; Development; Disease; Domestic Violence; Drug abuse; Drug usage; Economics; Education; Employment; Epidemic; Family; Feeling suicidal; Funding; Future; Generations; Goals; Health; Helping to End Addiction Long-term; Hour; Housing; Individual; Infrastructure; Intention; Intervention; Intravenous; Knowledge; Legal; Maintenance; Mental Health; Mental disorders; Methamphetamine; Methamphetamine use disorder; Methods; National Institute of Drug Abuse; Opioid; Oregon; Outcome; Parents; Participant; Poverty; Prevention; Prevention Research; Problem Solving; Provider; Public Health; Quality of life; Reporting; Research; Risk; Rural; Secondary Prevention; Services; Speed; Substance abuse problem; Suicide; Symptoms; System; Testing; Time; Time Series Analysis; Transportation; child neglect; comorbidity; cost; design; effectiveness evaluation; experience; food insecurity; health care availability; health data; illicit drug use; improved; member; methamphetamine use; opioid misuse; opioid use; opioid use disorder; prevent; preventive intervention; programs; recruit; response; rural area; rural counties; scale up; service providers; social health determinants; social structure; social vulnerability; stem; substance use; treatment services; violence exposure

PROJECT SUMMARY/ABSTRACT 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 尽管长期以来，社会决定者（SDOH）已被认为是重要的贡献者 个人的生活质量和长期成果，直到最近才进行预防性干预工作 直接以贫困SDOH为目标，以此来改善健康结果。关于 破坏贫困SDOH持续负面影响或如何干预可延展的SDOH的干预措施 （例如，就业）在不易赎回的SDOH（例如农村地区）的背景下。此应用程序，干扰 健康的社会决定因素，以改善农村父母的物质使用和心理健康成果 区域直接响应NIDA RFA DA-22-036，并试图测试多级，多组分 家庭积极改善关系（公平）干预措施，以防止“阿片类药物使用障碍和合并症 通过干预卫生社会决定者（SDOH）的条件。”利用自然发生的滚动 在俄勒冈州五个县的五个县，被称为公平的父母（n = 250）将被招募到 参与。俄勒冈是该项目的理想环境 - Data于2022年1月发布 领导国家使用阿片类药物和甲基苯丙胺的使用，心理健康障碍和自杀。参与 县虽然县的县卫生指标都很不同，但提供了检查的机会 外部结构条件对干预目标和随后的预防结果的影响。 同意父母将每周报告他们的SDOH需求18个月，无论他们是否是 从事服务。当订婚时，他们的公平临床医生也将每周进行调查以进行干预报告 用于解决SDOH的策略。干预措施不会被操纵，但会被观察到他们自然而然的 发生。将评估父母的阿片类药物和甲基苯丙胺使用，包括静脉注射药物和精神 健康症状，包括基线，9个月和18个月的自杀（构想，意图，尝试）。到 评估静脉注射药物使用和自杀的长期预防，将从中收集行政健康数据 在基线后的同意时间为24-42个月。密集，纵向的测序设计将允许 分析公平组件（目标1）如何破坏个人和系统性的SDOH以及OID的升级 和/或甲基苯丙胺的使用和心理健康障碍； （AIM 2）受外部，结构SDOH的影响； （AIM 3）可以影响SDOH与个人与系统成果之间的关系，成本， 从提供商诊所的角度来看，提供公平的诊所。成果将（a）告知未来的公平规模 为在整个治疗过程中靶向和测序的经验基础， 以及这些临床决策对结果和诊所 - 裔裔成本的影响，（b）提供了可推广的 了解靶向后果的后果，无论是在处理合并症阿片类药物和 甲基苯丙胺的使用和心理健康障碍。父母贫穷的SDOH的破坏具有潜力 对于几代人的积极成果的级联，并带来了公共卫生的重大改善。