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

项目总结/摘要 自2014年以来，涉及兴奋剂的致命过量迅速增加;涉及精神兴奋剂的死亡， 主要是甲基安非他明的吸毒人数增加了四倍，而涉及可卡因的致命吸毒过量人数增加了三倍。黑色、 拉丁美洲人和美洲原住民越来越多地使用兴奋剂，并死于过量，虽然低- 收入白色男性仍然是使用兴奋剂（PWUS）并死于过量的最大群体。的 RFA-CE-21-002目标2：“评估非法贩运毒品的风险和保护因素， 兴奋剂使用、使用障碍和过量，可能有助于制定或调整干预措施 战略”。我们的目标是确定可以制定或调整的干预战略， 兴奋剂使用（SU）和改善SU健康结果（SU障碍，恢复和过量）。我们会进行 我们的研究在两个州有不同的SU危机：马萨诸塞州（MA），可卡因和芬太尼过量 正在上升，包括黑人和拉丁美洲人，以及南达科他州（SD），在那里， 甲基苯丙胺的使用和过量使用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层次的风险和保护因素， SU和SU健康结果动态地相互作用，重点是与社会决定因素相关的差异， 卫生，在千年发展目标和特殊发展中（目标1）。我们将对影响SU的多层次因素进行系统的回顾 和SU的健康结果和多层次的干预策略，可以协同减少SU， 改善统一工会的健康成果（目标1.1）。我们还将与MA和SD的社区合作伙伴进行合作， 在半结构化的系统中，兴奋剂使用的多个层次（PWUS，供应商和政策制定者） 定性访谈，以制定一个统一的因果循环图（CLD），描述风险和保护性 这些因素动态地相互作用（目标1.2）。接下来，我们将确定干预策略，以减少SU并改善 SU健康成果，包括所有人群的可推广战略和减少 代表性不足人口的健康差距（目标2）。我们将开发一个系统动力学模拟 模型，使用CLD和生活系统评价，解释SU和SU在MA中的健康结局趋势， SD（目标2.1）。然后，我们将利用该模型来探索和确定具有 在MA和SD中减少SU并改善SU健康结局的最大潜力，同时还产生了见解 （目标2.2）。 拟议的研究将通过以下方式解决SU，SU障碍和过量的公共卫生问题： 确定有效和公平的干预策略。我们与社区合作伙伴的合作 使用系统建模方法将使我们能够为决策者提供即时可翻译的见解， MA和SD。从长远来看，我们的研究结果将为减少SU和改善SU的干预策略提供信息 所有PWUS以及代表性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.