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

基于社区的系统科学方法，用于评估风险和保护因素，并提高兴奋剂使用、使用障碍和用药过量干预策略的有效性和公平性

• 批准号: 10662417
• 负责人: Arielle R. Deutsch
• 金额: $ 36.21万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10662417
• 关键词: community; based; systems; science; approach

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.

项目概要/摘要 自 2014 年以来，因服用兴奋剂而致死的人数迅速增加； 主要是甲基苯丙胺，增加了四倍，而涉及可卡因的致命过量服用增加了两倍。 拉丁裔和美洲原住民越来越多地使用兴奋剂并死于过量服用，尽管这一比例较低 收入 白人男性仍然是使用兴奋剂 (PWUS) 并死于过量服用兴奋剂的最大群体。 拟议的研究目标 RFA-CE-21-002 目标 2：“评估非法行为的风险和保护因素 兴奋剂的使用、使用障碍和过量可能有助于干预措施的制定或适应 我们的目标是确定可以制定或调整的干预策略，以减少 我们将进行兴奋剂使用 (SU) 并改善 SU 健康结果（SU 紊乱、恢复和过量）。 我们在两个具有明显 SU 危机的州进行了研究：马萨诸塞州 (MA)，那里可卡因和芬太尼过量 的人口数量正在上升，其中包括黑人和拉丁裔人口，以及南达科他州 (SD)，这些地区的人口数量迅速增加 甲基苯丙胺的使用和过量使用对美洲原住民造成了不成比例的影响。 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如何 SU 和 SU 健康结果动态相互作用，重点关注与社会决定因素相关的差异 健康，在 MA 和 SD（目标 1）中，我们将对影响 SU 的多层次因素进行实时系统回顾。 和 SU 健康结果以及可以协同减少 SU 和 SU 的多层次干预策略 改善 SU 健康成果（目标 1.1）。我们还将与 MA 和 SD 的社区合作伙伴合作。 半结构化的兴奋剂使用基础系统的多个层面（PWUS、提供者和政策制定者） 定性访谈，以制定统一的因果循环图（CLD），描述风险和保护如何 接下来，我们将确定减少 SU 和改善的干预策略。 SU 健康成果，包括适用于所有人群的通用策略和减少 代表性不足的人群的健康差异（目标 2）我们将开发系统动力学模拟。 模型，使用 CLD 和生活系统评价来解释 MA 和 SU 的 SU 和 SU 健康结果趋势 SD（目标 2.1）然后我们将利用该模型来探索和确定具有以下特征的干预策略： 在 MA 和 SD 中减少 SU 和改善 SU 健康结果的最大潜力，同时也产生洞察力 适用于全国（目标 2.2）。 拟议的研究将通过以下方式解决 SU、SU 失调和药物过量的公共卫生问题 确定有效且公平的干预策略。 使用系统建模方法将使我们能够立即向政策制定者提供可转化的见解 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。