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.
