Development and validation of a community-level social determinants of health index for drug overdose deaths in the HEALing Communities Study

INTRODUCTION

Social determinants of health (SDoH), such as socioeconomic status, education level, and food insecurity, are believed to influence the opioid crisis. While global SDoH indices such as the CDC's Social Vulnerability Index (SVI) and Area Deprivation Index (ADI) combine the explanatory power of multiple social factors for understanding health outcomes, they may be less applicable to the specific challenges of opioid misuse and associated outcomes. This study develops a novel index tailored to opioid misuse outcomes, tests the efficacy of this index in predicting drug overdose deaths across contexts, and compares the explanatory power of this index to other SDoH indices.

METHODS

Focusing on four HEALing Communities Study (HCS) states (Kentucky, Massachusetts, New York and Ohio; encompassing 4269 ZIP codes), we identified multilevel SDoH potentially associated with opioid misuse and aggregated publicly available data for each measure. We then leveraged a random forest model to develop a composite measure that predicts age-adjusted drug overdose mortality rates based on SDoH. We used this composite measure to understand HCS and non-HCS communities in terms of overdose risk across areas of varying racial composition. Finally, we compared variance in drug overdose deaths explained by this index to variance explained by the SVI and ADI.

RESULTS

Our composite measure included 28 SDoH measures and explained approximately 89 % percent of variance in age-adjusted drug overdose mortality across HCS states. Health care measures, including emergency department visits and primary care provider availability, were top predictors within the index. Index accuracy was robust within and outside of HCS communities and states. This measure identified high levels of overdose mortality risk in segregated communities.

CONCLUSIONS

Existing SDoH indices fail to explain much variation in area-level overdose mortality rates. Having tailored composite indices can help us to identify places in which residents are at highest risk based on their composite contexts. A comprehensive index can also help to develop effective community interventions for programs such as HCS by considering the context in which people live.

Identifying opportunities for collective action around community nutrition programming through participatory systems science

PURPOSE

To apply principles of group model building (GMB), a participatory systems science approach, to identify barriers and opportunities for collective impact around nutrition programming to reduce cancer risk for immigrant communities in an urban environment.

METHODS

We convened four in-person workshops applying GMB with nine community partners to generate causal loop diagrams (CLDs)-a visual representation of hypothesized causal relationships between variables and feedback structures within a system. GMB workshops prompted participants to collaboratively identify programmatic goals and challenges related to (1) community gardening, (2) nutrition education, (3) food assistance programs, and (4) community-supported agriculture. Participants then attended a plenary session to integrate findings from all workshops and identify cross-cutting ideas for collective action.

RESULTS

Several multilevel barriers to nutrition programming emerged: (1) food policies center the diets and practices of White Americans and inhibit culturally tailored food guidelines and funding for culturally appropriate nutrition education; (2) the lack of culturally tailored nutrition education in communities is a missed opportunity for fostering pride in immigrant food culture and sustainment of traditional food practices; and (3) the limited availability of traditional ethnic produce in food assistance programs serving historically marginalized immigrant communities increases food waste and worsens food insecurity.

CONCLUSION

Emergent themes coalesced around the need to embed cultural tailoring into all levels of the food system, while also considering other characteristics of communities being reached (e.g., language needs). These efforts require coordinated actions related to food policy and advocacy, to better institutionalize these practices within the nutrition space.

What Predicts a Clinical Discussion About PrEP? Results From Analysis of a U.S. National Cohort of HIV-Vulnerable Sexual and Gender Minorities

HIV-outcome inequities remain prevalent in the U.S. Medical providers (MPs) are gatekeepers of PrEP, and understanding the dynamics of PrEP assessments is of major interest for public health. We analyzed data from Together 5000, an internet-based U.S. national cohort of sexual and gender minority (SGM) individuals aged 16-49 years and at risk for HIV. Among those eligible for PrEP uptake (n = 6264), we modeled predictors of discussing PrEP with an MP. A third (31%) of participants had spoken to a MP about PrEP. Among those who spoke to a MP, 45% suggested they would initiate PrEP; this outcome was more common among participants older than 24. With a persistent stagnant uptake nationwide, new opportunities to influence PrEP uptake must be explored. An attractive less targeted space is the medical office, specifically ways to support an initial and continued discussion about PrEP between MPs and their patients.

The HEALing (Helping to End Addiction Long-term SM) Communities Study: Protocol for a cluster randomized trial at the community level to reduce opioid overdose deaths through implementation of an integrated set of evidence-based practices

BACKGROUND

Opioid overdose deaths remain high in the U.S. Despite having effective interventions to prevent overdose deaths, there are numerous barriers that impede their adoption. The primary aim of the HEALing Communities Study (HCS) is to determine the impact of an intervention consisting of community-engaged, data-driven selection, and implementation of an integrated set of evidence-based practices (EBPs) on reducing opioid overdose deaths.

METHODS

The HCS is a four year multi-site, parallel-group, cluster randomized wait-list controlled trial. Communities (n = 67) in Kentucky, Massachusetts, New York and Ohio are randomized to active intervention (Wave 1), which starts the intervention in Year 1 or the wait-list control (Wave 2), which starts the intervention in Year 3. The HCS will test a conceptually driven framework to assist communities in selecting and adopting EBPs with three components: 1) a community engagement strategy with local coalitions to guide and implement the intervention; 2) a compendium of EBPs coupled with technical assistance; and 3) a series of communication campaigns to increase awareness and demand for EBPs and reduce stigma. An implementation science framework guides the intervention and allows for examination of the multilevel contexts that promote or impede adoption and expansion of EBPs. The primary outcome, number of opioid overdose deaths, will be compared between Wave 1 and Wave 2 communities during Year 2 of the intervention for Wave 1. Numerous secondary outcomes will be examined.

DISCUSSION

The HCS is the largest community-based implementation study in the field of addiction with an ambitious goal of significantly reducing fatal opioid overdoses.

Common and differential associations between levels of alcohol drinking, gender-specific neurobehaviors and mental distress in college students

BACKGROUND

Binge drinking is associated with poor academic behaviors and performance. Excessive alcohol drinking induces molecular changes and neurobehaviors that support use of other substances and alter cognitive functions. The purpose of this study was to compare neurobehaviors and academic effort among college students with low alcohol use with those of high alcohol consumption and build conceptual models that represent the integration of the different variables.

METHOD

College students from several U.S colleges were assessed through an anonymous online survey for alcohol use, academic performance, lifestyle factors and mental distress.

RESULTS

Our results depicted common neurobehaviors and differential responses to high alcohol use.

CONCLUSION

The common responses in young men and women with high alcohol use are reflective of a hyperactive limbic system. The different responses involve cognitive aptitudes, typically controlled by cortical regions and affected by levels of brain connectivity known to be dissimilar between men and women.

Principal component regression of academic performance, substance use and sleep quality in relation to risk of anxiety and depression in young adults

Adverse lifestyle factors increase risk of anxiety and depression in young adults. Consequently, neurochemical and neuroanatomical alterations ensue, and may initiate a vicious cycle of mental distress, poor lifestyle choices and academic performance. A total of 558 students from different US colleges completed an anonymous survey on academic performance, daytime sleepiness, substance use and mental distress. Low mental distress in college students positively associated with good academic efforts and limited daytime sleepiness. Mild mental distress correlated with borderline work neglect and with a marginal negative association with Grade-point average (GPA). Severe mental distress correlated with excessive daytime sleepiness and poor academic performance. A System Dynamic model was developed to reflect the integration of these variables with mental distress and academic performance. Our results demonstrate that manageable lifestyle factors contribute to mental health in college students, which become potentially cyclic events that may impact academic performance.

Spatial dynamics of access to primary care for the medicaid population

Primary care (PC) has always been underestimated and underinvested by the United States health system. Our goal was to investigate the effect of Medicaid expansion and the Affordable Care Act (ACA) provisions on PC access in Broome County, NY, a county that includes both rural and urban areas, and can serve as a benchmark for other regions. We developed a spatial system dynamics model to capture different stages of PC access for the Medicaid population by using the health belief model constructs and simulate the effect of several hypothetical interventions on PC utilisation. The government data portals used as data sources for calibrating our model include the New York State Department of Health, the Medicaid Delivery System Reform Incentive Payment (DSRIP) dashboards, and the US census. In our unique approach, we integrated the simulation results within Geographical Information System (GIS) maps, to assess the influence of geospatial factors on PC access. Our results identify hot spot demographic areas that have poor access to PC service facilities due to transportation constraints and a shortage in PC providers. Our decision support tool informs policymakers about programmes with the strongest impact on improving access to care, considering spatial and temporal characteristics of a region.

Principal component analysis identifies differential gender-specific dietary patterns that may be linked to mental distress in human adults

Independent reports describe the structural differences between the human male and female brains and the differential gender-susceptibility to mood disorders. Nutrition is one of the modifiable risk factors that has been reported to impact brain chemistry and affect mental health. Objectives: To study dietary patterns in adult men and women in relation to mental distress. Another aim was to develop evidence-based prototypes using System Dynamic Modeling methodology to better describe our findings. Methods: An anonymous internet-based survey was sent through social media platforms to different social and professional networks. Multivariate analyses were used for data mining. Data were stratified by gender and further by tertiles to capture the latent variables within the patterns of interest. Results: Mental distress in men associated with a consumption of a Western-like diet. In women, mental wellbeing associated with a Mediterranean-like diet and lifestyle. No other patterns in both genders were linked to mental distress. Based on the generated prototypes, men are more likely to experience mental wellbeing until nutritional deficiencies arise. However, women are less likely to experience mental wellbeing until a balanced diet and a healthy lifestyle are followed. In men, dietary deficiencies may have a profound effect on the limbic system; whereas dietary sufficiency in women may potentiate the mesocortical regulation of the limbic system. Discussion and conclusion: Our results may explain the several reports in the literature that women are at a greater risk for mental distress when compared to men and emphasize the role of a nutrient-dense diet in mental wellbeing.

Assessment of dietary factors, dietary practices and exercise on mental distress in young adults versus matured adults: A cross-sectional study

The importance of the diet in modulating mental health is uncovering as many dietary factors have been described to alter brain chemistry. Brain maturation may not complete until the age of 30 which may explain the differential emotional control, mindset, and resilience between young adults and matured adults. As a result, dietary factors may influence mental health differently in these two populations.

OBJECTIVES

To study dietary intake, dietary practices and exercise in young adults (YA) (18-29 years) versus matured adults (MA) (30 years and older) in relation to mental distress. Another aim was to assess whether mental well-being potentially stimulates healthy eating, healthy practices, and exercising.

METHODS

An anonymous internet-based survey was sent through social media platforms to different professional and social group networks. Best-fit models were constructed using the backward regression analysis to assess the relationship between dietary variables, exercise, and mental distress in YA versus MA.

RESULTS

YA mood seems to be dependent on food that increases availability of neurotransmitter precursors and concentrations in the brain (such as frequent meat consumption and exercise, respectively). However, MA mood may be more reliant on food that increases availability of antioxidants (fruits) and abstinence of food that inappropriately activates the sympathetic nervous system (coffee, high glycemic index, and skipping breakfast).

DISCUSSION AND CONCLUSION

Level of brain maturation and age-related changes in brain morphology and functions may necessitate dietary adjustments for improving mental well-being.