Through the HEAL Initiative, NIH requests applications for studies designed to develop and test sustainable, scalable interventions to prevent opioid misuse, opioid use disorder, and co-occurring mental health conditions by intervening directly on social determinants of health (SDOH). This initiative aims to build an evidence base for preventive interventions that address inequities, social risks and/or social disadvantage. Interventions targeting social determinants may be structural (e.g. policy, regulatory, or systemic-wide changes) or designed to alter outcomes of individuals affected by contextual risk factors, and may be implemented in conjunction with psychosocial interventions designed to address behavioral risks.
Social Determinants of Health (SDOH) are the conditions in environments where people are born, live, learn, work, play, worship, and age that affect health, functioning, and quality-of-life outcomes (for more information on SDOH see: Social Determinants of Health – Healthy People 2030 | health.gov) Data show significant variation in opiod use and opioid use disorder by socioeconomic factors and other contextual factors, but relatively few research studies have tested interventions that directly address social determinants to affect meaningful improvements in individual or population-level opioid misuse, OUD, and related conditions, such as mental health disorders. In fact, the extent to which educational, persuasion-based, or other psychosocial prevention interventions are rendered ineffective or less effective because of the impact of social determinants, such as literacy, numeracy, or language barriers, unstable housing, food insecurity, or discriminatory practices etc., is poorly understood. While the need for improved drug treatment and pain management are well-recognized, more research is needed to understand the opportunities for and mechanisms of preventing the onset of opioid use disorders and co-occurring conditions before treatment is indicated.
SDOH are often discussed in the context of “upstream” vs. “downstream” causes of poor health outcomes; upstream causes typically are more foundational (often referred to as root causes) while downstream causes are more proximal and reflect the cumulative effects of upstream factors. SDOH can also be characterized as “structural” or “individual,” and measures of SDOH can be assessed at aggregate (e.g., community) or individual levels (see PhenX Tool kit SDOH Collection). In the response to the opioid crisis, many have called for a greater emphasis on upstream SDOH and on intervening on structural and/or systemic causes, both of which are aligned with prevention efforts.
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