RESEARCH

About 20% of US young adults have high blood pressure (BP), however, the optimal BP screening and treatment strategies in young adults are unknown. Many young adults are not aware of their high BP, and are not recommended for BP lowering medication, partly due to the lack of evidence. The overall goal of this study is to determine the optimal BP screening intervals and identify subgroups of young adults with high cardiovascular risk who may benefit most from BP lowering medications.

The current US atherosclerotic cardiovascular disease (ASCVD) risk prediction tools are limited by failing to include data on social determinants of health (SDOH) and important US ethnic groups. The overall goal of this project is to improve ASCVD risk assessment for both primary and secondary prevention by drawing from more contemporary data sources. Results of this study will improve lipid-lowering therapy use and may reduce health inequities.

This study will incorporate the voice of the patient and provider stakeholders as part of the implementation of the Zero Suicide framework in three health settings from the NIMH-funded parent award as well as the Southcentral Foundation which is an Alaska Native-owned, nonprofit health care organization serving nearly 65,000 American Indian/Alaskan Native people living in and around Anchorage, Alaska. Our scientific premise is that by 1) understanding the stakeholder perspective on the role of health systems in opioid-related overdoses, and 2) involving these stakeholders in all aspects of developing strategies that health systems can use to prevent opioid-related overdoses within the implementation of the Zero Suicide framework, we will have a much greater impact on reducing the mortality rates associated with opioid use.

This observational, data-only study will use diagnostic and treatment data from the electronic medical records (EMR) and administrative systems from three Kaiser regions (Northwest, Southern California, and Georgia) including depression screening rates, rates of depression treatment initiation and receipt of different depression treatment services. The overall goal is to examine how race/ethnicity impacts these services. The study aims are: Aim 1: Examine how race/ethnicity impacts receipt of screening for depression in all settings or service types for adults at 3 sites, including examining unadjusted differences, and differences controlling for other patient-level factors (age, socioeconomic status, insurance coverage, other social determinants of health). Aim 2: Controlling for severity of depression symptoms (PHQ-9 category) and other sociodemographic characteristics, do racial and ethnic groups of patients have different patterns of depression diagnosis and treatment initiation compared to White patients? Aim 3: Do racial and ethnic groups of patients who screen positive for depression (PHQ-9 score above 9) have different longer-term outcomes compared to White patients? Aim 4: Explore whether response to depression treatment is associated with treatment outcomes, and whether these outcomes are different for racial and ethnic groups of patients compared to White patients.