Longitudinal Pathways to the Use of Health Services

描述(由申请人提供)：这项新的赠款申请基于对物质使用的35年纵向研究(T1-T7)，建议通过绘制成年人在中年早期利用服务的纵向路径(目标1)，确定在人生的第五个十年中卫生保健服务利用的决定因素和障碍。此外，拟议的研究将评估物质使用(酒精、大麻和烟草)在这一未被研究的发展时期的长期后果(目标2)。在T8，我们将收集有关成人中年早期身体和心理社会功能的重要领域的信息(身体疾病、精神障碍和成人角色的功能)，并将这些信息与物质使用史联系起来。从之前的几波数据收集中可以获得关于参与者的广泛的纵向数据，包括青春期(T2、T3)、新兴成年期(T4)和青年成年期(T5、T6和T7)。在T8，将与参与者进行面对面的访谈。心理测量学方面的量表将从调查中开发出来。主要的数据分析技术将是结构方程建模、增长混合建模和回归。这项研究将使我们能够提供关于促进和阻碍向中年过渡的成年人利用卫生保健服务的因素的关键信息。此外，拟议的研究将深入了解长期使用药物对成年后心理社会和身体功能的累积影响。由于药物滥用和依赖是一种慢性、复发性疾病，可能会在人的一生中持续存在，前瞻性地研究它们在一生中的模式和伴随关系对公共卫生至关重要。

DESCRIPTION (provided by applicant): This new grant application, which is based on a 35-year longitudinal study (T1-T7) of substance use, proposes to identify the determinants and barriers to health care services utilization in the fifth decade of life by charting the longitudinal pathways to the utilization of services by adults in early midlife (Aim 1). In addition, the proposed research will assess the long-term consequences of substance use (alcohol, marijuana, and tobacco) in this understudied developmental period (Aim 2). At T8, we will gather information about important areas of physical and psychosocial functioning in adults in early midlife (physical diseases, psychiatric disorders, and functioning in adult roles), and relate these to the histories of substance use. Extensive longitudinal data are available on the participants from previous waves of data collection, including adolescence (T2, T3), emerging adulthood (T4), and young adulthood (T5, T6, and T7). At T8, face-to-face interviews will be conducted with the participants. Psychometrically sound scales will be developed from the surveys. The primary data-analytic techniques will be structural equation modeling, growth mixture modeling and regression. This research will enable us to provide crucial information about factors facilitating and barriers impeding the utilization of health care services among adults transitioning to midlife. In addition the proposed research will provide insight into the cumulative impact of prolonged substance use on psychosocial and physical functioning in adulthood. Since substance abuse and dependence are chronic, relapsing diseases, which may persist throughout a person's life, studying their patterns and concomitants prospectively over the life course is of crucial importance to public health.