Longitudinal Pathways to the Use of Health Services

描述（由申请人提供）：这项新的拨款申请基于一项为期35年的物质使用纵向研究（T1-T7），建议通过绘制中年早期成年人利用服务的纵向路径来确定生命第五个十年中使用卫生保健服务的决定因素和障碍（目标1）。此外，拟议的研究将评估物质使用（酒精、大麻和烟草）在这一未充分研究的发育时期的长期后果（目标2）。在T8，我们将收集关于中年早期成年人身体和心理功能的重要领域的信息（身体疾病、精神疾病和成人角色的功能），并将这些信息与药物使用史联系起来。广泛的纵向数据来自前几波数据收集的参与者，包括青春期（T2, T3），成年初期（T4）和青年期（T5， T6和T7）。在T8，将与参与者进行面对面的访谈。心理测量学上的声音量表将从调查中发展出来。主要的数据分析技术将是结构方程建模、生长混合模型和回归。这项研究将使我们能够提供有关促进和阻碍成年人过渡到中年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物质使用对成年期心理社会和身体功能的累积影响。由于药物滥用和依赖是慢性的、反复发作的疾病，可能贯穿人的一生，因此对其在整个生命过程中的模式和伴随物进行前瞻性研究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.