Age-Varying Effects in the Epidemiology of Drug Abuse

 描述（由申请人提供）：为了提高药物滥用干预的效率和疗效，了解行为患病率、合并症和健康差异的年龄相关变化，以及从青春期到中年期各种风险因素的演变作用至关重要。今天，现有的高质量数据数量空前，这些数据具有巨大的潜力，可以为这些问题提供新的见解。其中许多数据集具有全国代表性，来自不同年龄段的人口。现在存在新的方法来挖掘这些数据，以便从发展的角度解决有关药物使用，滥用和依赖（药物UAD）的重要的新科学问题。为此，我们提出了时变效应模型（TVEM）的创新应用，从两个互补的国家研究的健康风险行为的数据：青少年健康的国家纵向研究（N=20,745）和2012年全国药物使用和健康调查（N=63,809）。TVEM灵活地估计行为流行率和变量之间的关联，作为连续的，灵活的年龄函数。具体而言，该项目的具体目标如下。(1)模拟从青春期到中年的药物UAD的灵活，年龄变化的趋势。我们将估算酒精、烟草、大麻和其他药物使用、滥用和依赖的比率，作为12岁至50岁连续年龄的复杂函数。将估计不同性别和种族/民族的趋势，以记录不同年龄的健康差异。(2)阐明从青春期到中年期药物UAD过程中心理健康问题的年龄变化作用。我们将研究抑郁症状和自杀意念如何与药物UAD作为一个连续的，复杂的功能，从12岁到50岁的差异。(3)估计从青春期到中年期早期和并发风险因素对药物UAD的年龄变化影响。我们将研究如何以及何时特定的风险和保护因素与12至50岁的药物UAD相关。我们将考虑个人，父母，同龄人，学校和社区层面的早期风险因素，以及婚姻和父母身份等并发因素。(4)研究药物使用中健康差异的贡献者。为了进一步了解健康差异的发展过程，我们将研究性别和种族/民族作为（a）药物UAD和精神健康问题的年龄变化共病和（B）风险因素和药物UAD之间年龄变化相关性的调节因素。该项目将提供有关药物UAD的发展过程和相关健康差异的知识，使预防科学家和临床医生能够设计干预措施，使最有希望的变化机制与人口亚组中最合适的年龄段相匹配。为了最大限度地提高项目的整体影响，我们将积极向药物滥用研究人员传播这一有前途的新分析方法。

 DESCRIPTION (provided by applicant): To improve the efficiency and efficacy of drug abuse interventions, an understanding of the age-related changes in behavior prevalences, comorbidities, and health disparities, and the evolving role of various risk factors from adolescence through middle adulthood, is crucial. Today there is an unprecedented amount of existing high-quality data that have enormous potential to shed new light on these issues. Many of these data sets are nationally representative, drawn from populations that span a wide range of ages. New methods now exist to tap those data in order to address important, new scientific questions about drug use, abuse, and dependence (drug UAD) from a developmental perspective. To this end, we propose the innovative application of the time-varying effect model (TVEM) to data from two complementary national studies of health risk behaviors: The National Longitudinal Study of Adolescent Health (N=20,745) and the 2012 National Survey on Drug Use and Health (N=63,809). TVEM flexibly estimates behavior prevalences and associations among variables as continuous, flexible functions of age. Specifically, the specific aims for this projec are as follows. (1) To model flexible, age-varying trends in drug UAD from adolescence into middle adulthood. We will estimate rates of alcohol, tobacco, marijuana, and other drug use, abuse and dependence as a complex function of continuous age from ages 12 to 50. Trends will be estimated across sex and race/ethnicity to document age-varying health disparities. (2) To elucidate the age-varying role of mental health problems in the course of drug UAD from adolescence into middle adulthood. We will examine how depressive symptoms and suicidal ideation are differentially associated with drug UAD as a continuous, complex function from ages 12 to 50. (3) To estimate age-varying effects of early and concurrent risk factors on drug UAD from adolescence into middle adulthood. We will examine how and when specific risk and protective factors are associated with drug UAD from ages 12 to 50. We will consider early risk factors at the individual, parent, peer, school, and community levels, as well as concurrent factors such as marriage and parenthood. (4) To examine contributors to health disparities in drug use. To advance understanding of the developmental course of health disparities, we will examine sex and race/ethnicity as moderators of (a) age-varying comorbidities of drug UAD and mental health problems and (b) age-varying associations between risk factors and drug UAD. This project will provide knowledge about the developmental course of drug UAD and related health disparities, allowing prevention scientists and clinicians to design interventions that matc the most promising mechanisms of change to the most appropriate age period within population subgroups. To maximize the project's overall impact, we will actively disseminate this promising new analytic approach to drug abuse researchers.