An innovative methodological approach to analyzing alcohol use transitions in the context of prescription drug misuse and other health behaviors

在处方药滥用和其他健康行为的背景下分析酒精使用转变的创新方法

• 批准号: 9387529
• 负责人: Jason Elliott Goldstick
• 金额: $ 7.75万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9387529
• 关键词: Accident and Emergency department; Address; Adolescence; Affect; Age; Aggressive behavior; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Anxiety; Back; Behavior; Calendar; Characteristics; Communities; Crime; Data; Dependence; Development; Drug Prescriptions; Drug usage; Early Intervention; Empirical Research; Etiology; Family; Frequencies; Funding; Future; HIV; HIV risk; Health Transition; Health behavior; Home environment; Individual; Injury; Interruption; Intervention; Knowledge; Linear Models; Link; Longitudinal Studies; Maps; Markov Chains; Measurement; Mental Depression; Methodology; Michigan; Modeling; National Institute of Drug Abuse; Opioid; Overdose; Participant; Patient Self-Report; Pattern; Prevention; Prevention program; Probability; Public Health; Recruitment Activity; Research; Research Personnel; Risk; Risk Behaviors; Risk Factors; Role; Schedule; Schools; Severities; Specific qualifier value; Techniques; Testing; Time; TimeLine; Variant; Violence; Work; Youth; adolescent alcohol; adolescent drug use; aged; alcohol involvement; alcohol measurement; alcohol misuse; alcohol use disorder; alcohol use initiation; analytical method; base; binge drinking; college; contagion; design; drinking; emerging adulthood; follow-up; hazardous drinking; high risk; high risk drinking; innovation; interest; intervention program; male; misuse of prescription only drugs; models and simulation; novel; opioid use; parental influence; peer; peer influence; prescription opioid; prevent; sedative; sex risk; social; study population; theories; therapy design; weapons

ABSTRACT This proposal describes a plan to study what drives transitions in alcohol misuse in youth, and how those transitions coalesce with other health behavior transitions. Of particular concern is the recent increase in the prescribing, and misuse, of prescription opioids and sedatives, which has facilitated the emergence of a new crisis related to alcohol misuse: its contribution to overdose risk when used in combination with prescription opioids and/or sedatives. Prior research has identified individual-, peer-, parental-, and community-level correlates of alcohol misuse, but little empirical research focuses on what drives transitions in alcohol use behavior. Filling this gap has great potential to inform intervention and prevention design. Specifically, factors that facilitate transitions into more problematic drinking patterns are important targets for prevention, while those associated with sustained problematic drinking over time are targets for intervention. To address this knowledge gap, we will analyze data collected during the NIDA-funded (R01) Flint Youth Injury study, a longitudinal study of 600 drug-using youth recruited from an Emergency Department in Flint, Michigan. Using an innovative analytic technique, we will model behaviors over the follow-up period (roughly 6-month follow-ups for two years, for a total of five measurements) as continuous-time Markov Chains with covariate-modulated transition probabilities. In addition to the direct modeling of how covariates affect transition rates, a key advantage of this modeling framework is the elegant handling of missing time points and variation in the exact follow-up schedule. The first, and primary, specific aim of this project will be to estimate the effects of variables at multiple levels (individual, peer, parental, community) on transitions between alcohol use states; covariate effects will be tested for state-dependence to explicitly differentiate between targets for prevention vs. intervention. In the second aim, we will carry out analogous analyses for transitions in other behaviors – HIV-risk behaviors, weapon aggression, and non-medical prescription drug use – over the study period. In the third aim, we will use 90-day substance use timeline follow-back calendar data gathered at each follow-up to ascertain the number of overdose risk days (i.e. days with concurrent alcohol use and prescription drug use) for each participant, and to model, using generalized linear models, how alcohol use transitions during the previous follow-up period map onto frequency of overdose risk days. These works will provide information about a) key targets for intervention and prevention programs; b) how alcohol use transitions coalesce with other health transitions; and c) what types of alcohol use patterns are predictive of prescription drug overdose risk.

摘要 这项提案描述了一项研究青年酗酒转变的驱动因素的计划，以及 这些转变是如何与其他健康行为转变相结合的。特别值得关注的是 最近处方类阿片和镇静剂的处方和滥用增加，这已经 促成了与酒精滥用有关的新危机的出现：其对过量用药的贡献 当与处方阿片类药物和/或镇静剂联合使用时，风险。先前的研究已经 已确定的个人、同龄人、父母和社区层面的酒精滥用相关性，但很少 实证研究的重点是什么驱动酒精使用行为的转变。填补这一空白已经 为干预和预防设计提供信息的巨大潜力。具体地说，促进 过渡到更有问题的饮酒模式是预防的重要目标，而 那些与长期饮酒问题有关的人是干预的目标。至 为了解决这一知识差距，我们将分析在NIDA资助的(R01)弗林特期间收集的数据 青少年伤害研究--一项对600名从急诊招募的吸毒青少年的纵向研究 密歇根州弗林特的部门。使用创新的分析技术，我们将对行为进行建模 在随访期内(大约6个月的随访期为两年，共五年 测量)作为具有协变量调制转移的连续时间马氏链 概率。除了直接模拟协变量如何影响转换率之外，一个关键的 该建模框架的优点是能够很好地处理丢失的时间点和变化 在确切的后续日程安排中。该项目的第一个也是主要的具体目标将是 评估多个层面上的变量(个人、同伴、父母、社区)对 酒精使用状态之间的转换；协变量效应将被测试状态依赖于 明确区分预防和干预的目标。在第二个目标中，我们将 对其他行为的转变进行类似的分析--艾滋病毒危险行为、武器 攻击性和非医疗处方药的使用--在研究期间。在第三个目标中，我们 将使用在每次后续行动中收集的90天物质使用时间表后续日历数据 确定过量服药风险天数(即同时饮酒和开处方的天数 药物使用)，并使用广义线性模型对酒精使用情况进行建模 在前一个随访期的过渡映射到过量用药风险日的频率。这些 Works将提供关于a)干预和预防计划的主要目标的信息；b) 酒精使用转变如何与其他健康转变相结合；以及c)什么类型的酒精 使用模式可以预测处方药过量的风险。