Older Drug Users: A Life Course Study of Turning Points in Drug Use and Injection

老年吸毒者：吸毒和注射转折点的生命历程研究

• 批准号: 7660917
• 负责人: MIRIAM W BOERI
• 金额: $ 20.1万
• 依托单位: KENNESAW STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-15 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7660917
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Admission activity; Adolescent; Adult; Affect; Age; Aging; Area; Behavior; Cocaine; Communities; Data; Data Set; Development; Drug usage; Drug user; Elderly; Epidemic; Event; Evolution; Exploratory/Developmental Grant; Future; Gender; Geographic Locations; Goals; Grant; Gray unit of radiation dose; HIV; Health; Health Services; Heroin; Illicit Drugs; Injection of therapeutic agent; Intervention; Interview; Investigation; Knowledge; Lead; Learning; Life; Life Cycle Stages; Literature; Methamphetamine; Methodology; Methods; Modeling; Older Population; Pattern; Pharmaceutical Preparations; Policies; Population; Predictive Value; Preventive Intervention; Public Health; Qualitative Methods; Race; Recording of previous events; Relapse; Research; Research Project Grants; Risk; Risk Behaviors; Risk Factors; Role; Route; Rural; Sampling; Sampling Studies; Services; Sex Behavior; Site; Social Environment; Techniques; Testing; Time; War; age group; base; career; cohort; computer based statistical methods; experience; innovation; insight; life history; mathematical model; metropolitan; predictive modeling; public health relevance; rural area; social; suburb; transmission process; treatment program; treatment strategy; trend; young adult

DESCRIPTION (provided by applicant): Although drug use and HIV rates among older drug users are increasing at alarming rates, knowledge on drug use patterns and risk behaviors among this cohort as older adults is limited. National trend data show that adults who are 45 or older comprise the fastest growing age group of drug users as well as new drug treatment admissions and new HIV/AIDS cases. The two-fold goal of this exploratory R21 application is to address the lack of current knowledge on older drug users and provide innovative mathematical models that have the potential to inform future research on specific turning points in drug use and related health risks over the life course. In this mixed-methods study we use quantitative methods to identify turning points in drug use and risk behaviors, qualitative methods to explore these turning points more thoroughly, and mathematical analysis to build predictive models on turning points in drug trajectories. The community-based sample will consist of active users (n=50) and former users (n=50) of heroin, cocaine, and methamphetamine age 45 and older. Data are collected using a quantitative matrix on drug history and social roles and a qualitative in-depth interview. The study site is the metropolitan statistical area (MSA) of Atlanta that includes urban, suburban and rural settings. The knowledge gained from an in-depth exploration of this sample will add to our understanding of an aging drug-using population, inform future research on older drug users and provide innovative mathematical models on risk behaviors and drug use to be tested in future large-sample studies. To accomplish this we propose three specific aims: (1) To identify turning points in the onset, continuation, and cessation of drug use throughout the life course of a sample of older users; specifically how social roles, race, gender, age, social contexts, policies and historical events influence turning points in drug use and drug- related HIV risk behaviors; (2) To thoroughly explore these turning points and transitions over the life course, specifically changes in drug availability, risk behaviors, routes of administration, social roles, networks, support, policies, settings, and geographic locations, imbedded in a life course perspective; (3) To build Dynamic Bayesian Networks that best model the static and dynamic aspects found in our quantitative and qualitative data. In so doing we are able to identify not only statistical relationships between the variables but also the influence and progression of these through time. Together these aims provide needed in-depth details on the lives of older drug users as well as trajectory models that can be used to target treatment strategies on the turning points in drug use trajectories. The information and models provided by this study can be used to develop better prevention, intervention and treatment programs by focusing on specific turning points in drug careers. This is a unique and innovative exploration of methodologies that can lead to future studies. The models developed from this R21 exploratory research grant will be used to propose a R01 grant to extend the predictive value of the models on turning points in drug trajectories throughout the life course. PUBLIC HEALTH RELEVANCE: Recent health studies show an alarming increase in drug use and HIV/AIDS among older adults, a cohort composed primarily of aging baby boomers. Retrospective life histories of older adult drug users allow an in- depth exploration how risk factors are influenced by the social context of drug users over the life course and help to identify turning points in the drug trajectory. By applying what we learn from the lives of older drug users in this sample, the findings will inform research and health initiatives for older as well as younger users, including prevention, intervention and treatment programs.

描述（由申请人提供）：尽管老年吸毒者的吸毒和艾滋病毒率正在以惊人的速度增加，对毒品使用模式的知识和该队列中的风险行为的知识有限。国家趋势数据显示，45岁或以上的成年人构成了增长最快的吸毒者年龄段以及新药物治疗招生和新的艾滋病毒/艾滋病病例。此探索性R21应用程序的两个目标是解决当前对年长吸毒者的知识，并提供创新的数学模型，这些模型有可能为对药物使用和相关健康风险的特定转折点的未来研究提供信息。在这项混合方法研究中，我们使用定量方法来识别药物使用和风险行为中的转折点，定性方法更彻底地探索这些转折点，而数学分析来建立对药物轨迹转弯点的预测模型。基于社区的样本将由活跃用户（n = 50）和前用户（n = 50）的海洛因，可卡因和45岁及以上的甲基苯丙胺组成。使用有关药物史和社会角色的定量矩阵以及定性的深入访谈收集数据。研究地点是包括城市，郊区和农村环境在内的亚特兰大的大都市统计区（MSA）。从对该样本的深入探索中获得的知识将增加我们对使用衰老的人群的理解，为未来对年长吸毒者的研究提供信息，并提供有关风险行为和药物使用的创新数学模型，并在未来的大型样本研究中进行测试。为此，我们提出了三个特定的目标：（1）在整个年长用户样本的整个生命过程中，在整个生命过程中确定毒品使用的转折点；特别是社会角色，种族，性别，年龄，社会环境，政策和历史事件如何影响毒品使用和与毒品相关的HIV风险行为的转折； （2）彻底探索生活过程中的这些转折点和过渡，特别是在药物可用性，风险行为，行政途径，社会角色，网络，支持，政策，环境和地理位置的变化，并以人生的观点嵌入； （3）建立动态的贝叶斯网络，最能模拟我们的定量和定性数据中发现的静态和动态方面。在这样做时，我们不仅能够确定变量之间的统计关系，而且还可以确定这些变量之间的影响和进展。这些目标共同提供了有关老年吸毒者生活以及可用于针对药物使用轨迹转折点的治疗策略的轨迹模型所需的深入细节。这项研究提供的信息和模型可用于通过关注毒品职业的特定转折点来制定更好的预防，干预和治疗计划。这是对可能导致未来研究的方法的独特而创新的探索。 R21探索性研究赠款开发的模型将用于提出R01赠款，以在整个生命过程中扩展模型在药物轨迹转弯点上的预测价值。 公共卫生相关性：最近的健康研究表明，老年人的毒品使用和艾滋病毒/艾滋病的增加，这是一个主要由衰老的婴儿潮一代组成的队列。老年人吸毒者的回顾性生活史允许探索危险因素如何受到吸毒者在生活过程中的社会环境的影响，并有助于确定药物轨迹中的转折点。通过在此样本中运用我们从老年吸毒者的生活中学到的知识，这些发现将为年龄较大的使用者和年轻用户（包括预防，干预和治疗计划）提供有关研究和健康计划的信息。