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）：尽管老年吸毒者中的吸毒和艾滋病毒感染率正在以惊人的速度增加，但对该群体中老年人的吸毒模式和危险行为的了解有限。国家趋势数据显示，45 岁或以上的成年人是吸毒者、新吸毒治疗入院人数和新艾滋病毒/艾滋病病例增长最快的年龄组。这一探索性 R21 应用的双重目标是解决目前对老年吸毒者缺乏了解的问题，并提供创新的数学模型，这些模型有可能为未来关于吸毒特定转折点和生命过程中相关健康风险的研究提供信息。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危险行为的转折点，使用定性方法来更彻底地探索这些转折点，并使用数学分析来建立药物轨迹转折点的预测模型。基于社区的样本将由 45 岁及以上的海洛因、可卡因和甲基苯丙胺活跃使用者 (n=50) 和前使用者 (n=50) 组成。使用药物史和社会角色的定量矩阵以及定性深入访谈来收集数据。研究地点是亚特兰大大都市统计区 (MSA)，包括城市、郊区和农村地区。通过对该样本的深入探索获得的知识将增加我们对老龄化吸毒人群的了解，为未来对老年吸毒者的研究提供信息，并提供有关风险行为和吸毒的创新数学模型，以便在未来的大样本研究中进行测试。为了实现这一目标，我们提出了三个具体目标：（1）确定老年吸毒者样本在整个生命过程中开始、持续和停止吸毒的转折点；具体来说，社会角色、种族、性别、年龄、社会背景、政策和历史事件如何影响吸毒和吸毒相关艾滋病毒风险行为的转折点； (2) 深入探索生命历程中的这些转折点和转变，特别是药物供应、风险行为、给药途径、社会角色、网络、支持、政策、环境和地理位置的变化，纳入生命历程的视角； (3) 构建动态贝叶斯网络，对定量和定性数据中的静态和动态方面进行最佳建模。通过这样做，我们不仅能够识别变量之间的统计关系，还能识别这些变量随时间的影响和进展。这些目标共同提供了老年吸毒者生活所需的深入细节以及轨迹模型，可用于在吸毒轨迹转折点制定治疗策略。这项研究提供的信息和模型可用于通过关注毒品职业中的特定转折点来制定更好的预防、干预和治疗方案。这是对方法论的独特且创新的探索，可以引导未来的研究。根据 R21 探索性研究资助开发的模型将用于提出 R01 资助，以扩展模型对整个生命过程中药物轨迹转折点的预测价值。 公共卫生相关性：最近的健康研究表明，老年人中吸毒和艾滋病毒/艾滋病的数量惊人地增加，这一群体主要由老龄化的婴儿潮一代组成。老年吸毒者的回顾性生活史可以深入探索危险因素如何受到吸毒者生命历程中社会背景的影响，并有助于识别吸毒轨迹的转折点。通过应用我们从该样本中老年吸毒者生活中学到的知识，研究结果将为老年和年轻吸毒者的研究和健康举措提供信息，包括预防、干预和治疗计划。