Alcohol Trajectories and Service Use in Young Adults: Nine Years Post Treatment

年轻人的酒精轨迹和服务使用：治疗后九年

• 批准号: 7890142
• 负责人: CYNTHIA I CAMPBELL
• 金额: $ 35.15万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-20 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7890142
• 关键词: 18 year old; Abstinence; Accident and Emergency department; Address; Adolescence; Adolescent; Adult; Aftercare; Age; Alcohol abuse; Alcohol consumption; Alcohols; Analgesics; Arts; Cannabis; Caring; Catchment Area; Characteristics; Chemicals; Clinical; Comorbidity; Conflict (Psychology); Data; Dependency; Development; Disease Management; Divorce; Drug Insurance; Drug usage; Education; Employment; Enrollment; Environment; Ethnic Origin; Family; Family Characteristics; Family member; Female; Funding; Future; Gender; General Population; Growth; Health; Health Care Costs; Health Insurance; Health Planning; Health Policy; Health Services; Health Services Accessibility; Health Services Research; Health system; Heavy Drinking; Individual; Inpatients; Insurance; Insurance Benefits; Insurance Coverage; Intake; Lead; Legal; Length; Length of Stay; Life; Life Cycle Stages; Literature; Longitudinal Studies; Managed Care; Marriage; Measures; Mediating; Medical; Mental Health; Mental Health Services; Methods; Modeling; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Peer Group; Pharmaceutical Preparations; Policies; Population; Primary Health Care; Process; Recording of previous events; Recovery; Religion and Spirituality; Research; Risk Factors; Role; Sampling; Sampling Studies; Services; Social Network; Social Problems; Staging; Techniques; Testing; Time; Tobacco; Treatment Cost; Uninsured; Unmarried; Vulnerable Populations; Youth; adolescent alcohol; age group; aged; alcohol and other drug; alcohol use disorder; base; cohort; cost; demographics; experience; follow-up; health disparity; improved; indexing; innovation; inpatient service; intervention program; medical specialties; men; mental health education; peer; peer influence; primary care setting; programs; public health relevance; reduced alcohol use; service utilization; sex; social; therapy development; treatment program; trend; young adult

DESCRIPTION (provided by applicant):This health services study, responding to PA-07-066: Alcohol Use Disorders: Treatment, Services Research, and Recovery (RO1), proposes to study the long-term trajectories of alcohol use, related social outcomes, service use and cost in a clinical cohort of young adults. This is a secondary analysis of a sample (N=419) of adolescents who entered chemical dependency (CD) treatment in a private managed care health plan between 2000 and 2002. Follow-up data are available at 6 months, 1, 3, 5, and 7 years, and we are currently collecting 9-year data with support from NIAAA supplemental funds and Kaiser Permanente's Division of Research. With the 9 year data, the full sample (aged 13-18 years at baseline, aged 22-27 years for the proposed study) will have been measured during the important maturation period of adolescence to young adulthood. Few longitudinal studies have examined treatment samples through this developmental period with this long of a follow-up. By 9 years, the study sample has had the time to experience significant life transitions (i.e. marriage, parenthood), and the role of these transitions may be different for a treatment sample compared to general population samples. The study addresses significant gaps in the literature: We examine the role of health services on long-term outcomes, which the trajectories literature has not done. We propose an innovative approach to examine the impact of health services use by defining and testing a model of Continuing Care that includes a combination of primary care (PC) and specialty CD/mental health services using a disease-management approach. We also examine trajectories of long-term medical services and costs, which have also not been examined. Finally, we study lack of insurance on long-term outcomes and service use/costs in this vulnerable group with a history of alcohol and other drug problems, a key issue impacting health and access to care. This age group has the highest uninsured rates and it is an important health disparities issue. Our conceptual framework is based on a health services and a developmental perspective. Specifically, we examine a multivariate model of individual (demographics and problem characteristics, developmental transitions), treatment (CD services and Continuing Care) and extra-treatment characteristics (family environment, peer environment, 12-step participation) and how they relate to trajectories of alcohol use and related outcomes over 9 years. We also use this model in our analysis of medical service and cost trajectories. We use state-of-the art analytic techniques, including latent growth models, to address specific research questions. Findings from this study have implications for identifying factors important for long-term recovery for youth, for developing targeted intervention programs, and health systems will be able to use findings to develop a continuing care approach to recovery. Findings related to health insurance have significant implications for health reform and policy. PUBLIC HEALTH RELEVANCE: This study is a secondary analysis of a cohort of young adults aged 22-27 who entered chemical dependency treatment as adolescents, and who are now 9 years post treatment. We examine the relationship of important life transitions, lack of health insurance, and health services use, including a Continuing Care model, to long- term trajectories of alcohol use and related outcomes, medical services and cost.

描述（由申请人提供）：这项卫生服务研究，对PA-07-066的反应：酒精使用障碍：治疗，服务研究和恢复（RO1），建议研究饮酒的长期轨迹，相关的社会结果，服务使用，服务使用和成本，以临床成年人的临床同类群体中。这是对在2000年至2002年之间在私人托​​管护理健康计划中进入化学依赖（CD）治疗的青少年样本（n = 419）的次要分析。随访数据可在6个月，1、3、5和7年中获得，我们目前正在借助NIAAA补充资金和KAISERSERSERSERSERSERESERSERESTE的NIAAA补充资金和KAISERESERSERESERESERENTE的9年数据。有了9年的数据，将在重要的成年至年轻人成年期间测量完整的样本（基线时13-18岁，在拟议研究中年龄22-27岁）。很少有纵向研究通过这一长期随访，在此发育时期检查了治疗样本。到9年来，研究样本已经有时间经历重大的生命过渡（即婚姻，育儿），与一般人群样本相比，治疗样本的这些过渡的作用可能有所不同。该研究解决了文献中的巨大差距：我们研究了卫生服务对长期结局的作用，而轨迹文献尚未做到。我们提出了一种创新的方法，通过定义和测试一种持续护理模型来检查健康服务使用的影响，该模型包括初级保健（PC）和专业CD/心理健康服务，使用疾病管理方法。我们还研究了长期医疗服务和成本的轨迹，这些轨迹也没有进行检查。最后，我们研究了这个脆弱群体中的长期结果和服务使用/成本缺乏保险，该群体具有酒精和其他毒品问题的历史，这是影响健康和获得护理的关键问题。这个年龄段的未保险率最高，这是一个重要的健康差异问题。我们的概念框架是基于卫生服务和发展的观点。具体而言，我们研究了个体（人口统计和问题特征，发育过渡），治疗（CD服务和持续护理）以及治疗特征（家庭环境，同伴环境，12步参与）的多元模型，以及它们如何与9年以上的少量酒精使用轨迹和相关成果相关联。我们还在分析医疗服务和成本轨迹时使用了该模型。我们使用包括潜在增长模型在内的最先进的分析技术来解决特定的研究问题。这项研究的发现对确定对青年人长期康复重要的因素，制定有针对性的干预计划的重要性有影响，卫生系统将能够使用发现来开发持续的护理方法进行康复。与健康保险有关的发现对健康改革和政策具有重大影响。 公共卫生相关性：这项研究是对22-27岁的年轻人队列的次要分析，他们以青少年的身份进入化学依赖治疗，并且在治疗后9年。我们研究了重要的人寿转变，缺乏健康保险以及健康服务的使用（包括持续护理模型）与酒精使用及相关结果，医疗服务和成本的长期轨迹的关系。