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(申请人提供)：这项健康服务研究，回应PA-07-066：酒精使用障碍：治疗，服务研究和康复(RO1)，建议在年轻人的临床队列中研究酒精使用的长期轨迹，相关的社会结果，服务使用和费用。这是对2000年至2002年期间在私人管理保健保健计划中接受化学依赖(CD)治疗的青少年样本(N=419)的二次分析。有6个月、1年、3年、5年和7年的跟踪数据，我们目前正在NIAAA补充基金和Kaiser Permanente研究部的支持下收集9年的数据。利用9年的数据，整个样本(基线年龄为13-18岁，拟议研究的年龄为22-27岁)将在青春期到成年期的重要成熟期进行测量。很少有纵向研究通过这么长时间的随访来检查这一发育期的治疗样本。到9岁时，研究样本已经有时间经历重大的人生转变(即婚姻、为人父母)，这些转变的作用对于治疗样本来说可能与普通人群样本不同。这项研究解决了文献中的重大空白：我们研究了卫生服务对长期结果的作用，而轨迹文献没有做到这一点。我们提出了一种创新的方法来检查卫生服务使用的影响，通过定义和测试持续护理模式，该模式包括使用疾病管理方法的初级保健(PC)和专业CD/精神卫生服务的组合。我们还检查了长期医疗服务和成本的轨迹，这些也没有被检查过。最后，我们研究了这一有酒精和其他药物问题史的弱势群体缺乏长期结果和服务使用/费用的保险，这是影响健康和获得护理的关键问题。这个年龄段的未参保率最高，这是一个重要的健康差距问题。我们的概念框架是基于健康服务和发展的观点。具体地说，我们考察了个人(人口统计学和问题特征，发展转变)、治疗(CD服务和持续护理)和治疗外特征(家庭环境、同伴环境、12步参与)的多变量模型，以及它们与9年来酒精使用轨迹和相关结果的关系。我们也使用这个模型来分析医疗服务和成本轨迹。我们使用最先进的分析技术，包括潜在增长模型，来解决特定的研究问题。这项研究的结果对确定青少年长期康复的重要因素、制定有针对性的干预计划具有重要意义，卫生系统将能够利用这些发现制定持续护理的康复方法。与医疗保险相关的研究结果对医疗改革和政策具有重大影响。 公共卫生相关性：这项研究是对一群22-27岁的年轻人的二次分析，他们在青少年时期进入化学依赖治疗，现在治疗后9年。我们考察了重要的人生转变、缺乏医疗保险和医疗服务使用(包括持续护理模式)与酒精使用的长期轨迹以及相关结果、医疗服务和成本的关系。