Health and Functioning in New Midlife Adults: Understanding the Role of Alcohol Use, Social Environments, and Preventive Intervention over the Life Course

摘要 中年的重大转变对一些人来说可能是积极的，但许多人也经历了情感上的挑战， 身体健康下降，适应新的社会角色的压力很大。然而，中年时的健康和功能 与老年人相比，他们受到的关注较少，因为疾病和残疾仍然相对罕见。这 日益严重的健康挑战和较低的致残率相结合，为干预提供了机会 预防和延缓更严重的疾病和损伤。这项研究解决了在以下方面的重要知识差距 更好地利用这些机会。对于那些现在处于中年的人来说，中年可能会有什么不同，我们知之甚少 40多岁和50多岁--通常被贴上X世代的标签--他们在人口结构和家庭成员上更加多样化 形成和教育/职业道路比前几代人更多。大多数现有的中年研究也集中在 关于相对狭隘的健康结果，很少考虑身心健康和 在工作和公民生活中发挥作用。最近的研究表明，新的中年队列中的健康状况显著下降 此外，还强调需要关注中年健康方面的差异和社会人口统计学差异 以及解释这些问题的机制，特别是酒精滥用的增加及其在中年健康中的核心作用 风险。这项研究通过利用现有的纵向数据来检验这些问题 西雅图社会发展项目(SSDP)，并在中年早期收集新数据。SSDP遵循了 性别平衡、多种族和社会经济多元化的小组由808名参与者组成，来自 年龄在10岁至39岁之间，保留率高。数据包括对社会环境的理论指导的评估 贯穿始终；对社区环境进行独特的纵向评估，将自我报告、人口普查、 和地理信息系统测量；以及酒精和其他物质使用和紊乱、精神和精神障碍的纵向测量 身体健康，在工作、社区和公民生活中发挥作用。新数据扩展和扩展现有数据 措施进入中年，并使中年特有的经历得以检验。该研究的目的是 研究(1)现在进入中年的人的社会人口状况和转变如何影响 中年早期的共病健康后果；(2)中年期间饮酒、误用及相关行为 影响中年健康，以及酒精使用和误用导致的人生轨迹的影响 到中年；(3)可塑性社会和邻里环境因素如何影响酒精的使用和误用 并反过来影响中年健康；以及(4a)检查社会的长期延展性 通过儿童干预机制检验从青春期早期到中年的环境因素 (嵌入现有研究)；和(4b)通过聚焦确定有希望的成人干预目标 有参与者的小组，帮助设计和定制预防计划。在经验研究的指导下 和参与者本身，这项研究的目标是为研究人员和健康从业者提供 针对中年成年人公共卫生优先事项的预防性干预的具体建议。

ABSTRACT Significant transitions at midlife can be positive for some, but many also experience emotional challenges, physical health declines, and high stress in adapting to new social roles. Yet, health and functioning at midlife have received less attention compared to older ages because disease and disability remain relatively rare. This combination of growing health challenges and low rates of disability points to opportunities for intervention to prevent and delay more serious illness and impairment. This study addresses important gaps in knowledge to better capitalize on these opportunities. Little is known about how midlife may be different for those now in their 40s and 50s—often labeled Generation X—who are much more diverse demographically and in their family formation and education/career paths than prior generations. Most existing midlife research has also focused on relatively narrow health outcomes with little consideration of the interplay of physical and mental health and functioning in work and civic life. Recent studies showing significant health declines in new midlife cohorts additionally underscore the need for a focus on disparities and sociodemographic differences in midlife health and mechanisms to explain them, particularly increasing alcohol misuse and its central role in midlife health risks. This study brings strengths to examining these issues by drawing on existing longitudinal data from the Seattle Social Development Project (SSDP) and collecting new data in early midlife. SSDP has followed a gender-balanced, multiethnic, and socioeconomically diverse panel of 808 participants across 15 waves from age 10 to 39 with high retention. Data include theory-guided assessments of the social environment throughout; unique longitudinal assessments of neighborhood environments that integrate self-report, Census, and GIS measures; and longitudinal measures of alcohol and other substance use and disorder, mental and physical health, and functioning in work, community, and civic life. New data augment and extend existing measures into midlife and enable the examination of midlife-specific experiences. The study aims are to examine (1) how sociodemographic statuses and transitions among those now entering midlife influence comorbid health outcomes in early midlife; (2) how alcohol use, misuse and related behaviors during midlife influence midlife health, as well as the influence of life course trajectories of alcohol use and misuse leading up to midlife; (3) how malleable social and neighborhood environmental factors influence alcohol use and misuse over the life course and, in turn, affect midlife health; and to (4a) examine the long-term malleability of social environmental factors from early adolescence to midlife by testing the mechanisms of a childhood intervention (embedded in the existing study); and (4b) identify promising adult intervention targets by conducting focus groups with participants to help design and tailor prevention programs. With guidance from empirical findings and participants themselves, the goal of the study is to provide researchers and health practitioners with specific recommendations for preventive interventions addressing public health priorities for midlife adults.