Assessing the Contribution of Alcohol and Psychotropic Medication Use to Upward US Injury and Poisoning Trends

项目总结 奖学金申请者的长期目标是建立一个酒精和毒品流行病学的学术研究 (1)澄清人群层面酒精和毒品使用模式的原因和后果的方案 以及(2)产生可转化为公共卫生政策建议的结果。相互的 本方案中的强化培训计划和研究学习旨在帮助申请者参加 为实现他的目标采取必要的方法和专业步骤。 项目基本原理和目标：近年来，因伤害、中毒、自杀和肝病导致的死亡 大幅增加，并导致美国人预期寿命的下降。酒精和处方 药物使用已被确定为主要贡献者，但这种贡献的性质和范围需要 进一步澄清，以创造有效的解决方案。高风险的酒精和药物使用趋势并没有 在人群中统一表现。例如，最近狂欢饮酒的增加集中在 在45岁以上的成年人中，男性和女性之间的全国饮酒模式差异正在缩小 迅速地。同时，中枢神经系统抑制剂(CNS-D)药物的处方(例如，阿片类药物， 苯二氮卓类药物和Z-药物安眠药)大幅增加，也集中在 年龄在45岁以上的女性。同时使用酒精和中枢神经系统D类药物会放大患高血压的风险 伤害或中毒，这种风险在某些亚群中甚至可能进一步放大(例如，老年人或 女性)。这些动态可能对发病率趋势造成不成比例的影响。通过使用受限数据 将医疗支出小组调查(MEPS)中的处方药数据与酒精使用联系起来的文件 在国家健康访谈调查(NHIS)中针对同一个人的数据，我们可以开发出更多 美国酒精和药物相关发病率的综合解释模型研究 此F32中的项目旨在确定(1)酒精使用、药物使用和 人口统计学改变了受伤或中毒的风险，以及(2)患病率的变化程度 高风险的酒精和药物使用模式是人口伤害和中毒趋势的原因。 培训：该奖学金的培训计划概述了四个学习目标：(1)酒精流行病学和 酒精政策研究；(2)流行病学和药物流行病学的先进分析方法；(3) 内容--国家健康调查的知识和分析；(4)职业发展(包括 负责进行研究和K01赠款开发)。这些目标将通过以下途径实现 正式课程、定向阅读、与导师的讨论以及拟议项目的执行。这些 经验填补了特定知识和技能的空白，并将增强申请者发展 独立研究生涯。

PROJECT SUMMARY The fellowship applicant's long-term goal is to build an academic alcohol and drug epidemiology research program that (1) clarifies the causes and consequences of population-level patterns of alcohol and drug use and (2) generates results that can be translated into public health policy recommendations. The mutually reinforcing training plan and research study in this proposal are designed to help the applicant take the necessary methodological and professional steps towards his goal. Project rationale and objectives: In recent years, mortality due to injury, poisoning, suicide, and liver disease increased substantially and contributed to a decline in U.S. life expectancy. Alcohol and prescription medication use have been identified as key contributors, but the nature and scope of this contribution require further clarification in order to create effective solutions. Risky alcohol and medication use trends have not manifested uniformly in the population. For example, recent increases in binge drinking are concentrated among adults age 45+ and differences in national drinking patterns between males and females are shrinking rapidly. In parallel, prescriptions for central nervous system depressant (CNS-D) medication (e.g., opioids, benzodiazepines, and Z-drug sleep medications) increased substantially and are also concentrated among those age 45+ and among females. Concurrent use of alcohol and CNS-D medications amplifies the risk of injury or poisoning, and this risk may be even further magnified among certain subgroups (e.g., older adults or females). These dynamics may be contributing disproportionately to morbidity trends. By using restricted data files to link prescription medication data in the Medical Expenditure Panel Survey (MEPS) with alcohol use data for the same individual in the National Health Interview Survey (NHIS), we can develop a more comprehensive explanatory model of alcohol- and medication-related morbidity in the U.S. The research project within this F32 is aimed at determining (1) which patterns of alcohol use, medication use, and demographics alter the risk of injury or poisoning, and (2) the extent to which changes in the prevalence of high-risk alcohol and medication use patterns account for population-level injury and poisoning trends. Training: The training plan in this fellowship outlines four learning objectives: (1) alcohol epidemiology and alcohol policy research; (2) advanced analytical methods in epidemiology and pharmacoepidemiology; (3) content-knowledge and analysis of national health surveys; (4) professional development (including responsible conduct of research and K01 grant development). These objectives will be achieved through formal courses, directed readings, discussions with mentors, and execution of the proposed project. These experiences fill specific knowledge and skill gaps and will enhance the applicant's ability to develop an independent research career.