Midlife Health and Service Utilization Associated with Early Life Drug Use

描述(申请人提供)：非法药物使用在年轻人中很常见。在18-34岁的普通人群中，报告过去一年使用非法药物的人数(30%-34%)几乎与报告“危险”饮酒水平(30%-44%)的人数一样多，其中只有不到一半的人符合滥用或依赖诊断的条件。筛查、短暂干预和转诊(SBIR)的国家政策倡议代表着1.085亿美元的联邦投资，目前针对的是毒品和酒精使用。然而，以证据为基础的协商一致机构只赞同对有风险的饮酒采取这种干预措施，并报告说，证据仍然不足以支持在普通人群中使用药物的这种干预措施。弥合证据和联邦政策之间的这一令人不安的差距将需要证明，普通人口中成年人使用药物与较差的健康和服务结果相关，并且使用情况的改变与这些结果的变化相关。到目前为止，健康结果数据主要来自成瘾者的临床样本，可能不能为初级保健中的普通人群提供信息。因此，我们建议通过对参加青年冠状动脉风险发展(CARDIA)研究的成年人进行为期20年、地域和种族不同的前瞻性社区队列分析来弥合这一证据差距。这5115名健康的年轻人在1985/86年招募时年龄在18至30岁之间，自那时以来一直接受反复的亲自检查和详细的心理社会评估。CARDIA的药物和酒精使用情况与同时期的国家样本相当。我们建议分析CARDIA的现有数据：(1)表征青壮年(40-52岁)的药物使用轨迹与中年(40-52岁)健康结果之间的关联；(2)表征青壮年的药物使用轨迹与中年的卫生服务利用(包括住院和获得初级医疗保健)之间的关联。假说驱动的分析将考虑大麻和非大麻药物的轨迹与一般健康结果(死亡率、与健康相关的生活质量和医疗条件计数)、特定药物的特定健康结果(与可卡因有关的高血压、与大麻有关的肺功能下降)以及卫生服务利用(住院、急诊室利用和获得初级保健的机会)之间的关系。这一队列的庞大规模，以及对药物、健康、健康服务和心理社会数据的预期收集，使CARDIA独一无二地非常适合这一目的。由于药物使用在生命过程中不断变化，本应用的一个关键创新是应用基于群体的轨迹分析来最佳地捕捉药物使用随时间的动态特征。

DESCRIPTION (provided by applicant): Illicit drug use is common among young adults. Among 18-34 year olds in the general population, nearly as many report past-year use of an illicit drug (30-34%) as report "at-risk" levels of drinking (30-44%), and fewer than half of these qualify as having either an abuse or dependence diagnosis. National policy initiatives for Screening, Brief Intervention and Referral (SBIR), representing a $108.5 million federal investment, presently target both drug and alcohol use. However, evidence-based consensus bodies endorse such interventions only for at-risk drinking, and have reported that the evidence remains insufficient to support such interventions in regard to drug use in the general population. Closing this troubling gap between evidence and federal policy will require a demonstration that drug use among adults in the general population is associated with worse health and service outcomes, and that alterations in use are associated with changes in these outcomes. To date, health outcomes data have principally been accrued from clinical samples of persons with addictions and may not be informative for persons in the general population seen in primary care. We therefore propose to close this evidentiary gap through the analysis of a geographically and racially-diverse 20-year prospective community-based cohort of adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. These 5115 healthy young adults were 18-30 years old when recruited in 1985/86 and have undergone repeated in-person examinations as well as detailed psychosocial assessments since that time. Drug and alcohol use in CARDIA are comparable in prevalence to contemporaneous national samples. We propose analysis of CARDIA's existing data to: (1) Characterize associations between drug use trajectories in young adulthood and health outcomes in middle age (ages 40-52), and (2) Characterize associations between drug use trajectories in young adulthood and health service utilization in middle age, including hospitalization and access to primary medical care. Hypotheses-driven analyses will consider associations between the trajectories of marijuana and nonmarijuana drugs and general health outcomes (mortality, health-related quality of life, and count of medical conditions); specific health outcomes for particular drugs (hypertension in relation to cocaine, pulmonary function decline in relation to marijuana); and health service utilization (hospitalization, emergency department utilization, and access to primary care.) The large size of this cohort, and the prospective collection of detailed drug, health, health service and psychosocial data make CARDIA uniquely well-suited for this purpose. Because drug use changes over the life-course, a key innovation for the present application is the application of group-based trajectory analysis to optimally capture the dynamic character of drug use over time.