Midlife Health and Service Utilization Associated with Early Life Drug Use

描述（由申请人提供）：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%）与报告“有风险”饮酒水平的人数（30-44%）几乎一样多，其中不到一半的人被诊断为滥用或依赖。筛查、短暂干预和转诊国家政策倡议（SBIR）是联邦投资的1.085亿美元，目前以吸毒和酗酒为目标。然而，以证据为基础的共识机构只支持对高危饮酒进行此类干预，并报告说，在普通人群中支持此类干预的证据仍然不足。要缩小证据与联邦政策之间的这一令人不安的差距，就需要证明，普通人群中成年人的吸毒与更差的健康和服务结果有关，而且吸毒的改变与这些结果的变化有关。迄今为止，健康结果数据主要来自成瘾者的临床样本，可能无法为初级保健中的一般人群提供信息。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20年前瞻性社区成人队列的地理和种族分析来缩小这一证据差距。这5115名健康的年轻人在1985/86年被招募时年龄在18-30岁之间，从那时起，他们接受了多次亲自检查以及详细的心理社会评估。CARDIA的药物和酒精使用的流行程度与同期的国家样本相当。我们建议对CARDIA现有数据进行分析，以：(1)表征青年期药物使用轨迹与中年期（40-52岁）健康结果之间的关联，以及(2)表征青年期药物使用轨迹与中年期卫生服务利用之间的关联，包括住院和获得初级医疗保健。假设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状况计数）之间的关联；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）；卫生服务的利用（住院、急诊科的利用和获得初级保健）。该队列的庞大规模，以及详细的药物、健康、卫生服务和社会心理数据的前瞻性收集，使CARDIA非常适合这一目的。由于药物使用在生命过程中会发生变化，因此当前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变化的动态特征。

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.