Inter-Relationships Between Life-Course Alcohol Patterns and Health Conditions

说明(由申请人提供)：确定酒精消费、饮酒模式和常见健康问题之间的因果关系，对于消费者的健康教育、酒精政策和监管、预防规划和卫生服务成本估算非常重要。虽然有大量文献讨论了这一主题，但可以得出的结论受到三个重要且相互关联的领域的缺陷的限制：对酒精摄入量的测量不当，对终生饮酒和戒酒的评估有限；对健康问题对随后的酒精模式的影响缺乏关注；以及对潜在的混杂健康风险因素，如童年逆境和经济困难，以及健康行为，如吸烟、吸毒和锻炼的治疗不足。此外，人们对酒精与健康相互关系中的种族/民族差异的关注有限，尽管有证据表明存在这种差异。为了解决现有文献中的这些问题和差距，拟议的研究将对1979年和1997年的全国青年纵向调查(NLSY)和2010年的全国酒精调查(NAS)进行新的分析。我们将研究：(1)特定的普遍健康状况(心脏病/心脏问题、高血压、糖尿病、癌症和中风)、由酒精引起的健康问题和自我报告的健康状况对一生饮酒的影响；(2)一生饮酒和童年逆境(身体虐待、性虐待、父母酗酒、经济困难和严重疾病)对特定健康状况的影响；以及(3)一生饮酒模式、儿童和成人的逆境以及2008-09年经济衰退对自我报告的一般健康状况的影响。这项拟议的研究从生命过程的角度出发，既关注饮酒对健康的影响，也关注健康对饮酒的影响，同时关注重要的替代健康风险因素。NLSY和2010年NAS都对拉美裔和非裔美国人进行了过度抽样的研究，从而能够考虑可能导致种族和族裔在健康状况和问题上存在差异的因素。该项目使用创新的统计方法 纵向数据包括边际结构Cox比例风险生存模型和潜在班级增长曲线模型，以及回溯性队列设计生存模型和倾向得分匹配模型。研究结果将为酒精使用和健康之间的相互关系提供新的见解，避免常见的错误分类问题，这些问题破坏了之前大多数将酒精与健康结果联系在一起的研究的有效性。研究结果将记录一般饮酒和与酒精有关的健康问题的患病率、严重性和对未来饮酒的影响，估计特定健康状况和总体健康状况的酒精模式风险，并估计童年逆境和最近经济衰退中的经济损失对这些健康结果的影响。

DESCRIPTION (provided by applicant): Establishing causal relationships between alcohol consumption, drinking patterns and common health problems is important for health education of consumers, alcohol policy and regulation, prevention programming and cost estimates for health services. While a large body of literature has addressed this topic, the conclusions that can be drawn have been limited by shortcomings in three important and inter- related areas: poor measurement of alcohol intake and limited assessment of life-course drinking and abstention; lack of attention to the influence of health problems on subsequent alcohol patterns; and inadequate treatment of potentially confounding health risk factors, such as childhood adversity and economic hardship, and health behaviors such as tobacco use, drug use, and exercise. Moreover, there has been limited attention to racial/ethnic differences in the inter-relationships of alcohol and health, despite suggestive evidence of such. To address these issues and gaps in the extant literature, the proposed study would conduct new analyses of the National Longitudinal Survey of Youth (NLSY) 1979 and 1997 cohorts and of the 2010 National Alcohol Survey (NAS). We will examine: (1) effects of specific prevalent health conditions (heart disease/heart problems, hypertension, diabetes, cancers and stroke), alcohol-attributable health problems and self-reported health status on alcohol consumption over the life course, (2) influences of life-course alcohol use and childhood adversity (physical abuse, sexual abuse, parental alcoholism, economic hardship and serious illnesses) on the onset of specific health conditions, and (3) effects of life-course alcohol use patterns, childhood and adult adversity and economic impacts of the 2008-09 recession on self-reported general health status. The proposed study is informed by a life- course perspective, focusing on both the influences of drinking on health and the influences of health on drinking while attending to important alternative health risk factors. Both the NLSY and 2010 NAS studies over-sampled Hispanics and African Americans, allowing consideration of factors that may contribute to racial and ethnic disparities in health conditions and problems. This project uses innovative statistical methods for longitudinal data including marginal structural Cox proportional hazards survival models and latent class growth curve models as well as retrospective cohort design survival models and propensity score matching. Results will provide new insights into inter-relationships between alcohol use and heath by avoiding common misclassification problems that undermine the validity of most previous research linking alcohol with health outcomes. Study findings will document the prevalence, severity and impact on future drinking of general and alcohol attributed health problems, provide estimates of alcohol pattern risks for specific health conditions and overall health status, and will provide estimates of impacts of childhood adversity and economic losses in the recent recession on these health outcomes.