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

描述（由申请人提供）：建立酒精消费，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，酒精政策和法规，预防规划和卫生服务的成本估计非常重要。虽然有大量的文献论述了这一主题，但所能得出的结论受到三个重要和相互关联的领域的缺陷的限制：酒精摄入量的测量不佳，对终生饮酒和戒酒的评估有限;缺乏对健康问题对随后饮酒模式的影响的关注;以及对潜在的混杂健康风险因素（如童年逆境和经济困难）和健康行为（如烟草使用、药物使用和锻炼）的治疗不足。此外，尽管有暗示性的证据，但对酒精与健康之间相互关系的种族/民族差异的关注有限。为了解决这些问题和现存文献中的空白，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）特定流行健康状况的影响（心脏病/心脏问题，高血压，糖尿病，癌症和中风），酒精引起的健康问题和自我报告的健康状况对一生中饮酒的影响，（2）一生中饮酒和童年逆境的影响（身体虐待、性虐待、父母酗酒、经济困难和严重疾病），以及（3）终生饮酒模式、童年和成年逆境以及2008-09年经济衰退对自我报告的总体健康状况的影响。拟议中的研究是由生命过程的角度来了解的，重点是饮酒对健康的影响和健康对饮酒的影响，同时注意到重要的替代健康风险因素。NLSY和2010年NAS的研究都对西班牙裔和非洲裔美国人进行了过度抽样，从而考虑了可能导致健康状况和问题中种族和民族差异的因素。该项目采用创新的统计方法， 纵向数据包括边际结构考克斯比例风险生存模型和潜在类增长曲线模型以及回顾性队列设计生存模型和倾向评分匹配。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，这些问题破坏了大多数先前将酒精与健康结果联系起来的研究的有效性。研究结果将记录一般和酒精引起的健康问题的患病率，严重程度和对未来饮酒的影响，提供特定健康状况和整体健康状况的酒精模式风险的估计，并将提供儿童逆境和经济损失的影响的估计在最近的经济衰退对这些健康结果。

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.