Chronic Stressors and Alcohol and Drug Abuse in Middle-aged Adults: White/BlackDifferences

摘要 这项全国性的研究解决了导致这一逆转的最显著的心理社会原因 自2005年以来，受教育程度较低的美国非西班牙裔白人中年死亡率下降 1998年，主要是由于药物和酒精中毒以及自杀造成的死亡率。具体目标 是为了1.实证证明个体慢性应激源和 社区层面的压力源、酒精和药物滥用以及随时间推移的健康结果 中年白人与非西班牙裔黑人相比，与教育程度有关。 建立慢性应激源之间关系的显著中介和调节变量模型， 酒精和药物滥用，以及中年人的健康后果，包括社会- 心理因素(与显著参照组相比，感知到的成就限制)， 社会参与(社会支持、政治参与、宗教参与、婚姻/伴侣 健康、精神健康和药物滥用服务的获得和利用。我们的 理论模型体现了来自参考群体理论、社会参与的因素 与失范和缺乏获得健康、精神健康和药物滥用服务的情况相比 治疗应激源衍生的症状，这种症状可以用酒精替代自我用药 和毒品，并对健康造成负面影响。我们的假设将通过进行 纵向四波邮寄测量(第一波N=2500)。我们将利用一个全国性的地址- 以中年成年人(40-60岁)为基础样本，按种族、教育程度和 农村与城市/郊区的位置。数据分析技术将包括结构方程 建模和纵向生长曲线分析。定性访谈与小分部 受访者样本(N=40)将探索主要假设因素如何以及为什么预测 酒精和药物滥用以及随着时间的推移健康状况下降，与白人相比， 非西班牙裔黑人。这项研究的结果将有助于形成证据-- 以最有希望阻止的社会政策和治疗干预措施为基础的增加 研究不足、酗酒和吸毒高危人群的中年死亡率。

Abstract This national study addresses the most salient psychosocial causes of the reversal in the decline in midlife mortality for U.S. white non-Hispanics of lower educational attainment since 1998, largely due to death rates from drug and alcohol poisoning and suicide. The specific aims are to 1. Empirically demonstrate the associations between individual chronic stressors and community-level stressors, alcohol and drug abuse, and health outcomes over time among middle-aged whites compared to non-Hispanic blacks linked with educational attainment and 2. Model the salient mediators and moderators of the relationships between chronic stressors, alcohol and drug abuse, and health outcomes in middle-aged individuals, including social- psychological factors (perceived achievement limitations compared to salient reference group), social engagement (social support, political engagement, religious involvement, marital/partner status) and access to and utilization of health, mental health and substance abuse services. Our theoretical model embodies factors derived from reference group theory, social engagement versus anomie and lack of access to health, mental health and substance abuse services to treat stressor-derived symptomatology which may be alternatively self-medicated with alcohol and drugs and negatively impact health. Our hypotheses will be tested by conducting a longitudinal four wave mail survey (N=2500 at wave 1). We will utilize a nationwide address- based sample of middle-aged adults (40-60), oversampling by race, educational attainment and rural versus urban/suburban location. Data analytical techniques will include structural equation modelling and longitudinal growth curve analyses. Qualitative interviews with a small sub- sample of respondents (N=40) will explore how and why the main hypothesized factors predict alcohol and drug abuse and diminished health over time differentially for whites compared to non-Hispanic blacks. The findings from this study will contribute to the formulation of evidence- based social policies and treatment interventions with the most promise for halting increased midlife mortality in an understudied group at high risk for alcohol and drug abuse.