Health and Functioning in New Midlife Adults: Understanding the Role of Alcohol Use, Social Environments, and Preventive Intervention over the Life Course

摘要 中年的重大转变对一些人来说是积极的，但许多人也会经历情感上的挑战， 身体健康下降，适应新的社会角色的压力很大。然而，中年的健康和功能 与老年人相比，老年人受到的关注较少，因为疾病和残疾仍然相对罕见。这 日益严重的健康挑战和较低的残疾率相结合，为采取干预措施提供了机会， 预防和延迟更严重的疾病和损伤。本研究探讨了知识方面的重要差距， 更好地利用这些机会。对于那些现在处于中年的人来说， 40岁和50岁的人-通常被称为X一代-在人口统计学和家庭中更加多样化 教育和职业发展比前几代人。大多数现有的中年研究也集中在 健康结果相对狭窄，很少考虑身心健康的相互作用， 在工作和公民生活中发挥作用。最近的研究显示，新的中年人群的健康状况显着下降 还强调需要关注中年健康方面的差距和社会人口差异 以及解释它们的机制，特别是酒精滥用的增加及其在中年健康中的核心作用 风险这项研究通过利用现有的纵向数据， 西雅图社会发展项目（SSDP）和收集中年早期的新数据。SSDP遵循了 性别平衡，多种族和社会经济多样化的808名参与者组成的小组，来自 年龄在10到39岁之间，保持率很高。数据包括理论指导的社会环境评估 独特的纵向评估邻里环境，整合自我报告，人口普查， 和地理信息系统措施;以及酒精和其他物质使用和紊乱、精神和 身体健康，以及在工作，社区和公民生活中的功能。新数据扩充和扩展现有数据 这些措施有助于对中年人的具体经历进行审查。研究的目的是 研究（1）社会人口状况和现在进入中年的人的转变如何影响 中年早期的共病健康结果;（2）中年期间酒精使用，滥用和相关行为 影响中年健康，以及酒精使用和滥用的生命历程轨迹的影响， （3）可塑性的社会和邻里环境因素如何影响酒精的使用和滥用 在生命过程中，反过来，影响中年健康;和（4a）检查社会的长期可塑性 环境因素从青春期早期到中年通过测试儿童干预机制 （已纳入现有研究）;及（4 b）透过进行重点研究， 与参与者一起帮助设计和定制预防方案。在经验发现的指导下 和参与者本身，研究的目标是为研究人员和卫生从业人员提供 针对中年人公共卫生优先事项的预防性干预措施的具体建议。

ABSTRACT Significant transitions at midlife can be positive for some, but many also experience emotional challenges, physical health declines, and high stress in adapting to new social roles. Yet, health and functioning at midlife have received less attention compared to older ages because disease and disability remain relatively rare. This combination of growing health challenges and low rates of disability points to opportunities for intervention to prevent and delay more serious illness and impairment. This study addresses important gaps in knowledge to better capitalize on these opportunities. Little is known about how midlife may be different for those now in their 40s and 50s—often labeled Generation X—who are much more diverse demographically and in their family formation and education/career paths than prior generations. Most existing midlife research has also focused on relatively narrow health outcomes with little consideration of the interplay of physical and mental health and functioning in work and civic life. Recent studies showing significant health declines in new midlife cohorts additionally underscore the need for a focus on disparities and sociodemographic differences in midlife health and mechanisms to explain them, particularly increasing alcohol misuse and its central role in midlife health risks. This study brings strengths to examining these issues by drawing on existing longitudinal data from the Seattle Social Development Project (SSDP) and collecting new data in early midlife. SSDP has followed a gender-balanced, multiethnic, and socioeconomically diverse panel of 808 participants across 15 waves from age 10 to 39 with high retention. Data include theory-guided assessments of the social environment throughout; unique longitudinal assessments of neighborhood environments that integrate self-report, Census, and GIS measures; and longitudinal measures of alcohol and other substance use and disorder, mental and physical health, and functioning in work, community, and civic life. New data augment and extend existing measures into midlife and enable the examination of midlife-specific experiences. The study aims are to examine (1) how sociodemographic statuses and transitions among those now entering midlife influence comorbid health outcomes in early midlife; (2) how alcohol use, misuse and related behaviors during midlife influence midlife health, as well as the influence of life course trajectories of alcohol use and misuse leading up to midlife; (3) how malleable social and neighborhood environmental factors influence alcohol use and misuse over the life course and, in turn, affect midlife health; and to (4a) examine the long-term malleability of social environmental factors from early adolescence to midlife by testing the mechanisms of a childhood intervention (embedded in the existing study); and (4b) identify promising adult intervention targets by conducting focus groups with participants to help design and tailor prevention programs. With guidance from empirical findings and participants themselves, the goal of the study is to provide researchers and health practitioners with specific recommendations for preventive interventions addressing public health priorities for midlife adults.