Drug Abuse Trajectories in the Transition to Adulthood: Risk Factors and Outcomes

描述(由申请者提供)：在过去的一个月里，全国750万全日制大学生中估计有21%的人使用过违禁药物。此外，我们在过去三年的工作证明，同时使用非医疗处方药、其他非法药物使用和大量饮酒都可能影响大学生的健康、安全和福祉。不幸的是，之前对大学生的大多数研究都只关注酒精；关于大学生吸毒和相关问题的少数研究解释能力有限，或者没有涵盖广泛的风险因素和后果。关于毒品问题(包括药物使用障碍)及其大学毕业后的后遗症的持续存在的问题仍然没有答案。这一知识差距严重阻碍了青少年的毒品预防工作和预防性保健服务。2003年，我们的调查团队开始了一项由NIDA资助的史无前例的倡议，以弥补这一差距-并更多地了解大学生中非法药物使用的自然历史和后果。系统抽样获得了1253名学生进行纵向前瞻性研究的队列，其中95%的学生在3年的跟踪调查后仍活跃在研究中。深入的年度访谈产生了丰富的数据集，其中包含广泛的风险因素和结果。所有学生，无论学术地位如何，都仍在接受研究。这项续签申请建立在我们之前的发现基础上，并建议继续我们对这一有价值的队列的后续行动，以回答有关成年后心理社会和身体健康结果的新问题。具体地说，它的目的是：1)研究药物使用轨迹的持续性，包括药物问题的解决和依赖性的发展；2)了解大学药物使用可能如何干扰职业目标和适应性社会支持结构等发展里程碑的实现；3)检查药物使用和心理健康随着时间的推移与身体健康(包括高危性行为)和生活质量的相互关系；以及4)检查可卡因和非医疗处方药使用的潜在不良长期后果，在我们的样本中，随着时间的推移，这两者都显著增加。这一更新为该领域提供了一个探索新的跨学科研究领域的难得机会，并将使用前瞻性多维建模，该模型将利用十年的数据来了解他们在大学后时期的健康和功能。这项研究的继续将使NIDA在该项目上的早期投资获得最大回报。最终，这些结果将导致创新的药物滥用干预战略，塑造临床决策，并改善年轻人的卫生服务提供系统。我们雄心勃勃和全面的方法确保这项纵向前瞻性研究将回答以下主要问题：如何减少与药物滥用相关的长期个人和家庭动荡，使年轻人能够发挥他们的个人潜力，并减少社会不必要的经济成本。公共卫生相关性：这项继续跟踪1253名大学生纵向队列的续签申请具有广泛的公共卫生影响，因为它侧重于影响年轻人的三个最重要的健康后果(即药物滥用、精神障碍和性传播疾病)。该项目将继续衡量广泛的风险和保护因素，并从纵向发展的角度提供信息；因此，该项目在阐明特别是预防药物滥用的目标以及为年轻人提供一般保健服务方面具有很大潜力。我们雄心勃勃和全面的方法将使我们能够确定可以改变有问题的轨迹以避免长期后果的点，使年轻人能够发挥他们的个人潜力，并减少社会不必要的经济成本。

DESCRIPTION (provided by applicant): An estimated 21 percent of the nation's 7.5 million full-time college students have used an illicit drug in the past month. Moreover, our work over the past three years has documented that concurrent nonmedical prescription drug use, other illicit drug use, and heavy drinking can all potentially affect the health, safety and well-being of college students. Unfortunately, most prior research on college students has focused solely on alcohol; the few studies on college student drug use and associated problems have had limited explanatory power or have not covered a wide scope of risk factors and consequences. Questions regarding the persistence of drug problems, (including substance use disorder) and their sequelae after college remain unanswered. This knowledge gap has severely hampered drug prevention efforts and preventive health care services for young adults. In 2003, our investigative team began an unprecedented NIDA- funded initiative to address this gap-and learn more about the natural history and consequences of illicit drug use among college students. Systematic sampling yielded a cohort of 1253 students for a longitudinal prospective study, of which 95 percent are still active in the study after 3 years of follow-up. In-depth annual interviews have yielded a rich dataset containing a wide array risk factors and outcomes. All students, regardless of academic status, are still being studied. This renewal application builds on our previous findings and proposes to continue our follow-up of this valuable cohort to answer new questions about psychosocial and physical health outcomes as they transition to adulthood. Specifically, it aims to: 1) study the persistence of drug use trajectories, including the resolution of drug problems and development of dependence; 2) understand how college drug use might interfere with achieving developmental milestones such as occupational goals and adaptive social support structures; 3) examine the reciprocal relationships over time of drug use and mental health in relation to physical health (including high-risk sexual behaviors) and quality of life; and, 4) examine potential adverse long-term consequences of cocaine and nonmedical prescription drug use, which have both significantly increased over time in our sample. This renewal offers the field a rare opportunity to probe into new transdisciplinary areas of research, and will use prospective multidimensional modeling that will take advantage of ten years of data to understand their health and functioning in the post-college period. The continuation of this study will maximize the return on NIDA's earlier investment in the project. Ultimately, the results will lead to innovative drug abuse intervention strategies, shape clinical decision-making, and improve health service delivery systems for young adults. Our ambitious and comprehensive approach ensures that this longitudinal prospective study will answer major questions about how to reduce the long-term personal and family turmoil associated with drug abuse, enable young adults to fulfill their individual potential, and reduce unnecessary economic costs to society. PUBLIC HEALTH RELEVANCE: This renewal application to continue following a longitudinal cohort of 1253 college students has broad public health implications in that it focuses on three of the most significant health outcomes affecting young adults (i.e., drug abuse, mental disorders, and sexually transmitted diseases). The project will continue to measure a wide array of risk and protective factors, and is informed by a longitudinal developmental perspective; therefore, it has great potential for elucidating targets for drug abuse prevention in particular, and the delivery of health care services in general for young adults. Our ambitious and comprehensive approach will enable us to identify points at which problematic trajectories can be changed to avoid long-term consequences, enable young adults to fulfill their individual potential, and reduce unnecessary economic costs to society.