POLICY AS ENVIRONMENT : LONG-TERM EFFECTS OF LAWS RESTRICTING YOUTH SUBSTANCE USE

描述（由申请人提供）：早期使用成瘾物质是随后物质相关问题（包括依赖性）的可靠预测因素。然而，关于旨在遏制早期使用的政策和其他干预措施是否会对长期依赖性的形成和相关的健康问题产生重大影响，存在着争论。此处提议的研究的全球目标是，利用关于青年可以合法购买酒精或烟草的年龄的历史性政策变化作为自然实验，以检验青少年接触可能对成年期药物使用问题和与药物有关的发病率和死亡率产生非常长期的影响这一假设。我们最近的工作已经确定，最低法律的饮酒年龄法律（MLDAs）可能会影响物质使用障碍的风险，即使在30多岁、40多岁或50多岁的个体中也是如此（Norberg et al. 2009）。在本项目中，这一办法将扩大到其他长期成果，并将对限制青年获得烟草的政策采用类似办法。分析将使用现有的流行病学数据集，这些数据集往往具有全国代表性，样本规模从数万到数十万不等，从而能够研究按种族、性别或其他变量分列的影响异质性。计量经济学方法将用于控制许多观察到的和未观察到的潜在混杂因素。如有可能，将检查各数据集结果的一致性。具体目标包括：（1）调查MLDA政策对酗酒，其他物质使用以及成年后共同发生的条件和行为的长期影响。调查限制青少年获得烟草的法律（YATT法律）对成年人吸烟行为和成年人饮酒及吸毒的影响。根据我们的初步结果，作为一个子目标的假设，YATT的法律预测降低吸烟率的孕妇将进行测试。3.）第三章研究MLDA政策对发病率和死亡率的影响。烟草和酒精成瘾是美国和全球主要的公共卫生问题之一。这里提出的工作有可能阐明可改变的环境风险因素对明确的环境问题的持续影响。

DESCRIPTION (provided by applicant): Early use of addictive substances is a robust predictor of subsequent substance-related problems, including dependence. However, there is debate about whether policy and other interventions aimed at curbing early use would have significant effects on the development of dependence and related health problems over the long- term. The global aim of the studies proposed here is to use historical policy changes governing the age at which youth may legally purchase alcohol or tobacco as natural experiments to test the hypothesis that adolescent exposures may have very long-term effects on substance-use problems and substance-related morbidity and mortality in adulthood. Our recent work has established that minimum legal drinking age laws (MLDAs) may influence risk for substance use disorder, even among individuals in their 30s, 40s or 50s (Norberg et al. 2009). In this project, this approach will be extended to other long-term outcomes and a similar approach will be applied to policies restricting youth access to tobacco. Analyses will use existing epidemiological data sets, often nationally representative, with sample sizes in the range of tens to hundreds of thousands, enabling the study of heterogeneity of effects by race, sex or other variables. Econometric methods will be used to control for many observed and unobserved potential confounders. When possible, consistency of results across data sets will be examined. Specific Aims include 1.) To investigate the long-term effects of MLDA policy on binge drinking, other substance use, and co-occurring conditions and behaviors in adulthood 2.) To investigate the effects of laws restricting youth access to tobacco (YATT laws) on adult smoking behavior and adult drinking and drug use. Based on our preliminary results, as a sub-aim the hypothesis that YATT laws predict reduced rates of smoking among pregnant women will be tested. 3.) To examine morbidity and mortality effects of MLDA policy. Addiction to tobacco and alcohol are among the leading public health problems both in the U.S. and globally. The work proposed here has the potential to shed light on persistent effects of modifiable environmental risk factors for problems of clear