Age-Varying Effects in the Epidemiology of Drug Abuse

 描述(由申请人提供)：为了提高药物滥用干预的效率和效果，了解与年龄相关的行为流行率、合并症和健康差距的变化，以及从青春期到中年的各种危险因素的演变作用，是至关重要的。今天，现有的大量高质量数据具有巨大的潜力，可以为这些问题提供新的线索。其中许多数据集具有全国代表性，来自不同年龄段的人群。现在有了新的方法来挖掘这些数据，以便从发展的角度解决关于药物使用、滥用和依赖(药物UAD)的重要的新的科学问题。为此，我们建议创新地将时变效应模型(TVEM)应用于两项互补的全国性健康危险行为研究的数据：全国青少年健康纵向研究(N=20,745)和2012年全国药物使用与健康调查(N=63,809)。TVEM灵活地将行为普及率和变量之间的关联估计为年龄的连续、灵活的函数。具体地说，这一项目的具体目标如下。(1)模拟从青春期到中年的灵活的、不同年龄的药物UAD趋势。我们将估计酒精、烟草、大麻和其他药物使用、滥用和依赖的比率，作为从12岁到50岁连续年龄的复杂函数。将对性别和种族/族裔的趋势进行估计，以记录不同年龄段的健康差距。(2)阐明心理健康问题在吸毒人群从青春期到成年中期的年龄变化过程中的作用。我们将研究抑郁症状和自杀意念如何与药物UAD作为一个连续的、复杂的功能从12岁到50岁的不同相关。(3)评估从青春期到中年的早期和合并危险因素对药物UAD的年龄变化影响。我们将研究如何以及何时特定的风险和保护因素与12岁至50岁的药物UAD有关。我们将考虑个人、父母、同伴、学校和社区层面的早期风险因素，以及婚姻和为人父母等同时存在的因素。(4)审查毒品使用中造成健康差距的因素。为了加深对健康差异发展过程的了解，我们将考察性别和种族/民族作为(A)不同年龄的药物UAD和精神健康问题共生的调节因素，以及(B)危险因素和药物UAD之间的不同年龄相关性。该项目将提供有关药物UAD的发展历程和相关健康差距的知识，使预防科学家和临床医生能够设计干预措施，使人口亚组中最有希望的变化机制达到最合适的年龄阶段。为了最大限度地扩大该项目的整体影响，我们将积极向药物滥用研究人员传播这一有前途的新分析方法。

 DESCRIPTION (provided by applicant): To improve the efficiency and efficacy of drug abuse interventions, an understanding of the age-related changes in behavior prevalences, comorbidities, and health disparities, and the evolving role of various risk factors from adolescence through middle adulthood, is crucial. Today there is an unprecedented amount of existing high-quality data that have enormous potential to shed new light on these issues. Many of these data sets are nationally representative, drawn from populations that span a wide range of ages. New methods now exist to tap those data in order to address important, new scientific questions about drug use, abuse, and dependence (drug UAD) from a developmental perspective. To this end, we propose the innovative application of the time-varying effect model (TVEM) to data from two complementary national studies of health risk behaviors: The National Longitudinal Study of Adolescent Health (N=20,745) and the 2012 National Survey on Drug Use and Health (N=63,809). TVEM flexibly estimates behavior prevalences and associations among variables as continuous, flexible functions of age. Specifically, the specific aims for this projec are as follows. (1) To model flexible, age-varying trends in drug UAD from adolescence into middle adulthood. We will estimate rates of alcohol, tobacco, marijuana, and other drug use, abuse and dependence as a complex function of continuous age from ages 12 to 50. Trends will be estimated across sex and race/ethnicity to document age-varying health disparities. (2) To elucidate the age-varying role of mental health problems in the course of drug UAD from adolescence into middle adulthood. We will examine how depressive symptoms and suicidal ideation are differentially associated with drug UAD as a continuous, complex function from ages 12 to 50. (3) To estimate age-varying effects of early and concurrent risk factors on drug UAD from adolescence into middle adulthood. We will examine how and when specific risk and protective factors are associated with drug UAD from ages 12 to 50. We will consider early risk factors at the individual, parent, peer, school, and community levels, as well as concurrent factors such as marriage and parenthood. (4) To examine contributors to health disparities in drug use. To advance understanding of the developmental course of health disparities, we will examine sex and race/ethnicity as moderators of (a) age-varying comorbidities of drug UAD and mental health problems and (b) age-varying associations between risk factors and drug UAD. This project will provide knowledge about the developmental course of drug UAD and related health disparities, allowing prevention scientists and clinicians to design interventions that matc the most promising mechanisms of change to the most appropriate age period within population subgroups. To maximize the project's overall impact, we will actively disseminate this promising new analytic approach to drug abuse researchers.