An innovative methodological approach to analyzing alcohol use transitions in the context of prescription drug misuse and other health behaviors

摘要 该提案描述了一项计划，研究是什么推动了青年酒精滥用的转变， 这些转变如何与其他健康行为转变结合。特别令人关切的是 最近处方类阿片和镇静剂的处方和滥用有所增加， 促进了与酒精滥用有关的新危机的出现：它对过量的贡献 与处方阿片类药物和/或镇静剂联合使用时存在风险。先前的研究 确定了酒精滥用的个人，同伴，父母和社区水平的相关性，但很少 实证研究的重点是什么驱动酒精使用行为的转变。填补这一空白， 为干预和预防设计提供信息的巨大潜力。具体而言，促进 转变成更有问题的饮酒模式是预防的重要目标， 那些与长期持续酗酒有关的人是干预的目标。到 为了解决这一知识差距，我们将分析在NIDA资助的（R 01）弗林特期间收集的数据， 青年伤害研究，一项对600名从急诊室招募的吸毒青年的纵向研究 在密歇根州弗林特市。使用创新的分析技术，我们将模拟行为 在随访期间（大约6个月随访2年，共5年）， 测量）作为具有协变量调制转移的连续时间马尔可夫链 概率除了协变量如何影响转换率的直接建模外， 这种建模框架的优点是对缺失时间点和变异的优雅处理 跟进时间表里的该项目的第一个也是主要的具体目标是 估计变量在多个层面（个人，同伴，父母，社区）的影响， 酒精使用状态之间的转换;将检验协变量效应的状态依赖性， 明确区分预防目标和干预目标。第二个目标，我们将 对其他行为的转变进行类似分析-艾滋病毒危险行为、武器 攻击性和非医疗处方药的使用-在研究期间。第三个目标，我们 将使用每次随访时收集的90天物质使用时间轴随访日历数据， 确定过量风险天数（即同时使用酒精和处方的天数 药物使用），并使用广义线性模型对酒精使用情况进行建模 前一个随访期间的转换映射到过量风险日的频率。这些 工作将提供以下信息：a）干预和预防方案的关键目标; B） 酒精使用过渡如何与其他健康过渡结合;以及c）什么类型的酒精 使用模式可以预测处方药过量的风险。

ABSTRACT This proposal describes a plan to study what drives transitions in alcohol misuse in youth, and how those transitions coalesce with other health behavior transitions. Of particular concern is the recent increase in the prescribing, and misuse, of prescription opioids and sedatives, which has facilitated the emergence of a new crisis related to alcohol misuse: its contribution to overdose risk when used in combination with prescription opioids and/or sedatives. Prior research has identified individual-, peer-, parental-, and community-level correlates of alcohol misuse, but little empirical research focuses on what drives transitions in alcohol use behavior. Filling this gap has great potential to inform intervention and prevention design. Specifically, factors that facilitate transitions into more problematic drinking patterns are important targets for prevention, while those associated with sustained problematic drinking over time are targets for intervention. To address this knowledge gap, we will analyze data collected during the NIDA-funded (R01) Flint Youth Injury study, a longitudinal study of 600 drug-using youth recruited from an Emergency Department in Flint, Michigan. Using an innovative analytic technique, we will model behaviors over the follow-up period (roughly 6-month follow-ups for two years, for a total of five measurements) as continuous-time Markov Chains with covariate-modulated transition probabilities. In addition to the direct modeling of how covariates affect transition rates, a key advantage of this modeling framework is the elegant handling of missing time points and variation in the exact follow-up schedule. The first, and primary, specific aim of this project will be to estimate the effects of variables at multiple levels (individual, peer, parental, community) on transitions between alcohol use states; covariate effects will be tested for state-dependence to explicitly differentiate between targets for prevention vs. intervention. In the second aim, we will carry out analogous analyses for transitions in other behaviors – HIV-risk behaviors, weapon aggression, and non-medical prescription drug use – over the study period. In the third aim, we will use 90-day substance use timeline follow-back calendar data gathered at each follow-up to ascertain the number of overdose risk days (i.e. days with concurrent alcohol use and prescription drug use) for each participant, and to model, using generalized linear models, how alcohol use transitions during the previous follow-up period map onto frequency of overdose risk days. These works will provide information about a) key targets for intervention and prevention programs; b) how alcohol use transitions coalesce with other health transitions; and c) what types of alcohol use patterns are predictive of prescription drug overdose risk.