Chronic Stressors and Alcohol and Drug Abuse in Middle-aged Adults: White/BlackDifferences

摘要 这项全国性的研究探讨了造成这种逆转的最突出的社会心理原因， 自2005年以来，美国白色非西班牙裔美国人的中年死亡率下降， 1998年，主要是由于药物和酒精中毒和自杀的死亡率。具体目标 是1。从经验上证明个人慢性压力源和 社区一级的压力，酒精和药物滥用，以及随着时间的推移， 与非西班牙裔黑人相比，中年白人与教育程度有关，2. 模拟慢性压力源之间关系的显著中介者和调节者， 酒精和药物滥用，以及中年人的健康结果，包括社会- 心理因素（与显著参考组相比，感知的成就限制）， 社会参与（社会支持，政治参与，宗教参与，婚姻/伴侣 健康、精神健康和药物滥用服务的获得和利用。我们 理论模型体现了参考群体理论、社会参与 与失范和缺乏获得保健、心理健康和药物滥用服务的机会相比， 治疗应激源性精神病，也可以用酒精进行自我治疗 和毒品，对健康产生负面影响。我们的假设将通过进行一项 纵向四波邮寄调查（第1波，N=2500）。我们将使用全国性的地址- 基于中年人（40-60岁）的样本，按种族、教育程度和 农村与城市/郊区位置。数据分析技术将包括结构方程 建模和纵向增长曲线分析。与一个小的子定性访谈- 受访者样本（N=40）将探讨如何以及为什么主要假设因素预测 酒精和药物滥用以及随着时间的推移健康状况的下降， 非西班牙裔黑人这项研究的结果将有助于形成证据- 最有希望阻止艾滋病毒/艾滋病增加的社会政策和治疗干预措施 在未充分研究的酒精和药物滥用高风险人群中的中年死亡率。

Abstract This national study addresses the most salient psychosocial causes of the reversal in the decline in midlife mortality for U.S. white non-Hispanics of lower educational attainment since 1998, largely due to death rates from drug and alcohol poisoning and suicide. The specific aims are to 1. Empirically demonstrate the associations between individual chronic stressors and community-level stressors, alcohol and drug abuse, and health outcomes over time among middle-aged whites compared to non-Hispanic blacks linked with educational attainment and 2. Model the salient mediators and moderators of the relationships between chronic stressors, alcohol and drug abuse, and health outcomes in middle-aged individuals, including social- psychological factors (perceived achievement limitations compared to salient reference group), social engagement (social support, political engagement, religious involvement, marital/partner status) and access to and utilization of health, mental health and substance abuse services. Our theoretical model embodies factors derived from reference group theory, social engagement versus anomie and lack of access to health, mental health and substance abuse services to treat stressor-derived symptomatology which may be alternatively self-medicated with alcohol and drugs and negatively impact health. Our hypotheses will be tested by conducting a longitudinal four wave mail survey (N=2500 at wave 1). We will utilize a nationwide address- based sample of middle-aged adults (40-60), oversampling by race, educational attainment and rural versus urban/suburban location. Data analytical techniques will include structural equation modelling and longitudinal growth curve analyses. Qualitative interviews with a small sub- sample of respondents (N=40) will explore how and why the main hypothesized factors predict alcohol and drug abuse and diminished health over time differentially for whites compared to non-Hispanic blacks. The findings from this study will contribute to the formulation of evidence- based social policies and treatment interventions with the most promise for halting increased midlife mortality in an understudied group at high risk for alcohol and drug abuse.