Older Drug Users: A Life Course Study of Turning Points in Drug Use and Injection

描述(由申请人提供)：尽管老年吸毒者的吸毒率和艾滋病毒感染率正在以惊人的速度增长，但作为老年人的这一群体对毒品使用模式和危险行为的了解有限。全国趋势数据显示，45岁或45岁以上的成年人构成吸毒人数增长最快的年龄组，以及新的药物治疗入院和新的艾滋病毒/艾滋病病例。这一探索性R21应用的双重目标是解决目前对老年吸毒者缺乏了解的问题，并提供创新的数学模型，这些模型有可能为未来关于吸毒的具体转折点和生命过程中相关健康风险的研究提供信息。在这项混合方法研究中，我们使用定量方法来识别药物使用和危险行为的转折点，定性方法来更深入地探索这些转折点，数学分析来建立药物轨迹转折点的预测模型。以社区为基础的样本将包括45岁及以上的海洛因、可卡因和甲基苯丙胺的活跃使用者(n=50)和曾经使用海洛因、可卡因和甲基苯丙胺的使用者(n=50)。数据收集使用关于毒品历史和社会角色的量化矩阵和定性的深度访谈。研究地点是亚特兰大的大都会统计区(MSA)，包括城市、郊区和农村环境。通过对这一样本的深入探索所获得的知识将增加我们对吸毒人口老龄化的了解，为未来对老年吸毒者的研究提供信息，并提供关于危险行为和药物使用的创新数学模型，以便在未来的大样本研究中进行测试。为此，我们提出了三个具体目标：(1)确定老年吸毒者在整个生命过程中开始、继续和停止使用药物的转折点；特别是社会角色、种族、性别、年龄、社会背景、政策和历史事件如何影响药物使用和与药物相关的艾滋病毒危险行为的转折点；(2)彻底探索这些转折点和生命过程中的转变，特别是嵌入在生命过程视角中的药物可获得性、危险行为、给药途径、社会角色、网络、支持、政策、环境和地理位置的变化；(3)建立动态贝叶斯网络，对定量和定性数据中的静态和动态方面进行最佳建模。通过这样做，我们不仅能够确定变量之间的统计关系，而且还能够确定这些变量随时间的影响和发展。这些目标共同提供了关于老年吸毒者生活的必要的深入细节，以及可用于针对药物使用轨迹转折点的治疗战略的轨迹模型。这项研究提供的信息和模型可用于通过关注毒品职业生涯的特定转折点来制定更好的预防、干预和治疗计划。这是对方法论的一次独特和创新的探索，可以导致未来的研究。根据这项R21探索性研究拨款开发的模型将被用于建议R01拨款，以延长模型在整个生命过程中对药物轨迹转折点的预测价值。 与公共卫生相关：最近的健康研究表明，老年人中吸毒和艾滋病毒/艾滋病的数量惊人地增加，这一群体主要由婴儿潮一代的老年人组成。回顾老年吸毒者的生活史，可以深入探讨风险因素如何在吸毒者的生命过程中受到社会背景的影响，并有助于确定毒品轨迹的转折点。通过应用我们从本样本中老年吸毒者的生活中学到的东西，这些发现将为针对老年和年轻吸毒者的研究和健康倡议提供信息，包括预防、干预和治疗计划。

DESCRIPTION (provided by applicant): Although drug use and HIV rates among older drug users are increasing at alarming rates, knowledge on drug use patterns and risk behaviors among this cohort as older adults is limited. National trend data show that adults who are 45 or older comprise the fastest growing age group of drug users as well as new drug treatment admissions and new HIV/AIDS cases. The two-fold goal of this exploratory R21 application is to address the lack of current knowledge on older drug users and provide innovative mathematical models that have the potential to inform future research on specific turning points in drug use and related health risks over the life course. In this mixed-methods study we use quantitative methods to identify turning points in drug use and risk behaviors, qualitative methods to explore these turning points more thoroughly, and mathematical analysis to build predictive models on turning points in drug trajectories. The community-based sample will consist of active users (n=50) and former users (n=50) of heroin, cocaine, and methamphetamine age 45 and older. Data are collected using a quantitative matrix on drug history and social roles and a qualitative in-depth interview. The study site is the metropolitan statistical area (MSA) of Atlanta that includes urban, suburban and rural settings. The knowledge gained from an in-depth exploration of this sample will add to our understanding of an aging drug-using population, inform future research on older drug users and provide innovative mathematical models on risk behaviors and drug use to be tested in future large-sample studies. To accomplish this we propose three specific aims: (1) To identify turning points in the onset, continuation, and cessation of drug use throughout the life course of a sample of older users; specifically how social roles, race, gender, age, social contexts, policies and historical events influence turning points in drug use and drug- related HIV risk behaviors; (2) To thoroughly explore these turning points and transitions over the life course, specifically changes in drug availability, risk behaviors, routes of administration, social roles, networks, support, policies, settings, and geographic locations, imbedded in a life course perspective; (3) To build Dynamic Bayesian Networks that best model the static and dynamic aspects found in our quantitative and qualitative data. In so doing we are able to identify not only statistical relationships between the variables but also the influence and progression of these through time. Together these aims provide needed in-depth details on the lives of older drug users as well as trajectory models that can be used to target treatment strategies on the turning points in drug use trajectories. The information and models provided by this study can be used to develop better prevention, intervention and treatment programs by focusing on specific turning points in drug careers. This is a unique and innovative exploration of methodologies that can lead to future studies. The models developed from this R21 exploratory research grant will be used to propose a R01 grant to extend the predictive value of the models on turning points in drug trajectories throughout the life course. PUBLIC HEALTH RELEVANCE: Recent health studies show an alarming increase in drug use and HIV/AIDS among older adults, a cohort composed primarily of aging baby boomers. Retrospective life histories of older adult drug users allow an in- depth exploration how risk factors are influenced by the social context of drug users over the life course and help to identify turning points in the drug trajectory. By applying what we learn from the lives of older drug users in this sample, the findings will inform research and health initiatives for older as well as younger users, including prevention, intervention and treatment programs.