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包括依赖在内的后续物质相关问题的有力预测因素。然而，对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的发展和相关的健康问题产生重大影响，存在争议。这里提出的研究的全球目的是利用管理青少年可以合法购买酒精或烟草的年龄的历史政策变化作为自然实验，来检验青少年接触酒精或烟草可能对成年期的药物使用问题和与药物相关的发病率和死亡率产生非常长期的影响的假设。我们最近的工作已经确定，最低法定饮酒年龄法(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多岁的人中也是如此(Norberg等人)。2009年)。在该项目中，这一方法将扩展到其他长期成果，并将类似的方法应用于限制青年吸烟的政策。分析将使用现有的流行病学数据集，通常具有全国代表性，样本量在数万到数十万之间，从而能够研究种族、性别或其他变量影响的异质性。计量经济学方法将被用来控制许多可观察到的和未观察到的潜在混杂因素。在可能的情况下，将检查数据集结果的一致性。具体目标包括1.)调查MLDA政策对成年期酗酒、其他物质使用以及共生条件和行为的长期影响。调查限制青少年接触烟草的法律(YATT法)对成人吸烟行为和成人饮酒和药物使用的影响。根据我们的初步结果，作为一个子目标，雅特定律预测孕妇吸烟率下降的假设将得到检验。3.)检查MLDA政策对发病率和死亡率的影响。烟酒成瘾是美国和全球主要的公共健康问题之一。这里提出的工作有可能阐明可改变的环境风险因素对与公共卫生明显相关的问题的持续影响。这些目标的实现将得到一个强大的跨学科团队和丰富的协作环境的推动。 公共卫生相关性：我们打算将管理青少年接触酒精和烟草的历史政策变化作为“自然实验”，研究青少年更容易接触酒精和烟草的政策环境是否会导致成瘾风险增加，并对成年后的健康产生相关影响。烟酒成瘾是美国和全球发病率和死亡率的主要可改变的原因之一；这些研究有可能揭示这些可改变的环境风险因素对重大公共问题的未研究的长期影响。

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 public health relevance. Accomplishment of these aims will be facilitated by a strong-interdisciplinary team and a rich collaborative environment. PUBLIC HEALTH RELEVANCE: We intend to use historical policy changes governing adolescent access to alcohol and tobacco as "natural experiments" to study whether policy environments in which adolescents have easier access to alcohol and tobacco lead to elevated risk for addiction and related health effects later in adulthood. Addiction to tobacco and alcohol are among the leading modifiable causes of morbidity and mortality in the U.S. and globally; and these studies have the potential to shed light on unstudied long-term effects of these modifiable environmental risk factors for significant public problems.