The fellowship applicant's long-term goal is to build an academic alcohol and drug epidemiology research program that (1) clarifies the causes and consequences of population-level patterns of alcohol and drug use and (2) generates results that can be translated into public health policy recommendations. The mutually reinforcing training plan and research study in this proposal are designed to help the applicant take the necessary methodological and professional steps towards his goal. Project rationale and objectives: In recent years, mortality due to injury, poisoning, suicide, and liver disease increased substantially and contributed to a decline in U.S. life expectancy. Alcohol and prescription medication use have been identified as key contributors, but the nature and scope of this contribution require further clarification in order to create effective solutions. Risky alcohol and medication use trends have not manifested uniformly in the population. For example, recent increases in binge drinking are concentrated among adults age 45+ and differences in national drinking patterns between males and females are shrinking rapidly. In parallel, prescriptions for central nervous system depressant (CNS-D) medication (e.g., opioids, benzodiazepines, and Z-drug sleep medications) increased substantially and are also concentrated among those age 45+ and among females. Concurrent use of alcohol and CNS-D medications amplifies the risk of injury or poisoning, and this risk may be even further magnified among certain subgroups (e.g., older adults or females). These dynamics may be contributing disproportionately to morbidity trends. By using restricted data files to link prescription medication data in the Medical Expenditure Panel Survey (MEPS) with alcohol use data for the same individual in the National Health Interview Survey (NHIS), we can develop a more comprehensive explanatory model of alcohol- and medication-related morbidity in the U.S. The research project within this F32 is aimed at determining (1) which patterns of alcohol use, medication use, and demographics alter the risk of injury or poisoning, and (2) the extent to which changes in the prevalence of high-risk alcohol and medication use patterns account for population-level injury and poisoning trends. Training: The training plan in this fellowship outlines four learning objectives: (1) alcohol epidemiology and alcohol policy research; (2) advanced analytical methods in epidemiology and pharmacoepidemiology; (3) content-knowledge and analysis of national health surveys; (4) professional development (including responsible conduct of research and K01 grant development). These objectives will be achieved through formal courses, directed readings, discussions with mentors, and execution of the proposed project. These experiences fill specific knowledge and skill gaps and will enhance the applicant's ability to develop an independent research career.
Increases in risky drinking and prescriptions for central nervous system depressant (CNS-D) medications (e.g. benzodiazepines) have been concentrated among adults age 45 and older and among women. The interplay among alcohol, CNS-D medications, and demographics, may confer excessively high risk for injury and poisoning ? potentially contributing disproportionately to the recent increases in U.S. mortality and morbidity. The objectives of this study are to determine how combinations of alcohol use, prescription medication use, and demographics contribute to the individual-level and population-level injuries and poisonings outcomes, and to provide the applicant with hands-on training in advanced epidemiological methods.
