This R03 grant application asks for a two year grant award for analysis of data collected as part of the Health and Adjustment of Young Adults Study (HAYA), a three wave, longitudinal study of 1007 21-30 year olds selected from enrollees in an HMO in southeastern Michigan. These analyses will shed light on the impact of drug involvement on health-related outcomes, with a particular focus on utilization of health services. In addition, results from this study will provide evidence on the relative importance of frequency of drug use versus classification of substance use disorders as indicators of drug involvement in relation to health outcomes. An additional component of the proposed analysis will determine sources of discordance between two instruments designed to measure DSM-IIIR substance use disorder, the Diagnostic Interview Schedule (DIS) and the University of Michigan Composite International Diagnostic Interview (UM-CIDI). The impact of this discordance on associations between substance use disorder and health outcomes will be examined. The DIS was administered to HAYA participants in 1989,1992, and 1994, with less than 5% of respondents lost to follow-up, providing longitudinal data on psychiatric disorders and their course for almost the entire sample. A supplement containing drug use items from the UM-CIDI was administered at the second wave of interview in 1992. Because participants were selected on the basis of enrollment in an HMO, computerized medical records are available, providing detailed information on the utilization of health services. This combination of available medical records and longitudinal data from a population based sample presents a unique opportunity to build on prior research for a relatively low cost. There are multiple potential public health benefits from this study. Greater understanding of the relationship between drug involvement and health outcomes among young adults in the general population will help guide public policy and prevention efforts. A comparison of results based on the DIS and UM-CIDI, and the relative impact of these measures of substance use disorder on will have implications for the selection of measures of drug involvement in future studies. The proposal includes a plan for the dissemination of results via scientific papers in peer- reviewed literature and through presentations at the scientific meetings (such as the College on Problems of Drug Dependence).
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