Preventing Substance Use in the Context of Poverty: Risk and Protection from Early Childhood to Early Adulthood

摘要 新冠肺炎疫情已经影响到世界各国人民的生活和福祉。在美国 在美国，不同的州采取了不同的措施来限制新冠肺炎的传播，但 经济放缓，社会孤立加剧，失去了通常可用的支持服务 不成比例地影响到种族和族裔少数群体以及处于不利社会经济地位的群体 组。烟草、大麻、酒精、阿片类药物和非法药物使用者很可能对新冠肺炎易感，因为 这些物质对呼吸和免疫系统的影响，以及正在接受治疗或 从药物滥用中恢复可能面临复发的风险，因为精神健康问题增加， 获得治疗和支持的额外障碍。有迹象表明，药物使用量有所增加 由于这场大流行，但尚未进行严格的前瞻性研究。早期的多站点步骤 从全国三个地理区域招募的不同低收入家庭的研究 (宾夕法尼亚州、弗吉尼亚州和俄勒冈州)，在这次大流行期间提供了独特的研究机会。有一个 关于早期步骤参与者的丰富数据，包括药物使用史、社会和 两个主要照顾者的卫生服务利用和心理健康(当前MAGE=43.8；SD=7.4) 青年(现任年龄18.6岁，SD=0.5)。由于研究设计还包括一项随机对照试验， 家庭体检干预，也可以检验干预对新冠肺炎的潜在保护作用 相关结果。我们计划对Easy Steps参与者进行两次新冠肺炎相关调查，时间均为6 新冠肺炎之后的12个月(2020年9月)和新冠肺炎之后的12个月(2021年3月)。我们的首要目标是 是为了检查新冠肺炎大流行对物质使用、心理健康和服务利用的影响 (例如，成瘾治疗、获得医疗保健)在照顾成年人和他们的年轻成年子女方面。我们 计划测试父母和年轻人的精神健康问题史的程度 缓和新冠肺炎对他们物质使用的影响，并测试 在为期12个月的评估中，为期6个月的评估调解了新冠肺炎对物质使用的影响 成人照顾者和年轻的成年儿童。我们将按地理位置、种族/民族、 生物性行为和收入。我们假设，那些在COVID后6个月服务利用率更高的人- 在新冠肺炎之后的12个月里，19人的物质使用量将会减少。我们的第二个目标是研究潜在的 家庭体检对6个月和12个月的物质使用和心理健康结果的缓冲作用 在新冠肺炎发作后，那些随机分配到干预中的家庭预计将显示 更低的物质使用水平，精神健康问题，以及更高的服务利用率。我们还将检查 潜在FCU保护作用的调节者，包括儿童、家庭和社区风险因素。这些数据 可以开始说明新冠肺炎对弱势群体的广泛影响。

ABSTRACT The COVID-19 pandemic has impacted the lives and well-being of people across the world. In the United States, different states have adopted different measures to limit the spread of COVID-19, but the impact of a slowed economy, increased social isolation, and the loss of typically-available support services has disproportionally affected racial and ethnic minorities, as well as those in disadvantaged socioeconomic groups. Tobacco, marijuana, alcohol, opioid, and illicit drug users are likely vulnerable to COVID-19 because of the effects of those substances on the respiratory and immune systems, and people who are in treatment or recovery from substance misuse may be at risk for relapse because of increased mental health issues and additional barriers to obtaining treatment and support. There are indications that substance use has increased because of the pandemic, but rigorous prospective studies have yet to be conducted. The Early Steps Multisite Study of diverse lower income families, recruited from three geographic areas across the country (Pennsylvania, Virginia, and Oregon), presents unique research opportunities during this pandemic. There is a wealth of data available on the Early Steps participants, including the history of substance use, social and health service utilization, and mental health of both primary caregiving adults (current Mage = 43.8; SD = 7.4) and youth (current Mage = 18.6; SD = 0.5). As the study design also included a randomized control trial of the Family Check-Up intervention, we can also test the potential protective effects of the intervention on COVID-19 related outcomes. We plan to administer two COVID-19 related surveys to Early Steps participants, at both 6 months post-COVID-19 (September of 2020) and at 12 months post-COVID-19 (March of 2021). Our first aim is to examine the effects of the COVID-19 pandemic on substance use, mental health, and service utilization (i.e., addiction treatment, access to health care) in both caregiving adults and their young adult children. We plan to test the extent to which a history of mental health problems among parents and young adults moderates the effects of COVID-19 on their substance use, and to test the extent to which service utilization at the 6-month assessment mediates the effects of COVID-19 on substance use at the 12-month assessment in adult caregivers and young adult children. We will examine differences by geographic location, race/ethnicity, biological sex, and income. We hypothesize that those with more service utilization at 6 months post-COVID- 19 will have less substance use at 12 months post-COVID-19. Our second aim is to examine the potential buffering effects of the Family Check-Up on substance use and mental health outcomes 6 and 12 months following the onset of COVID-19, with those families randomly assigned to the intervention expected to show lower levels of substance use, mental health problems, and greater service utilization. We also will examine moderators of potential FCU protective effects, including child, family, and community risk factors. These data can begin to illuminate the wide-ranging impact of COVID-19 on vulnerable populations.