Risks for Transitions in Drug use Among Urban Adults

描述（由申请人提供）：这是申请的第二次修订。团队规模略有扩大；预算保持不变；并根据审稿人的意见对文本进行了广泛的重写。尽管大量关于药物使用和依赖的流行病学和病因学研究集中在青少年，但人们对青年期的药物使用知之甚少。青年期是可能发生从药物使用升级到依赖的时期，也是区分实验性药物使用和慢性药物使用的轨迹明确的时期。由于对青年期转变的影响可能与青少年期不同，因此从童年、青少年期和成年早期到青年期的纵向数据对于理解自然史非常重要。对药物使用阶段转变的影响存在于个人和社会环境层面，以及它们之间的相互作用。重要的个人层面影响包括遗传背景和精神和行为障碍的存在，如抑郁症、酒精障碍、反社会行为和反社会人格障碍。重要的社会环境影响包括成人角色的参与、青年时期替代强化物的发展和邻里关系。在这些特征以及这些特征的前体和前体的早期历史不同的人群中，很可能存在不同的药物暴露、使用、依赖和缓解途径。本应用程序收集和分析来自预防研究中心（PRC）研究参与者的访谈和生物学数据，该研究是巴尔的摩市19所公立学校的2311名儿童的队列，其中包括1985年和1986年（现在接近28-29岁）一年级以来的10次数据。先前的评估包括精神和行为问题和障碍，以及上面列出的社会环境特征。建议的评估包括血液或口腔样本的DMA，和许多结构评估在先前的波。先前的实地工作表明，超过80%的原始队列可以定位和采访。该队列以人口为基础的方面，以及巴尔的摩的位置，其吸毒水平高，非洲裔美国人样本大，是该项目的重要优势。在青年成年期进行随访的时机和先前评估的丰富性是无与伦比的。如果要使预防药物使用以及升级为依赖和慢性的干预措施有效，实施措施必须包括针对最有可能发生这些转变的年轻人的战略。当针对有可靠证据表明存在潜在因果影响的风险和保护因素时，这些预防战略可能最为有效，例如我们拟收集的证据。

DESCRIPTION (provided by applicant): This is the second revision of an application. The team has expanded slightly; the budget has remained the same; and the text has been extensively rewritten in the light of reviewers' comments. Little is known about drug use in young adulthood, although a great deal of epidemiologic and etiologic research in drug use and dependence has focused on adolescence. Young adulthood is the period in which escalation from drug use to dependence is likely to occur and when trajectories differentiating experimental from chronic drug use are defined. Since influences on transitions in young adulthood likely differ from those in adolescence, longitudinal data that extend from childhood, through adolescence and early adulthood, and into young adulthood are important in understanding natural history. Influences on transitions in stages of drug use exist at the level of the individual and the social environment, and their interactions. Important individual-level influences include genetic background and the presence of psychiatric and behavioral disorders, such as depression, alcohol disorders, antisocial behaviors and antisocial personality disorder. Important social environmental influences include engagement in adult roles, development of alternative reinforcers during young adulthood, and neighborhoods. It is likely that there are distinct pathways to drug exposure, use, dependence, and remission among those who differ on these characteristics, as well as on early history of the precursors and antecedents of these characteristics. This application is to collect and analyze interview and biological data from participants in the Prevention Research Center (PRC) study, a cohort of 2311 children in 19 Baltimore City public schools, with 10 prior waves of data since they were in first grade in 1985 and 1986 (now approaching 28-29 years of age). Prior assessments include psychiatric and behavioral problems and disorders, as well as the social environmental characteristics listed above. Proposed assessments include blood or buccal sample for DMA, and many constructs assessed in prior waves. Prior field work suggests that more than 80% of the original cohort can be located and interviewed. The population-based aspect of the cohort, and the location in Baltimore, with its high level of drug use and large African-American sample, are important advantages of this project. The timing of follow-up in young adulthood, and the richness of prior assessments, is unmatched. If interventions for prevention of drug use, and escalation to dependence and chronicity, are to be effective, the implementation must include strategies targeted for young adults where these transitions are most likely to occur. These prevention strategies can be most effective when targeting risk and protective factors for which there is credible evidence of a potential causal influence such as we propose to gather.