Development and Prevention of Substance Abuse Problems

描述（由申请人提供）：这个竞争项目的目标是测试三个相互关联的反社会问题的发展和预防模型：暴力，药物滥用和危险的性行为。对这三个不同问题领域的联合审议带来了希望，因为平行流行病、共病、类似流行病学的“共病”，以及孤立的预防努力恰恰由于没有考虑到共同影响而失败的可能性。研究人员将测试三个主要假设：1)这些问题在整个发展过程中是共病的，早期的行为问题会导致每个成年人的结果；2)共病性反社会行为模式的发展是一个动态的级联过程，早期的危险因素使儿童倾向于后期的危险因素，从而导致问题的结果。该模型假定基因-环境的相互作用是通过获得的社会信息处理模式介导的。特定领域的结果也通过特定的服务经验发展；3)随机分配预防干预会降低成年期各种反社会结果的概率，遗传因素和早期生活因素起到调节作用，干预对早期行为问题和社会认知模式的影响起到中介作用。样本来自两个独立的，正在进行的品行障碍的前瞻性研究，儿童发展项目（CDP）和快速通道（FT）。CDP对585名目前26岁的学龄前男女进行了社区抽样调查，22年后的保留率很高（90%）。FT项目是一项多地点随机临床试验，其中891名开始早、有行为问题的青少年（31%是女孩，51%是非裔美国人）被分配到幼儿园，接受（或不接受）10年的综合干预，以预防行为障碍，并一直随访到24岁，参与者的保留率很高（83%）。在拟议的项目中，将在31岁之前的CDP和29岁之前的FT中对暴力、药物使用问题和危险的性行为进行相同的评估。增长分析、验证性因素分析和结构方程模型将检验假设。与公共卫生的相关性：该项目将有助于发现预防青少年反社会问题的方法，包括暴力、药物滥用和危险的性行为。公共卫生相关性：该项目将增加我们对暴力、药物滥用和危险性行为问题如何在整个生命周期中发展并相互关联的理解。它将测试长期干预在青年期预防这些问题的有效性。

DESCRIPTION (provided by applicant): The goal of this competing continuation project is to test models of the development and prevention of three inter-related antisocial problems in young adulthood: violence, substance abuse, and risky sexual behavior. Joint consideration of these three diverse problem domains holds promise because of the "syndemic" of parallel epidemics, comorbidity, similar epidemiology, and the possibility that isolated prevention efforts fail precisely because of the failure to consider joint effects. The investigators will test three major hypotheses: 1) these problems are comorbid across development, with early conduct problems leading to each adult outcome; 2) a comorbid antisocial behavior pattern develops as a dynamic cascade, in which early risk factors dispose a child to later risk factors, which lead to problem outcomes. The model posits gene-environment interactions that are mediated through acquired social information-processing patterns. Domain-specific outcomes also develop through specific affordance experiences; and 3) random assignment to preventive intervention will reduce the probability of each of antisocial outcome in adulthood, with moderation by genetic and early-life factors and mediation by intervention effects on early conduct problems and social-cognitive patterns. The samples come from two independent, ongoing prospective studies of conduct disorder, the Child Development Project (CDP) and Fast Track (FT). The CDP has followed a community sample of 585 preschool males and females who are now 26 years old, with high (90 percent) retention after 22 years. The FT Project is a multi-site randomized clinical trial, in which 891 early-starting, conduct-problem youth (31 percent girls; 51 percent African-American) were assigned in kindergarten to receive (or not) a 10-year comprehensive intervention to prevent conduct disorder and have been followed through age 24 with high (83 percent) retention of participants. In the proposed project, identical measures of violence, substance-use problems, and risky sexual behaviors will be assessed in the CDP through age 31 and in FT through age 29. Growth analyses, confirmatory factor analyses, and structural equation modeling will test hypotheses. Relevance to public health: This project will contribute to the discovery of ways to prevent young adult antisocial problems, including violence, substance abuse, and risky sexual behaviors. PUBLIC HEALTH RELEVANCE: This project will increase our understanding of how problems of violence, substance abuse, and risky sexual behavior develop across the lifespan and relate to each other. It will test the efficacy of a long-term intervention to prevent these problems in young adulthood.