Predictors of Pathological Gambling among African-American Young Adults

描述(由申请人提供)：对美国少数族裔人群中的赌博和问题/病态赌博知之甚少。这项研究的目的是：1)估计非裔美国年轻人流行病学样本中赌博和赌博问题(问题和病态赌博)的流行率和发生率，并评估与17岁、19岁和20岁时发现的关联相比，21岁时基本人口特征和邻里生态因素(邻里劣势、终身种族主义/偏见、社交能力、接触暴力和赌博机会)与赌博和赌博问题之间的关系的变化；2)确定儿童和青春期攻击性行为、多动症和冲动的不同轨迹，并测试特定轨迹是否与青年时期赌博和赌博问题的风险增加有关，探索邻里因素是否影响这些轨迹；3)确定青春期后期和青年赌博行为的不同轨迹；4)测试过去一年的沉淀压力是否与青年时期的赌博和赌博问题有关，并估计这些关联的强度；5)评估涉及烟草、酒精和药物的精神障碍与赌博和问题/病理性赌博之间的双向路径；6)通过追踪与赌博相关的临床特征的时间进程，描述赌博参与的演变自然历史和赌博障碍的发展。我们使用了一项正在进行的纵向研究的数据，这是约翰·霍普金斯大学巴尔的摩预防研究中心(BPRC)设计的第二代预防性干预试验。Logistic回归模型和条件Logistic回归模型将用于解决目标1、4和5。Logistic回归和一般成长混合模型(GGMM)将识别儿童和青少年攻击行为、多动和冲动的不同轨迹，并测试这些行为/障碍的特定轨迹是否预测青少年的赌博问题；以及识别不同的赌博轨迹。生存分析、潜在转移分析和广义估计方程(GEE)将识别早期赌博问题的显著特征，这些特征可能促进早期区分谁将或将不会进展为具有临床意义的病理性赌博。这项研究有助于制定预防战略，以减少与赌博有关的问题，并为那些出现与赌博有关问题的人制定有效的干预和治疗。公共卫生相关性：拟议的研究将有助于了解社区生态对赌博行为的影响，了解儿童时期赌博和赌博问题的前驱，以及在城市非裔美国青少年和年轻人样本中赌博/赌博问题与药物使用和精神障碍之间的双向路径。

DESCRIPTION (provided by applicant): Little is known about gambling and problem/pathological gambling among minority populations in the U.S. The objectives of this study are to: 1) estimate prevalence and incidence rates of gambling and gambling problems (problem and pathological gambling) among an epidemiologic sample of African-American young adults and assess changes in the association between basic demographic characteristics and neighborhood ecological factors (neighborhood disadvantage, lifetime racism/prejudice, social competence, exposure to violence and opportunity to gamble) with gambling and gambling problems at age 21 as compared to associations found at age 17, age 19, and age 20; 2) identify different trajectories of aggressive behaviors, hyperactivity and impulsivity at childhood and adolescence and test whether specific trajectories are associated with increased risk of gambling and gambling problems in young adulthood, exploring whether neighborhood factors influence these trajectories; 3) identify different late-adolescent and young adult trajectories of gambling behavior; 4) test whether past-year precipitating stress is associated with gambling and gambling problems in young adulthood and estimate the strength of these associations; 5) assess bi-directional pathways between tobacco, alcohol, and drug involvement and psychiatric disorders with gambling and problem/pathological gambling; 6) describe the evolving natural history of gambling involvement and development of gambling disorders by following the time course of clinical features associated with gambling. We use data from an ongoing longitudinal study, the second generation of a preventative intervention trial designed by the Baltimore Prevention Research Center (BPRC) at Johns Hopkins University. Logistic regression models and conditional logistic regression models will be used to address aims 1, 4 and 5. Logistic regression and general growth mixture models (GGMM) will identify different trajectories of childhood and adolescent aggressive behaviors, hyperactivity and impulsivity and test whether specific trajectories of these behaviors/disorders predict gambling problems in young- adulthood; as well as identify different gambling trajectories. Survival analysis, Latent Transition Analyses and Generalized Estimating Equations (GEE) will identify distinctive features of early gambling problems that may promote earlier differentiation of who will or will not progress to clinically significant pathological gambling. This study can contribute to the development of prevention strategies that target a decrease in gambling-related problems as well as to the development of effective intervention and treatment for those who develop problems related to gambling. PUBLIC HEALTH RELEVANCE: The proposed research will shed light in the understanding of neighborhood ecological influences on gambling behaviors, in childhood antecedents of gambling and gambling problems, and in bi-directional pathways between gambling/gambling problems with substance use and psychiatric disorders in a sample of urban African-American adolescents and young adults.