Substance use in foster care youth: Relations among maltreatment, use, and coping

描述（由申请人提供）：在美国，青少年药物使用和滥用是一个重要的公共卫生问题，也是青少年发病率和死亡率的一个风险因素。对药物使用风险的检查已经确定，儿童时期的虐待是一个相关因素；研究表明，遭受虐待的青少年比未受虐待的同龄人更有可能有药物使用问题。在某些情况下，儿童因虐待或忽视而被从家中带走，最近的研究表明，与一般人群中的同龄人相比，居住在家庭外安置的青少年中物质使用障碍的比例更高。虽然儿童时期的虐待与随后的药物使用之间的关系已得到承认，但与药物使用行为的风险和保护以及虐待后的其他负面结果相关的途径尚未得到充分描述。一个重要的因素，应对行为，已经牵连到不良生活事件和随后的行为和情绪结果之间的关系。物质使用与应对之间的关系尚不清楚；许多人假设，物质使用实际上可能是一种适应不良的迹象。此外，在调查青少年虐待和物质使用之间联系的文献中存在显著的方法学缺陷，包括过度使用成年人关于儿童虐待和物质使用的回顾性报告，研究人员未能调查其物质使用或虐待测量的心理测量特性，排除相关协变量，未能包括各种类型的虐待，如忽视和心理虐待，使用小样本。先前的文献综述强调了关注这些方法问题的必要性，并对参加家庭外护理的青少年进行了更多的研究。为了解决这一差距，本研究将提供一个全面的调查，在寄养青年样本中，虐待作为物质使用和应对行为的预测因子的作用。为了实现这一目标，本研究将利用结构方程模型框架来评估相互竞争的调节模型：1)虐待预测以应对行为为调节因素的物质使用模型和2)虐待预测以物质使用为调节因素的应对策略模型。初步分析将检查物质使用测量的测量模型，以及寄养样本中物质使用的潜在协变量，如儿童和安置特征。模型测试将评估每个调节模型的整体拟合度，然后参与者将从一项由美国国立卫生研究院资助的名为“儿童适应和恢复能力研究途径”（SPARK）的大型纵向研究中抽取，该研究将包括150名8岁及以上的儿童和青少年，他们在杰克逊县寄养中心登记。本研究对这些因素之间复杂相互作用的科学认识的提高，将为研究寄养青少年中儿童虐待、应对行为和药物使用之间的关系提供一个更全面的模型。

DESCRIPTION (provided by applicant): Youth substance use and abuse in the U.S. is a critical public health issue and a risk factor for morbidity and mortality in adolescents. Examination of risk for substance use has identified that maltreatment in childhood is a relevant factor; research has indicated that youth exposed to maltreatment are more likely than their non- maltreated peers to have substance use problems. In some cases, children are removed from their homes due to maltreatment or neglect, and recent research revealed higher rates of substance use disorders in youth residing in out-of-home placements when compared to peers in the general population. Although the relation between maltreatment in childhood and subsequent substance use is recognized, pathways related to risk and protection for substance use behavior and other negative outcomes following maltreatment have yet to be fully delineated. One important factor, coping behavior, has been implicated in the relation between adverse life events and subsequent behavioral and emotional outcomes. The association between substance use and coping remains unclear; many have hypothesized that substance use may actually be an indicator of maladaptive coping. Further, significant methodological weaknesses exist in the literature investigating the link between maltreatment and substance use in youth including overuse of retrospective reports by adults about childhood maltreatment and substance use, failure of researchers to investigate the psychometric properties of their measures of substance use or maltreatment, exclusion of relevant covariates, failure to include diverse types of abuse such as neglect and psychological maltreatment, and use of small samples. Previous reviews of the literature have highlighted the need for attention to these methodological issues and more research conducted with youth enrolled in out-of-home care. To address this gap, this study will provide a comprehensive investigation into the role of maltreatment as a predictor of substance use and coping behaviors in a sample of youth in foster care. To achieve this, the proposed study will utilize a structural equation modeling framework to assess competing models of moderation: 1) a model with maltreatment predicting substance use with coping behaviors as a moderator and 2) a model with maltreatment predicting coping strategies with substance use as a moderator. Preliminary analyses will examine the measurement model of the substance use measure, as well as potential covariates of substance use in the foster sample such as child and placement characteristics. Model testing will assess overall fit of each moderation model, then Participants will be drawn from a larger, longitudinal study funded by NIH entitled "Studying Pathways to Adjustment and Resilience in Kids" (SPARK) and will include 150 children and adolescents aged 8 years and older who are enrolled in Jackson County foster care. Improved scientific knowledge of the complex interactions of these factors from this study will provide a more comprehensive model for investigating associations between child maltreatment, coping behaviors, and substance use in foster care youth.