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关键的公共卫生问题，也是青少年发病率和死亡率的风险因素。对药物使用风险的研究发现，童年时期的虐待是一个相关因素;研究表明，遭受虐待的青年比未受虐待的同龄人更有可能出现药物使用问题。在某些情况下，儿童由于受到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，居住在家庭外安置点的青年中药物使用障碍的发生率较高。虽然儿童期虐待与随后的物质使用之间的关系得到了承认，但与风险和保护物质使用行为以及虐待后的其他负面后果有关的途径尚未得到充分界定。一个重要的因素，应对行为，已被牵连在不良生活事件和随后的行为和情绪结果之间的关系。物质使用和应对之间的关联仍然不清楚;许多人假设物质使用实际上可能是适应不良应对的一个指标。此外，在调查青少年虐待和药物使用之间联系的文献中存在重大的方法缺陷，包括过度使用成年人关于儿童虐待和药物使用的回顾性报告，研究人员未能调查其药物使用或虐待措施的心理测量特性，排除相关协变量，没有包括忽视和心理虐待等各种虐待，而且使用的样本很少。以往的文献综述强调，需要注意这些方法问题，并进行更多的研究与青年登记在家庭外护理。为了解决这一差距，本研究将提供一个全面的调查虐待的作用，作为一个样本的青年寄养物质使用和应对行为的预测。为了实现这一目标，拟议的研究将利用结构方程建模框架来评估竞争模型的适度：1）一个模型与虐待预测物质使用与应对行为作为一个主持人和2）一个模型与虐待预测应对策略与物质使用作为一个主持人。初步分析将检查物质使用措施的测量模型，以及潜在的协变量的物质使用的寄养样本，如儿童和安置特点。模型测试将评估每个适度模型的整体拟合度，然后参与者将从NIH资助的一项大型纵向研究中抽取，该研究题为“儿童适应和恢复力的研究途径”（SPARK），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。从这项研究中，这些因素的复杂的相互作用的科学知识的提高，将提供一个更全面的模型，调查儿童虐待，应对行为，并在寄养青年使用药物之间的关联。

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.