Alcohol abuse/dependence and its consequences for Indigenous adolescents

描述(由申请人提供)：这是我们RO1申请的第二次提交，以回应公告：现有酒精流行病学数据的二次分析(PA-08-167)。通过这项申请，我们寻求资金，将我们与Ojibwe人在四个美国保留地和四个加拿大保留地的社区参与性研究(CBPR)延长三年，与我们的社区合作伙伴合作，完成专注于Ojibwe青少年酒精滥用和依赖障碍发展的数据分析。对青少年(第一波10-12岁和第八波17-19岁)进行的一项为期八年的独一无二的小组研究拟议的最先进的纵向分析将促进我们对高危人群中酒精使用和滥用的发展过程的理解，为创新的、经验驱动的文化干预提供信息，并履行CBPR的义务，即在社区参与收集这些重要信息八年多后留下一些有用的东西。本申请所基于的研究计划是由NIDA和NIMH资助的滞后顺序设计。DA13580最初于2000年9月30日获得资金，并于2005年9月3日通过竞争性续展获得续签。MH067281最初于2002年7月1日获得资金，并于07年7月1日竞争性续签。这项工作包括迄今为止对土著青少年及其父母/照顾者进行的唯一一项长期发展诊断性研究。DA13580的资金将于2010年6月30日到期，随之而来的是我们维持社区伙伴关系的能力。最初的研究应用程序DA13580的具体目标已经实现，但仍有大量的分析工作，使用极其丰富和复杂的数据集，专门关注酒精使用和滥用的开始及其从青春期早期到后期的后果。分析计划将解决八个焦点：1)随着时间的推移出现酒精使用、滥用和依赖；2)酒精使用和滥用的内化和外化行为之间的关系；3)针对青少年酒精使用和滥用的保护因素；4)群体成员对酒精结果的影响；5)酒精滥用/依赖与其他精神障碍的共病，如严重抑郁发作、广泛性焦虑障碍和品行障碍；6)与酒精使用相关的行为的时间相互关系；7)酒精使用和反社会行为之间的潜在中介；以及8)社区特征对酒精使用/滥用的影响。这是我们所知道的跟踪土著青年整个青春期的唯一纵向诊断性数据集。八波数据集有四个DISC-R诊断数据点：第一波(10-12岁；父母/照顾者和青少年报告)；第四波(13-15岁；父母/照顾者和青少年报告)；第六波(15-17岁，青少年报告)；第八波(17-19岁，青少年报告)。除了四个诊断数据点，数据充满了症状和行为量表，父母/照顾者-青少年互动和青少年行为的多个报告者(父母/照顾者和青少年)测量，以及社区测量。拟议的分析提供了一个独特的机会来追踪酒精使用的早期出现及其发展后果，包括酒精滥用和依赖障碍的发生。

DESCRIPTION (provided by applicant): This [is the second submission of our RO1 application] in response to the announcement: Secondary Analysis of Existing Alcohol Epidemiology Data (PA-08-167). With this application we seek funding to extend our community-based participatory research (CBPR) with Ojibwe people on four U.S. reservations and four Canadian reserves for three additional years to work with our community partners to complete data analysis focusing on the development of alcohol abuse and dependence disorders among Ojibwe adolescents. The proposed state-of-the- science longitudinal analyses of a one-of-a-kind eight-year panel study of adolescents (aged 10 - 12 years at Wave 1 and 17 - 19 years at Wave 8) will advance our understanding of developmental processes regarding alcohol use and abuse among a high-risk population, inform innovative, empirically driven, cultural interventions and fulfill the CBPR obligation of leaving something useful behind after more than eight years of community involvement in collecting this important information. The program of research on which this application is based was a lagged sequential design funded by NIDA and NIMH. DA13580 was initially funded 9/30/2000 and renewed via a competitive continuation 9/03/2005. MH067281 was initially funded 7/01/2002 and competitively renewed 7/01/07. The work comprises the only long-term developmental, diagnostic study of Indigenous adolescents and their parents/caretakers to date. Funding for DA13580 runs out 6/30/2010 and with it our ability to maintain our community partnerships. The specific aims of the original research application DA13580 have been accomplished but there remains an enormous amount of analytic work with an extremely rich and complex data set focusing specifically on onset of alcohol use and abuse and its consequences from early to late adolescence. The analytic plan will address eight foci: 1) the emergence of alcohol use, abuse, and dependence across time; 2) the relationship between internalizing and externalizing behaviors on alcohol use and abuse; 3) protective factors against adolescent alcohol use and abuse; 4) the effects of group membership on alcohol outcomes; 5) co morbidities of alcohol abuse/dependence with other psychiatric disorders such as major depressive episode, generalized anxiety disorder, and conduct disorder; 6) the timing of behaviors related to alcohol use in relation to one another, 7) potential mediators between alcohol use and antisocial behaviors; and 8) the effects of community characteristics on alcohol use/abuse. This is the only longitudinal, diagnostic data set of which we are aware that follows Indigenous young people through their entire adolescence. The eight-wave data set has four DISC-R diagnostic data points: Wave 1 (ages 10 - 12 years; parent/caretaker and adolescent reports); Wave 4 (ages 13 - 15 years; parent/caretaker and adolescent reports); Wave 6 (ages 15 - 17 years, adolescent reports); Wave 8 (ages 17 - 19 years, adolescent reports). In addition to four diagnostic data points, the data is replete with symptom and behavioral scales, multiple reporter (parent/caretaker and adolescent) measures of parent/caretaker-adolescent interactions and adolescent behaviors, and community measures. The proposed analyses provide a unique opportunity to trace the early emergence of alcohol use and its developmental consequences, including the onset of alcohol abuse and dependence disorders.