Child Psychopathology, Adversity & Developing Drug Abuse

描述（由申请人提供）：成瘾和精神障碍的共病已被证明是普遍的，在全国科摩罗调查中，超过一半（54%）的15-54岁的人患有一种可诊断的疾病，至少有一种共病。关于青年合并症或其受环境因素影响的程度，我们所知甚少。该提案描述了一项为期两年的多层次调查，调查精神障碍和不利的家庭、学校和社区环境在增加儿童和青少年滥用酒精和其他药物的风险方面所起的作用。主要目的是确定可预防的青少年物质使用障碍的前因，使用发展心理病理学的方法。这些调查将通过对芝加哥社区人类发展项目（PHDCN）从1995年至2001年收集的3 000名青年及其社区的多层次研究进行二级分析来完成。将描述青年中精神和成瘾性疾病之间的共病;此外，将调查导致疾病本身在随后的物质问题的途径上的发展风险过程。这项建议是由一名接受过社会/精神病学流行病学培训的新调查员提交的。青少年，9-18岁的基线，和照顾者在家里采访了三次。1995年和2001年，从独立样本和受试者社区的录像带中测量了社区特征。将使用多水平统计方法，包括离散时间生存分析、分层线性建模和个体生长建模。这个样本是唯一适合于解决拟议的目标，考虑到（1）研究的纵向性质;（2）使用生态框架和测量的背景特征比较社区和学校的能力;（3）个人心理健康和物质使用行为的综合评估。现有数据集的使用为以具有成本效益的方式解决这些问题提供了机会。在1999年关于精神健康的报告中，前美国卫生局局长萨彻断言，人们对精神障碍在增加青少年滥用酒精和其他药物的风险方面的作用知之甚少。通过在科学合理的多层次研究设计中解决这种研究沉默，拟议研究的产品将对改善个人和当地社区层面的健康促进和药物滥用预防计划的规划和有效性做出重要贡献。

DESCRIPTION (provided by applicant): Comorbidity of addictive and mental disorders has been shown to be pervasive, with more than half (54%) of those aged 15-54 in the National Comorbidity Survey who had one diagnosable disorder having at least one co-occurring disorder. Less is known about comorbidity in youth or the degree to which it is affected by environmental factors. This proposal describes a two-year, multi-level investigation of the roles that mental disorders and adverse family, school, and community environments play in increasing risk of children and adolescents' misuse of alcohol and other drugs. The primary objective is to identify preventable antecedents of youth substance use disorders, using a developmental psychopathology approach. These investigations will be accomplished through secondary analyses of a multi-level study of 3000 youth and their communities, gathered by the Project on Human Development in Chicago Neighborhoods (PHDCN) from 1995-2001. Comorbidity between mental and addictive disorders among the youth will be described; additionally, the developmental risk processes that gave rise to the disorders themselves on the pathway to subsequent substance problems will be investigated. This proposal is being submitted by a new investigator, trained in social/psychiatric epidemiology. Youth, 9-18 years of age at baseline, and a caregiver were interviewed at home three times. Community characteristics were measured in 1995 and 2001 from independent samples and from videotapes of subjects' neighborhoods. Multilevel statistical methods will be used including discrete time survival analysis, hierarchical linear modeling, and individual growth modeling. This sample is uniquely suited to address the proposed aims, given (1) the longitudinal nature of the study; (2) the ability to compare neighborhoods and schools using an ecological framework and measurement of contextual features; and (3) comprehensive assessments of individual mental health and substance use behaviors. The use of existing data sets represents an opportunity to address these questions in a cost-effective manner. In his 1999 report on mental health, former U.S. Surgeon General Satcher asserted that little is known about the role of mental disorders in increasing the risk of misuse of alcohol and other drugs by youth. By addressing this research silence in a scientifically sound, multi-level study design, the products of the proposed research will be important contributions toward improving the planning and efficacy of health promotion and substance abuse prevention programs at the individual and local community level.