Distress Tolerance: Links with Family Emotional Climate and Adolescent HIV Risk

描述（由申请人提供）：汇聚的证据表明，个体难以忍受痛苦与药物滥用有重要联系，药物滥用是使青少年处于艾滋病毒风险中的关键行为（布兰登等人，2003; Brown，Lejuez，Kahler，& Strong，2002; Daughters，Lejuez，Bornovalova et al.，2005; Daughters，Lejuez，Kahler等人，Quinn，布兰登，& Copeland，1996）.这个研究机构已经从研究中出现，成年药物滥用者利用痛苦耐受的行为措施来评估一个人在强烈的情绪不适的存在下坚持目标导向行为的能力，或者简单地说，一个人有效地忍受情绪困扰的能力。最近，我们在青少年中建立了类似的联系（Daughters，Lejuez等人，2007年）。虽然以前没有研究过低痛苦容忍度与危险性行为的联系，但有理论和经验原因表明这种联系也可能存在（见Lejuez，2007）。鉴于有令人信服的证据表明，一个人的困难，忍受痛苦有重要的联系，药物滥用，并潜在的联系，危险的性行为，试图了解的前体痛苦的宽容在青少年有相当大的公共卫生相关性。一些理论观点和大量的经验证据表明，家庭的情感气氛和家庭关系的质量对儿童的功能有重大影响，包括参与危险行为（例如，Bornstein，2002; Maccoby，2007）。此外，对理论和研究的审查（例如，Bowlby，1969/1982; Cassidy和Shaver，1999; Eisenberg等人，1998; Gottman等人，1996，1997）提出了两个方面的家庭情绪气候，可能与青少年的痛苦容忍：（a）母亲的痛苦反应，（B）青少年的附件。因此，它似乎是有用的，以检查家庭因素和青少年的能力之间的联系，以容忍情绪困扰，并随后发展的艾滋病毒的危险行为。拟议的横断面研究有几个目标。首先，我们试图通过提供进一步的证据证明青少年的痛苦容忍度和物质使用之间的联系，以及通过研究，第一次，痛苦容忍度和危险的性行为之间的联系，来扩展以前的工作，研究青少年的痛苦容忍度和艾滋病毒风险行为之间的联系。第二，我们将试图通过关注家庭情绪气氛来阐明低痛苦耐受力的风险因素。最后，在一个基于消极情绪的艾滋病风险模型的背景下，我们将研究痛苦容忍度作为家庭情绪背景和艾滋病风险行为之间联系的中介。这项研究的一个优点是，参与者（240名13至16岁的青少年）将从一个正在进行的艾滋病毒风险行为的纵向研究，不解决家庭情绪气候。这种方法具有成本效益，并提供了机会，以加强现有的数据集，包括其他有关指标的艾滋病毒从遗传脆弱性和环境逆境，通过行为测量的风险承担倾向。 公共卫生相关性大量证据表明，在情绪困扰（痛苦不耐受）的背景下，难以坚持目标导向的行为与物质使用问题有关。我们将以两种重要的创新方式扩大这项工作的范围：（a）通过检查痛苦不耐受是否也与危险的性行为有关，（B）通过考虑家庭情感背景是否可以预测痛苦不耐受。因为这些数据将有助于开发一个更全面的艾滋病毒风险行为脆弱性模型，它们反过来将有助于制定有效的干预计划。

DESCRIPTION (provided by applicant): Converging evidence indicates that an individual's difficulty tolerating distress has important links to substance abuse, a key behavior that places adolescents at risk for HIV (Brandon et al., 2003; Brown, Lejuez, Kahler, & Strong, 2002; Daughters, Lejuez, Bornovalova et al., 2005; Daughters, Lejuez, Kahler et al., 2005; Quinn, Brandon, & Copeland, 1996). This body of research has emerged from studies with adult drug abusers utilizing behavioral measures of distress tolerance to assess one's ability to persist in goal directed behavior in the presence of intense emotional discomfort, or simply, one's ability to effectively tolerate emotional distress. More recently, we have established a similar link in adolescents (Daughters, Lejuez et al., 2007). Although links of low distress tolerance with risky sexual behavior have not been examined previously, there are theoretical and empirical reasons that suggest that this link may exist as well (see Lejuez, 2007). Given compelling evidence that an individual's difficulty tolerating distress has important links to substance abuse, and potential links to risky sexual behavior, attempts to understand the precursors of distress tolerance in adolescents have considerable public health relevance. Several theoretical perspectives and considerable empirical evidence suggest that the emotional climate of the family and the quality of family relationships have major implications for a child's functioning, including engagement in risk behaviors (e.g., Bornstein, 2002; Maccoby, 2007). Further, examination of theory and research (e.g., Bowlby, 1969/1982; Cassidy & Shaver, 1999; Eisenberg et al., 1998; Gottman et al., 1996, 1997) suggests two aspects of family emotional climate that may be linked to adolescent distress tolerance: (a) maternal response to distress, and (b) adolescent attachment. Thus, it appears useful to examine links between family factors and adolescent capacity to tolerate emotional distress, and the subsequent development of HIV risk behavior. The proposed cross-sectional study has several goals. First, we seek to extend previous work examining links between adolescent distress tolerance and HIV risk behavior by providing further evidence of the link between adolescent distress tolerance and substance use, as well as by examining, for the first time, the link between distress tolerance and risky sexual behavior. Second, we will attempt to elucidate risk factors for low distress tolerance by focusing on the family emotional climate. Finally, in the context of a negative- reinforcement-based model of HIV risk, we will examine distress tolerance as a mediator of the link between family emotional context and HIV risk behavior. An advantage of this study is that participants (240 13- to 16- year-olds) will be taken from an ongoing longitudinal study of HIV risk behavior that does not address family emotional climate. This approach is cost effective and provides opportunities to enhance an existing data set including other relevant indicators of HIV from genetic vulnerability and environmental adversity through behavioral measurement of risk-taking propensity. PUBLIC HEALTH RELEVANCE Considerable evidence indicates that difficulties persisting in goal-directed behavior in the context of emotional distress (distress intolerance) is linked to substance use problems. We will expand the scope of this work in two important and innovative ways: (a) by examining whether distress intolerance is also linked to risky sexual behavior, and (b) by considering whether distress intolerance can be predicted by family emotional context. Because these data will contribute to the development of a more comprehensive model of vulnerability to HIV risk behavior, they will in turn be useful in creating effective intervention programs.