Prenatal Cocaine Exposure: Young Adult Follow Up

描述（由申请人提供）：弹性的理论构建，潜在风险后的预期结果优于预期，为宫内可卡因暴露（IUCE）和宫内物质暴露（IUSE）的纵向研究提供了创新框架。复原力来自人与环境的相互作用，可以缓冲生物和社会风险的影响。我们建议对140-150名年龄在18-24岁的城市主要是非洲裔美国人/非洲加勒比海地区的参与者（50%患有IUCE）进行掩蔽的多学科纵向随访，自出生以来持续随访，以记录多个领域的风险，保护和促进因素。已收集和建议的数据集的独特功能包括：12个月时的安斯沃思依恋分类，从婴儿期开始对照顾者和儿童遭受暴力的情况进行重复的前瞻性测量，对物质困难的重复测量，以及父母的监禁，在这个周期中增加了歧视的测量，积极的种族认同，61%的样本通过自我报告或尿液分析在16岁之前开始使用物质。在拟定的研究期间（2010年4月1日至2015年3月31日），参与者进入发育时期，此时出现SUD，可能从此类疾病中恢复，承担早期成人角色的能力变得可测量，执行和记忆功能成熟。我们专注于选定的生物背景因素，这可能是至关重要的，在确定这些领域的弹性和风险。我们认为潜在的生物因素包括：性别，出生体重，宫内节育器，评估年龄，以及宫内物质暴露（IUSE）总体水平的一种新的复合测量方法，包括可卡因，烟草，酒精和大麻的水平，以及作为不同变量的单个物质。参与者开始使用精神活性物质的时间和青少年/年轻人使用精神活性物质的同时水平都是对仍在发育的中枢神经系统的生物风险的指标&这是一个主要结果。我们将分析从婴儿期到青年期的潜在缓冲环境因素的影响，这些因素有助于：1）免于SUD; 2）更大的适应性角色功能，包括更少的HIV风险行为，晚育，更少的精神症状，更少的犯罪行为，以及教育，就业和个人关系的积极适应; 3）执行和记忆功能的预期成熟。我们提出了广义混合线性模型，充分利用数据的纵向性质，包括增长曲线模型来描绘轨迹，分层和交互模型来检查主持人，结构方程路径模型来评估调解。 IUSE影响了从婴儿到成年人的所有种族的许多美国人。这个样本代表了一个人口统计，与其他群体相比，遭受更多的不良生活后果的物质使用，有或没有IUSE，面临不成比例的社区压力源。在这种健康差距的背景下，确定促进复原力的因素具有特别的科学和公共卫生意义。 公共卫生相关性：许多美国人，从婴儿到成年人，都经历过宫内暴露于精神活性物质，这可能会使他们在许多方面处于不利的生活轨迹的风险增加。因此，宫内暴露后，描绘婴儿，儿童，青少年和并发因素，可以促进或抑制弹性在年轻的成年期在多个领域（包括自由的物质使用障碍）有重要意义的公共卫生干预措施。

DESCRIPTION (provided by applicant): The theoretical construct of resilience, better-than-expected outcome following potential risk, provides an innovative framework for the longitudinal study of intrauterine cocaine exposure (IUCE) & intrauterine substance exposure (IUSE). Resilience evolves from person/environment interactions, which may buffer the impact of biologic & social risks. We propose a masked multidisciplinary longitudinal follow-up of 140-150 urban primarily African American/African Caribbean participants aged 18-24 (50% with IUCE), continuously followed since birth to document risks, protective & promotive factors in multiple domains. Unique features of the already collected & proposed data set include: Ainsworth attachment classification at 12 months, repeated prospective measurement since infancy of the caregiver's & child's exposure to violence, repeated measures of material hardship, & parents' incarceration, with the addition in this cycle of measures of discrimination, positive ethnic identity, & quality of young adult intimate relationships 61% of the sample initiated substance use by age 16 by self-report or urine assay. During the proposed period of study (4/1/2010 - 3/31/2015) the participants enter the developmental epoch when the emergence of SUDs, possible recovery from such disorders, & ability to undertake early adult roles become measurable, & executive & memory functions mature. We focus on selected biological contextual factors, which may be crucial in determining resilience & risk in these domains. We consider as potential biologic factors among others: gender, birth weight, IUCE, age at assessment, & a novel composite measurement of overall level of intrauterine substance exposures (IUSE) including levels of cocaine, tobacco, alcohol, & marijuana in a single scale, as well as the individual substances as distinct variables. The participant's timing of initiation & concurrent level of adolescent / young adult use of psychoactive substances are both indicators of biologic risk to the still developing central nervous system & a major outcome. We will analyze the influence of potentially buffering contextual factors from infancy to young adulthood contributing to: 1) Freedom from SUDs; 2) Greater adaptive role function including fewer HIV risk behaviors, later childbearing, fewer psychiatric symptoms, less criminal behavior, & positive adaptation in education, employment & personal relationships; & 3) Expected maturation of executive & memory functions. We propose generalized mixed linear models to utilize fully the longitudinal nature of the data, including growth curve models to delineate trajectories, stratified & interaction models to examine moderators, & structural equation path models to evaluate mediation. IUSE impacts many Americans of all ethnic groups ranging from infants to adults. This sample represents a demographic, which, compared to other groups, suffers more adverse life consequences from substance use & which, with or without IUSE, faces disproportionate levels of community stressors. Identification of factors fostering resilience in this context of health disparities is of particular scientific & public health relevance. PUBLIC HEALTH RELEVANCE: Many Americans, ranging from infants to adults, have experienced intrauterine exposures to psychoactive substances which may put them at increased risk of adverse life trajectories in many dimensions. Therefore, following intrauterine exposures, delineation of infant, childhood, adolescent, and concurrent factors which can promote or inhibit resilience during young adulthood in multiple domains (including freedom from substance use disorders) has important implications for public health interventions.