Mechanisms Underlying Differential Effects of Neighborhood Poverty on Problematic Adolescent Drug Use

项目总结/摘要 儿童成长的地方可能会增加他或她使用有问题药物的风险。令人惊讶的是，政策和 旨在改善社区条件的项目产生了令人震惊的结果， 贝内，别人受伤害。了解邻里行为影响问题的机制- 药物使用以及这些机制如何在亚组和城市之间存在差异-也就是说，了解在哪里， 为谁机制适用-是必不可少的，以优化未来的邻里干预的有效性。 涉及学校环境各方面的调解机制尚未得到审查，但可以证明， 有希望了解社区对有问题的药物使用的不同影响。的目的 K99/R 00是为了确定以学校为基础的机制，调解邻里贫困之间的关系， 和有问题的药物使用，并制定统计方法，以了解调解效果如何不同， 分组和地点。这一目标有助于实现提高干预措施有效性的长期目标， 通过调整干预措施以解决最相关的机制， 根据地点和个人的特点，为每个目标人口采取行动。K99阶段填补了 以下培训差距对实现研究目标和长期目标至关重要：1）方法学 因果调解分析方面的培训; 2）在乌干达进行预防药物滥用和依赖方面的专题培训; 禁止人口;和3）参与现实世界的学校为基础的干预措施，以制定方法， 效用拟议研究的目标1确定了调解关系的学校环境机制 邻里贫困和青少年问题药物使用之间的关系以及这些机制的修改者。目的2 扩展了统计方法最近开发的拟议的研究小组推广干预效果， 从一个城市到另一个城市的影响，以推广调解效果。最后，Aim 3使用了Aim中开发的方法 2确定学校环境机制如何调解邻里贫困和有问题的药物使用 在美国各大城市中，建议的研究预期会找出校本机制的基础- 社区贫困对青少年问题药物使用的不同影响，按亚组和地点使用 这是唯一一项随机化的社区居住研究。此外，它有望贡献一个新的统计 该方法结合了尖端的机器学习技术，以确定哪些中介机制可以 在不同的地方推广，推进转化研究。成功的干预措施被认为是在不同的工作- 输入设置，但实际情况并非如此。这项研究将使我们能够预测干预效果 同时考虑到人口构成和调解机制调节因素的差异。这将 通过告知未来社区的设计和目标，为改善健康做出重大贡献 在预防问题药物使用方面，对青少年和受影响最大的地方采取干预措施。

PROJECT SUMMARY/ABSTRACT Where a child grows up can influence his or her risk of problematic drug use. Surprisingly, policies and programs designed to improve neighborhood conditions have yielded conflicting results in which some children benefit but others are harmed. Understanding the mechanisms by which neighborhoods act to affect problem- atic drug use and how these mechanisms differ across subgroups and cities—that is, understanding where and for whom mechanisms apply—is essential to optimize the effectiveness of future neighborhood interventions. Mechanisms involving mediation by aspects of the school environment have been unexamined, but could prove promising for understanding differential effects of neighborhood on problematic drug use. The objective of this K99/R00 is to identify school-based mechanisms that mediate the relationship between neighborhood poverty and problematic drug use and to develop statistical methods to understand how mediation effects differ across subgroup and place. This objective contributes to the long-term goal of improving the effectiveness of interven- tions to prevent drug abuse and dependence by tailoring interventions to address the most relevant mechanisms of action for each target population based on place and individual-level characteristics. The K99 phase fills the following training gaps that are critical to achieving the research objective and long-term goal: 1) methodologic training in causal mediation analysis; 2) subject-matter training in drug abuse and dependence prevention in ur- ban populations; and 3) involvement in real-world school-based interventions to develop methods with practical utility. Aim 1 of the proposed research identifies the school environment mechanisms that mediate the relationship between neighborhood poverty and adolescent problematic drug use and modifiers of those mechanisms. Aim 2 extends a statistical method recently developed by the proposed research team for generalizing intervention ef- fects from one city to another to generalizing mediation effects. Finally, Aim 3 uses the method developed in Aim 2 to identify how the school environment mechanisms mediating neighborhood poverty and problematic drug use differ across major U.S. cities. The proposed research is expected to identify school-based mechanisms underly- ing differential effects of neighborhood poverty on adolescent problematic drug use by subgroup and place using the only study of randomized neighborhood residence. In addition, it is expected to contribute a novel statistical method that incorporates cutting-edge machine learning techniques to identify which mediation mechanisms can generalize across place, advancing translational research. Successful interventions are assumed to work in differ- ent settings, but that is not the case in practice. The proposed research will allow us to predict intervention effects while accounting for differences in population composition and modifiers of the mediation mechanism. This will make a significant contribution to improving health by informing the design and targeting of future neighborhood interventions to adolescents and places that may be most impacted in terms of problematic drug use prevention.