Gender and Developmental Trajectories to Adolescent Substance Use and Sexual Risk Behavior

项目总结/摘要 本申请拟进行二次比较分析研究，考察性别差异 早期行为问题的发展轨迹和随后的结果的相似性， 产前接触可卡因/多种药物青少年的物质使用（SU）和性危险行为（SRB） (PCE)与无PCE的匹配组相比。儿童行为问题（例如，攻击，注意力不集中） 已确立的SU和SRB的前身。尽管PCE与更多的行为相关， 问题，很少有人知道PCE如何有助于儿童的行为发展轨迹 这些问题可能会持续存在，停止或随着时间的推移而升级。此外，行为的发展轨迹 问题，SU和SRB可能因性别而异，但很少有研究比较性别特异性儿童 发展轨迹，导致SU和/或SRB。拟议的研究将协调来自两个 现有的大型社区出生队列（N= 1，803）：克利夫兰产前接触暴露研究 和母亲生活方式研究。最初研究的目的是检查子宫内的长期影响， 可卡因对儿童发育的影响在这个建议中，我们将研究发展中的异质性， 轨迹，具体侧重于测试PCE和性别是否交互地有助于具体轨迹 沿着生活逆境的作用（即，暴力暴露、童年虐待、性受害）， 也是SU疾病和SRB的关键病因因素。具体目标是：（1）确定发展 行为问题的轨迹（外化，内化，抑制控制/注意力）和测试 性别、PCE、环境和生物相关性的轨迹差异; 2）检查关联 男孩和女孩的SU和SRB行为问题的发展轨迹之间的关系;以及3） 探索生活逆境的作用（即，暴力暴露、儿童期虐待、性受害）， 分别为男孩和女孩提供了通向初级保健和工作人员代表机构的轨迹。从2/3岁开始， 4/5、6/7、9、10、11和12/13将用于使用生长混合模型对轨迹进行建模;广义 估计方程将用于模拟行为轨迹类成员资格对SU的影响， 15岁和16/17岁时的SRB，控制混杂因素，如父母依恋、监控和同伴 附件.拟议分析的结果将有助于提前早期识别 * 最需要预防服务，并具体说明可能针对性别的可修改目标， 促进正在制定的针对性别的预防方案，这是解决 NIDA在预防SU疾病方面的战略优先事项。此外，鉴于患有PCE的儿童往往是 少数民族和低社会经济地位， 这项研究将有助于减少健康差距， 在这一人群中观察到的行为健康干预措施，是健康人群的四个首要目标之一 2020.

PROJECT SUMMARY/ABSTRACT This application proposes to conduct a secondary comparative analysis study to examine gender differences and similarities in the developmental trajectories of early behavioral problems and subsequent outcomes of substance use (SU) and sexual risk behaviors (SRBs) in adolescents with prenatal cocaine/poly drug exposure (PCE) vs. a matched group without PCE. Childhood behavioral problems (e.g., aggression, inattention) are well-established precursors to SU and SRBs. Although PCE has been associated with more behavioral problems, little is known about how PCE contributes to childhood developmental trajectories of behavioral problems, which may persist, desist, or escalate over time. Further, developmental trajectories of behavioral problems, SU, and SRBs may differ by gender, yet few studies have compared gender-specific childhood developmental trajectories that lead to SU and/or SRBs. The proposed study will harmonize data from two large, existing community-based birth cohorts (N=1,803): The Cleveland Prenatal Cocaine Exposure Study and the Maternal Lifestyle Study. The aims of the original studies examined long-term effects of in-utero exposure to cocaine on child development. In this proposal, we will examine heterogeneity in developmental trajectories, with specific foci on testing whether PCE and gender interactively contribute to specific trajectories along with the role(s) of life adversities (i.e., violence exposure, childhood maltreatment, sexual victimization), also key etiological factors in SU disorders and SRBs. Specific Aims are to: 1) Identify developmental trajectories of behavioral problems (externalizing, internalizing, inhibitory control/attention) and test for trajectory differences in gender, PCE, and environmental and biological correlates; 2) Examine associations between developmental trajectories of behavioral problems with SU and SRBs for boys and girls; and 3) Explore role(s) of life adversity (i.e., violence exposure, childhood maltreatment, sexual victimization) in trajectories leading to SU and SRBs separately for boys and girls. Caregiver-reported behavior from ages 2/3, 4/5, 6/7, 9, 10, 11, and 12/13 will be used to model trajectories using growth mixture modeling; generalized estimation equations will be used to model the effects of the behavioral trajectory class membership on SU and SRBs at ages 15 and 16/17, controlling for confounders such as parental attachment, monitoring and peer attachment. Findings from the proposed analyses will contribute to advanced early identification of those in greatest need of prevention services and specification of modifiable targets that may be gender-specific, promoting the ongoing development of gender-specific prevention programs, a promising way to address NIDA's strategic priorities in prevention of SU disorders. Further, given that children with PCE tend to be of minority and low socioeconomic status (SES), this study will contribute to reducing health disparities in behavioral health interventions observed in this population, one of the four overarching goals of Healthy People 2020.