Research Project 1

研究项目1

• 批准号: 10713133
• 负责人: Mary Allison Barlow
• 金额: $ 38.32万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10713133
• 关键词: 19 year old; Abstinence; Address; Affect; Affordable Care Act; Age; Alaska Native; American Indians; Behavioral; Black, Indigenous, People of Color; Child; Child Development; Child Rearing; Communities; Country; Data; Development; Drug usage; Effectiveness; Emotional; Ensure; Equity; Ethnic Population; Expectancy; Family; Feeling suicidal; Follow-Up Studies; Future; Generations; Goals; Growth; Home; Home visitation; Impairment; Indigenous; Individual; Intervention; Intervention Trial; Interview; Knowledge; Leadership; Life Cycle Stages; Marijuana; Mediator; Medical; Medical Records; Mental Depression; Mental Health; Methodology; Mothers; National Institute of Drug Abuse; Native-Born; Outcome; Overdose; Parents; Participant; Pathway interactions; Patient Self-Report; Policies; Population; Postpartum Period; Pregnancy; Process; Psyche structure; Race; Randomized; Randomized, Controlled Trials; Recording of previous events; Recovery; Research; Research Project Grants; Resources; Risk; Risk Factors; Sampling; Social Problems; Stress; Suicide; Training; Transportation; Trauma; Tribes; Well Child Visits; Well in self; Youth; addiction; adolescent substance use; arm; behavioral health; children of color; depressive symptoms; design; disparity gap; early childhood; evidence base; follow-up; group intervention; health equity; health inequalities; illicit drug use; improved; intergenerational; marginalized population; maternal stress; meetings; multiple drug use; overdose death; personalized approach; post intervention; prenatal; programs; protective factors; racial population; racism; reduced substance use; secondary outcome; social; standard care; substance use; suicidal behavior; suicidal morbidity; suicidal risk; teenage mother; trial enrollment; tribal community; young adult

PROJECT SUMMARY This study, “Cradling Our Future Long-Term (16-year) Follow-Up,” will determine if a culturally tailored, evidence based early childhood home visiting intervention, called “Family Spirit®,” reduces long-term substance use, suicide, and related consequences among Indigenous mothers and their children16 years after they exited the program (at 3 years postpartum). Substance use and suicide comprise the largest and most devastating health inequities for American Indians and are the result of generations of racial trauma and oppression. Family Spirit was designed over an 8-year period specifically for and by American Indian communities through an intensive community based participatory process to promote behavioral and mental health across two generations. The original “Cradling Our Future” study (NIDA R01 DA019042-01A1) was a 1:1 randomized controlled trial that enrolled N = 322 expectant teen mothers by 32 weeks gestation and followed them and their children to 3 years postpartum. Mothers randomized to the intervention group received culturally tailored home visiting lessons delivered by local American Indian paraprofessionals focused on positive parenting and content addressing maternal stress, substance use, and depression. The control condition was transportation to prenatal and well-child visits and facilitated connections to community resources, which mothers in both the intervention and control arms received. Trial results demonstrated Family Spirit significantly improved parenting efficacy, reduced marijuana and illicit drug use and depressive symptoms in mothers, and improved social, emotional, and behavioral development for children until 3 years postpartum in ways that would predict less substance use and lower suicide risk and related problems across teen mothers' and youth's developmental life course. Based on this evidence, home visitors and supervisors have been trained to implement Family Spirit in over 150 tribal and additional non-tribal communities across the US, but long-term impacts of this and other home visiting programs on problematic substance use, overdose, and suicide are vastly understudied. The aims of this follow- up study are to identify long-term impacts of Family Spirit on mothers' (at 30-39 years old) and their children's (at 18-19 years old) substance use and suicidal thoughts and behaviors, while exploring moderators (i.e., discriminatory stress, cultural engagement) and mediators (i.e., continued positive parenting) of effects. We will also use qualitative narrative inquiry methodology to explore individual and intergenerational drug use pathways (e.g., first use, misuse, polydrug use, pre-addiction, abstinence, recovery) with a sub-sample of participants. If favorable long-term impacts are found, findings could leverage federal support for evidence-based home visiting implementation that is still under-utilized in tribal communities. Tribal populations deserve greater evidence for effective cultural strengths-based solutions to redress lasting behavioral and mental health effects of colonization and racism.

项目摘要 这项名为“养育我们未来的长期（16年）随访”的研究将确定是否有一个文化上定制的证据， 基于早期儿童家访干预，称为“家庭精神”，减少长期药物使用， 自杀，以及土著母亲及其子女在离开16年后的相关后果 产后三年（3 years postpartum）。药物使用和自杀是最大和最具破坏性的 美国印第安人的健康不平等，是几代人种族创伤和压迫的结果。家庭 精神是设计了超过8年的时间，专门为美国印第安人社区，通过一个 以社区为基础的密集参与过程，以促进两个国家的行为和心理健康 代最初的“拥抱我们的未来”研究（NIDA R 01 DA 019042 - 01 A1）是一项1：1的随机化研究， 一项对照试验，招募了N = 322名怀孕32周的准青少年母亲，并对她们及其 孩子产后3年。被随机分配到干预组的母亲接受了文化定制的家庭 由当地美国印第安人准专业人员提供的访问课程，重点是积极的育儿和内容 解决母亲压力、药物使用和抑郁症。对照条件是运输到产前 和健康儿童的访问，并促进与社区资源的联系，这两个干预措施的母亲， 和控制武器。实验结果表明，家庭精神显著提高了父母的教养效能， 减少了母亲的大麻和非法药物使用以及抑郁症状，并改善了社交，情感， 以及产后3年儿童的行为发展，这将预示着更少的物质使用 降低青少年母亲和青少年成长过程中的自杀风险和相关问题。基于 根据这一证据，已经对家访者和监督员进行了培训，以便在150多个部落实施家庭精神。 以及美国各地的其他非部落社区，但这种和其他家访的长期影响 关于有问题的物质使用、过量和自杀的方案都没有得到充分的研究。其目的如下- 研究的目的是确定家庭精神对母亲（30-39岁）及其子女的长期影响。 (at 18-19岁）物质使用和自杀想法和行为，同时探索调节者（即， 歧视性压力，文化参与）和调解人（即，持续的积极育儿）的影响。我们将 还使用定性叙述调查方法，探索个人和代际吸毒途径 (e.g.,第一次使用、滥用、多种药物使用、成瘾前、戒断、恢复）。如果 有利的长期影响，发现可以利用联邦支持循证家访 在部落社区中仍然没有得到充分利用。部落人口应该得到更多的证据， 以文化优势为基础的有效解决方案，以纠正殖民化对行为和心理健康的持久影响 和种族主义。