Health and Psychosocial Need: The Ascenze study of risk and protection in adolescence

南非（SA）是全球艾滋病毒流行最严重的国家，同时也受到贫困的影响， 不平等、暴力和其他种族隔离遗留问题。在弱势社区长大的儿童 艾滋病毒感染者在认知、行为、健康和教育问题上的风险很高，反过来， 增加他们感染或传播艾滋病毒的风险。这项研究的长期目标是阻止破坏 艾滋病毒流行的干预，以促进更好的认知，行为和心理社会功能， 青少年在SA我们将使用一个具有生命过程视角的社会生态模型， 调查与吸毒、酗酒和无保护性行为有关的因素，包括青少年的属性， 执行功能，以及过去和现在的家庭和背景因素。 基于人口的4-6岁儿童及其主要照顾者的Asenze队列， 通过R 01 DA 023697，将形成研究样品。他们居住在夸祖鲁-纳塔尔的五个贫困地区。 这些出生于2004年至2006年的儿童，先前在两个时间点进行了认知、生物和心理评估。 医疗和心理社会功能和他们的照顾者进行了采访，关于照顾者艾滋病毒，精神 健康、物质使用、压力、支助、家庭资产和家庭物质使用。超过25%的 照顾者是HIV+; 9%的人报告酗酒，31%的人精神疾病筛查呈阳性，超过30%的人 经历过伴侣暴力，17%的人报告家中有人有酗酒问题。 只有9%的家庭有一名完成中学教育的成年人。 Asenze队列在2017-2019年之间达到青春期，提供了一个独特的机会， 调查弱势群体青少年危险行为的早期起源，同时建立一个 为以后成年期的研究奠定了坚实的基础。我们将研究 青少年的执行功能和冲动，与早期和当前的社会环境（包括他们的 家庭的逆境、无组织性和支持以及朋友的行为）影响风险的启动 行为（吸毒、酗酒和无保护措施的性行为）。我们将把儿童期队列评估与 发展和早期逆境，以那些在早期和中期的青春期，包括 认知发展，执行功能和危险行为的启动。这些发现将对 为关键的预防计划提供信息，以阻止艾滋病毒的传播，促进健康的青少年功能。 我们将通过指导和培训新兴的南非科学家来建设研究能力， 硕士，博士和博士后学生，以建立研究专长，重点调查的影响， 青少年神经认知发展对危险行为的启动，从而导致消极的教育 和性健康结果，包括艾滋病毒感染。我们还将建立一个SA研究网络， 研究人员与队列研究合作，以促进其在神经科学和心理健康结果中的应用。

South Africa (SA) has the largest HIV epidemic globally, and is simultaneously affected by poverty, inequality, violence and other legacies of Apartheid. Children growing up in disadvantaged communities affected by HIV are at high risk for cognitive, behavioral, health and educational problems that, in turn, increase their risk of acquiring or transmitting HIV. This study has the long-term goal of halting the devastation of the HIV epidemic by intervening to promote better cognitive, behavioral, and psychosocial functioning of adolescents in SA. We will use a socio-ecological model with a life course perspective to prospectively investigate factors linked to drug use, binge drinking and unprotected sex including adolescent attributes such as executive function, and past and current family and contextual factors. The population-based Asenze cohort of 4-6 year old children and their primary caregiver, funded through R01 DA023697, will form the study sample. They reside in five disadvantaged areas in KwaZulu-Natal. The children, born between 2004 and 2006, were previously assessed at two time points on cognitive, bio- medical, and psychosocial functioning and their caregivers were interviewed about caregiver HIV, mental health, substance use, stress, support, household assets and household substance use. Over 25% of caregivers were HIV+; 9% reported binge drinking, 31% screened positive for a psychiatric disorder, over 30% had experienced partner violence and 17% reported that someone in the household had a drinking problem. Only 9% of households contained an adult who had completed secondary school. The Asenze cohort, reaching adolescence between 2017-2019, provides a unique opportunity to investigate the early-life origins of adolescent risk behavior in a disadvantaged population while building a strong foundation for later investigations into adulthood. We will investigate the pathways through which adolescent executive function and impulsivity, interact with both early and current social context (including their family adversity, disorganization and support as well as the behavior of their friends) affect the initiation of risky behaviors (drug use, binge drinking and unprotected sex). We will link the childhood cohort assessments of development and early adversity to those to be collected in both early and mid adolescence, including cognitive development, executive function and the initiation of risky behaviors. The findings will be crucial for informing critical prevention programs to halt the spread of HIV and promote healthy adolescent functioning. We will build research capacity through mentoring and training emerging South African scientists, masters, doctoral and post-doctoral students to build research expertise focused on investigating the impact of adolescent neurocognitive development on the initiation of risky behaviors, which result in negative education and sexual health outcomes, including HIV infection. We will also develop a SA research network of investigators working with cohort studies to promote their use in neuroscience and mental health outcomes.