Indigenous Pathways of Substance Use Risk and Resilience across Three Generations

项目总结/摘要 酒精和其他药物使用的不平等对许多美国印第安人产生了毁灭性的影响。 民族（土著）社区和家庭。健康的社会决定因素（SDH）至关重要 物质滥用（SA）、物质使用障碍（SUD）和恢复的风险和弹性机制 在SUD。该项目将超越在很大程度上忽视SU异质性的“风险因素”流行病学。 SDH的模式和影响，并未能实现人口健康的实质性变化 结果。我们将通过研究SDH的相对影响，重点确定哪些最重要，哪些对谁最重要 为SA在整个生命过程中和跨代的土著家庭。 这种竞争性的更新应用程序建立在我们现有的以社区为基础的参与性研究， 部落社区。我们建议继续使用计算机辅助调查访问现有的治疗 路径“目标参与者”（基线N = 735），我们已经有11波发育数据 跨越童年和成年早期。我们将招募他们自己的孩子参加多代研究 关于SA、SUD、恢复和复原力的流行病学信息。我们还将收集定性信息 捕捉社区对物质使用的背景和机制的微妙观点。 这项研究的结果将提高人们对疾病的性质、病因和后果的认识。 土著保留地/保留地社区的酒精和其他毒品使用问题和康复。 另一个成果是提高了识别与药物使用有关的SDH的准确性， 土著发展。因此，该项目的结果有可能优化 以及土著社区干预和预防方案和政策的目标。

PROJECT SUMMARY/ABSTRACT Alcohol and other drug use inequities have had devastating impacts for many American Indian/First Nations (Indigenous) communities and families. Social Determinants of Health (SDH) are critical mechanisms of risk and resilience for substance abuse (SA), substance use disorders (SUD), and recovery from SUD. This project will move beyond “risk-factor” epidemiology that largely ignores heterogeneity of SU patterns and impacts of SDH and has failed to materialize into substantial changes in population health outcomes. We will focus on identifying what matters most and to whom by examining relative impacts of SDH for SA over the life-course and across generations of Indigenous families. This competitive renewal application builds on our existing community-based participatory research with 8 tribal communities. We propose to continue computer-assisted survey interviews with existing Healing Pathways “target participants” (baseline N = 735) for whom we already have 11 waves of developmental data spanning childhood and early adulthood. We will enroll their own children in the study for multiple generations of epidemiological information on SA, SUD, recovery and resilience. We will also collect qualitative information to capture nuanced community perspectives on the contexts and mechanisms of substance use. Results of this research will increase awareness of the nature, etiology, and consequences of alcohol and other drug use problems and recovery in Indigenous reservation/reserve communities. Another outcome is enhanced precision in identifying SDH related to substance use and positive Indigenous development. Thus, the results of this project have potential to optimize the timing of and targets of intervention and prevention programs and policies in Indigenous communities.