Substance Use and Psychological Problems Among African Americans into Midlife

描述（由申请人提供）：国家数据表明，药物使用和心理问题在非洲裔美国人的中年时期变得更加明显，但很少有研究调查这些问题在非洲裔美国人社区的风险发展，特别是在成年中期。此外，高共现率需要一种既探索独特风险因素又探索共同风险因素的方法；然而，这些问题很少被放在一起研究。应用发展的观点，我们的目的是检查特定的风险，保护，调解和调节因素，影响后来的物质使用和心理问题，在以社区为基础的非裔美国人人口纵向跟踪。此外，非常有必要确定药物使用和心理问题是如何导致成年中期身体健康下降的。Woodlawn研究是一项对非裔美国人社区队列进行的流行病学前瞻性研究，跨度超过35年，为了解药物使用的风险和保护因素、短期和长期后果以及治疗之外的心理问题提供了广泛的数据。随着数据扩展到中年——生命过程中一个被忽视的维度——早期风险因素和关键的中介和调节影响可以在未充分研究的人群中确定。该队列最初于1966-67年作为一年级学生（N=1242）进行评估，并在青春期（15-16岁）、成年早期（32-33岁）和成年中期（42-43岁）进行随访，创造了一个前所未有的个人、家庭和环境特征、不同生命历程经历及其最终后果的编年史。本研究以生命历程社会场域理论为指导，重点研究物质使用与心理障碍的发展流行病学，确定中年时期物质使用与心理障碍的发病、持续、缓解、共现和相互作用；儿童和青少年药物使用和成人障碍及心理问题的危险因素；对早期危险因素的中介和调节作用；以及成年后对身体健康的影响。分析方法包括结构方程模型、倾向得分匹配、一般生长混合模型、潜在类别、生存和聚类分析。提高对药物使用和心理问题风险发展的时间和机制的理解，将为设计有效的预防和干预方案提供必要的指导。公共卫生相关性：项目叙述/公共卫生意义这个项目的公共卫生相关性是为非裔美国人进入中年的物质使用和心理问题的预防和干预方案的设计提供信息。该项目还将为城市非洲裔美国人在成年中期的身体健康问题提供重要见解，确定精神病理学对特定健康问题的贡献。

DESCRIPTION (provided by applicant): National data indicate that both substance use and psychological problems become more pronounced for African Americans in midlife, but few studies have examined the development of risk for these problems in African American communities, particularly into mid adulthood. Moreover, high rates of co-occurrence demand an approach that explores both unique and shared risk factors; however, these problems rarely have been studied together. Applying a developmental perspective, we aim to examine specific risk, protective, mediating, and moderating factors that influence later substance use and psychological problems among a community- based African American population followed longitudinally. In addition, there is a great need to determine how substance use and psychological problems contribute to physical health decline in mid adulthood. Spanning more than 35 years of life, the Woodlawn Study, an epidemiological, prospective study of an African American community cohort, provides extensive data for understanding risk and protective factors and the short- and long-term consequences of substance use and psychological problems outside the context of treatment. With data extending into midlife - a neglected dimension of the life course - early risk factors and key mediating and moderating influences can be identified in an understudied population. This cohort was assessed initially as first graders in 1966-67 (N=1242), and followed up in adolescence (age 15-16), early adulthood (age 32-33), and mid-adulthood (age 42-43), creating an unprecedented chronicle of individual, family, and environmental characteristics, diverse life-course experiences, and their ultimate consequences. Guided by the Life Course Social Field Theory, the study focuses on: the developmental epidemiology of substance use and disorders and psychological problems through midlife, identifying onset, persistence, remission, co-occurrence, and reciprocal effects; childhood and adolescent risk factors for adult substance use and disorders and psychological problems; mediating and moderating influences on early risk factors; and physical health consequences in adulthood. Analytic methods include structural equation modeling, propensity score matching, general growth mixture modeling, and latent class, survival, and cluster analyses. Improved understanding of the timing and mechanisms for development of risk for substance use and psychological problems will provide essential guidance in designing effective prevention and intervention programs. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE/PUBLIC HEALTH SIGNIFICANCE The public health relevance of this project is to inform the design of prevention and intervention programs for substance use and psychological problems among African Americans into midlife. The project will also provide critical insight into physical health problems of urban African Americans during mid-adulthood, identifying the contribution of psychopathology to specific health problems.