Role of Childhood Cumulative Risk in Substance Misuse and Co-occurring Problems

描述（由申请人提供）：在早期发展过程中经历多种背景风险（如出生相关风险和社会经济劣势）的青少年中，药物滥用的脆弱性最高。事实上，累积风险，定义为独立于任何特定风险存在与否的环境风险因素的数量，是青少年和年轻人药物滥用的有力预测指标。然而，关于累积环境风险与药物滥用的关系的知识存在重大差距。累积风险通常被研究为一种静态现象，因此这种风险在时间内和时间间累积的程度是未知的。此外，累积风险传统的研究通常将药物滥用视为单一结果，但药物滥用往往与外化和内化问题共同发生。重要的是，在对药物滥用累积风险影响的分析中，很少考虑到潜在的中介机制和调节影响，而且很少对性别调节进行测试。药物滥用是一个普遍存在的公共卫生问题，与单一问题相比，药物滥用合并症与严重损害有关；因此，需要进一步的研究。目前的资助申请通过提出研究与青少年和成年早期药物滥用和共同发生的外化和内化问题有关的早期发展期间的累积环境风险来帮助解决这些差距（目标1）。社会发展调节因子将作为干预机制进行检验（目的2a），社会发展调节因子假设缓冲风险的检验（目的2b）将使用1986年芬兰北部出生队列研究（NFBCS）的现有纵向数据进行。NFBCS是一项大规模的出生队列研究，采用多信息来源（父母、教师、青少年）、多来源（调查、人口登记）的数据，收集了9,432名青少年从产前到20多岁的样本数据。在社会发展模型（SDM）的指导下，中心假设是累积风险与青少年和年轻人药物滥用和共同发生的问题存在正相关，并且这些关联将通过SDM风险过程介导；SDM保护因子将起到缓冲调节作用。性别差异也将被探讨。这个应用程序是高度创新的。NFBCS是一项独特的，大规模的出生队列研究，具有非常广泛的生物心理学和社会背景评估，非常适合研究一般风险和恢复力过程。拟议研究的目的将由来自大学和服务提供者的跨学科研究小组完成，以促进研究结果转化为实践。研究结果有望通过阐明潜在的可塑性中介和调节因子，以选择性预防干预为目标，帮助促进弱势青年面对风险的复原力。

DESCRIPTION (provided by applicant): Vulnerability for substance misuse is highest among youth who experience multiple contextual risks, such as birth-related risks and socioeconomic disadvantage, during early development. Indeed, cumulative risk, defined as the number of contextual risk factors independent of the presence or absence of any particular risk, is a robust predictor of adolescent and young adult substance misuse. However, there are significant gaps in knowledge about the associations of cumulative contextual risk with substance misuse. Cumulative risk often has been studied as a static phenomenon, therefore the degree to which such risk accumulates both within and across time is unknown. Moreover, research in the cumulative risk tradition typically has examined substance misuse as a singular outcome, yet substance misuse often co-occurs with externalizing and internalizing problems. Importantly, potential mediating mechanisms and moderating influences infrequently have been considered in analyses of cumulative risk effects on substance misuse, and gender moderation rarely has been tested. Substance misuse is a prevalent public health concern, and substance misuse comorbidity is associated with heightened impairment compared to singular problems; thus, additional research is needed. The current grant application helps address these gaps by proposing to study cumulative contextual risk both within and across time during early development in relation to substance misuse and co- occurring externalizing and internalizing problems in adolescence and early adulthood (Aim 1). Social developmental mediators will be examined as intervening mechanisms (Aim 2a) and tests of social developmental moderators hypothesized to buffer risk (Aim 2b) will be conducted using existing longitudinal data from the 1986 Northern Finland Birth Cohort Study (NFBCS). The NFBCS is a large-scale birth cohort study with multi-informant (parent, teacher, adolescent), multi-source (surveys, population registries) data collected on a sample of 9,432 youth followed from the prenatal period to the 20s. Guided by the social development model (SDM), the central hypotheses are that there will be positive associations of cumulative risk with adolescent and young adult substance misuse and co-occurring problems, and that those associations will be mediated through SDM risk processes; SDM protective factors will serve as buffering moderators. Gender differences also will be explored. This application is highly innovative. The NFBCS is a unique, large-scale birth cohort study with an exceptionally broad range of biopsychological and social contextual assessments ideal for studying general risk and resilience processes. Aims of the proposed study will be accomplished by an interdisciplinary team of investigators from both university and service provider settings to facilitate translation of findings into practice. Study findings hold promise for helping to promote resilience in the face of risk among vulnerable youth by elucidating potentially malleable mediators and moderators to target in selective preventive interventions.