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

描述(由申请者提供)：在发育早期经历多种背景风险的青年中，药物滥用的脆弱性最高，例如与出生有关的风险和社会经济劣势。事实上，累积风险被定义为与任何特定风险的存在或不存在无关的背景风险因素的数量，是青少年和年轻人滥用药物的有力预测指标。然而，关于累积背景风险与物质滥用之间的关联的知识存在重大差距。累积风险通常被作为一种静态现象来研究，因此，这种风险在一段时间内和跨时间积累的程度是未知的。此外，累积风险传统的研究通常将物质滥用视为单一结果，但物质滥用往往与外部化和内部化问题并存。重要的是，在对物质滥用累积风险效应的分析中，很少考虑潜在的中介机制和缓和影响，而且很少对性别适度进行测试。物质滥用是一个普遍的公共卫生问题，与单一问题相比，物质滥用共病与高度损害有关；因此，需要进行更多的研究。目前的赠款申请通过提议研究在青春期和成年期早期的物质滥用和共生的外化和内化问题(目标1)，在早期发育过程中研究时间内和跨时间的累积背景风险，从而帮助弥补这些差距。将研究社会发展调节剂作为干预机制(目标2a)，并将使用1986年芬兰北部出生队列研究(NFBCS)的现有纵向数据对假设为缓冲风险的社会发展调节剂进行测试(目标2b)。NFBCS是一项大规模的出生队列研究，采用了多信息者(父母、教师、青少年)、多来源(调查、人口登记)的数据，从产前到20多岁期间对9432名青年进行了跟踪调查。在社会发展模型(SDM)的指导下，中心假设是累积风险将与青少年和青年药物滥用和共生问题存在正相关，并且这些关联将通过SDM风险过程进行调节；SDM保护因素将作为缓冲调节因素。此外，还将探讨性别差异。这个应用程序具有很高的创新性。NFBCS是一项独特的、大规模的出生队列研究，具有异常广泛的生物心理和社会背景评估，是研究一般风险和复原力过程的理想选择。拟议研究的目标将由来自大学和服务提供商环境的跨学科调查小组实现，以促进将调查结果转化为实践。研究结果有望通过阐明具有潜在延展性的调解人和调解人在有选择的预防干预措施中作为目标，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.