Maternal Age, Trajectories of Substance Use, and Health Disparities

描述（由申请人提供）：年轻的母亲有更高的药物使用率和艾滋病毒风险行为，她们的孩子也更有可能从事这些行为并经历少女怀孕。过早的意外怀孕表明，年轻母亲的后代在青春期进行无保护的性行为，使他们面临感染性病的风险。没有研究比较过母亲在育儿前和育儿期间的药物使用模式，以便在不考虑与母亲年龄相关的其他混杂因素的情况下，检验母亲年龄对药物使用发育模式的影响。本研究的目的是检查母亲物质使用的轨迹，作为母亲年龄对儿童危险行为和健康影响的调节因素。拟议的研究将利用2个现有的大型社区出生队列。在第一项研究中，母亲在第一次产前评估时的年龄是12-18岁。另一组的母亲年龄在18-42岁之间。最初研究的目的是检查产前药物使用的长期影响。两个队列均包括孕妇在怀孕前、怀孕期间和怀孕后4个时间点（儿童6岁、10岁、14岁和16岁时）的药物使用数据。父母研究从各个领域收集数据，包括详细的人口统计、心理和行为概况。更大的合并数据集将允许建立先进而复杂的物质使用随时间变化的统计模型，并允许我们测试有关母亲年龄、物质使用和儿童健康按种族和性别分层的几个新问题。我们的具体目标是：(1)确定母亲的药物使用轨迹；(2)确定产妇初产年龄是否能预测轨迹隶属度；(3)检查药物使用和生殖风险方面的种族差异；(4)探讨母亲物质使用轨迹对不同种族青少年子代生殖风险的影响；(5)检验母亲物质使用是否调节母亲年龄对不同种族青少年子代生殖风险的影响。该应用程序的一个创新之处在于，我们提出并测试了一种新的理论模型，即母亲年龄和母亲物质使用对后代早期生殖风险的影响。该模型基于脆弱性模型和生命历程理论，将有助于阐明将产妇年龄与下一代危险行为和生殖健康联系起来的机制。该模型将为针对高危家庭的针对性干预策略提供实证支持。该建议既省时又划算，因为我们可以从两个出生队列获得16年的前瞻性纵向数据。迄今为止，还没有研究检查产妇年龄和长期药物使用模式在育龄妇女中的作用，以确定产妇药物使用如何可能导致儿童早期药物使用和青少年生殖风险。

DESCRIPTION (provided by applicant): Younger mothers engage in higher rates of substance use and HIV risk behaviors, and their children are also more likely to engage in these behaviors and experience teenage pregnancy. Early unplanned pregnancies suggest that offspring of younger mothers are engaging in unprotected sex during adolescence, placing themselves at risk for STDs. No studies have compared maternal patterns of substance use before and during childrearing to examine the effect of maternal age on developmental patterns of substance use in isolation from other confounds associated with maternal age. The goal of this study is to examine trajectories of maternal substance use as a moderator of the effect of maternal age on child risky behavior and health. The proposed study will take advantage of 2 large existing community-based birth cohorts. In one, the mothers were 12-18 years old at the first prenatal assessment. In the other, the mothers were 18-42 years old. The aims of the original studies were to examine the long-term effects of prenatal substance use. Both cohorts include data on maternal substance use prior to pregnancy, during pregnancy, and 4 time points after pregnancy (when the children were 6, 10, 14 and 16 years old). The parent studies collected data from a wide variety of domains, including detailed demographic, psychological and behavioral profiles. The larger combined dataset will permit advanced and complex statistical models of substance use over time, and permit us to test several new questions about maternal age, substance use and child health stratified by race and gender. Our specific aims are to (1) identify maternal trajectories of substance use; (2) determine if maternal age at first birth predicts trajectory membership; (3) examine racial differences in substance use and reproductive risk; (4) investigate the effect of maternal substance use trajectories on reproductive risk in adolescent offspring of different races; and (5) test if maternal substance use moderates the effect of maternal age on reproductive risk in adolescent offspring of different races. An innovative feature of this application is that we are proposing and testing a new theoretical model of maternal age and maternal substance use on early reproductive risk in offspring. This model is based on vulnerability models and life course theory, and will help elucidate the mechanisms linking maternal age to risky behavior and reproductive health in the next generation. This model will provide empirical support for targeted intervention strategies with at-risk families. The proposal is both time- and cost-effective because we have access to 16 years of prospective, longitudinal data from two birth cohorts. To date, no studies have examined the role maternal age and long-term patterns of substance use in childbearing women to determine how maternal substance use may contribute to early child substance use and adolescent reproductive risk.