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危险行为，她们的孩子也更有可能从事这些行为并经历少女怀孕。早期意外怀孕表明，年轻母亲的后代在青春期进行无保护措施的性行为，将自己置于性传播疾病的风险之中。没有研究比较育儿前和育儿期间母亲的物质使用模式，以考察母亲年龄对物质使用发育模式的影响，而不是与母亲年龄有关的其他混淆。这项研究的目的是检查母亲物质使用的轨迹，作为调节母亲年龄对儿童危险行为和健康的影响的调节因素。这项拟议的研究将利用现有的两个大型社区出生队列。在第一次产前评估中，母亲的年龄在12-18岁之间。在另一组中，母亲的年龄在18-42岁之间。最初研究的目的是检查产前使用药物的长期影响。这两个队列都包括怀孕前、怀孕期间和怀孕后4个时间点(孩子分别为6岁、10岁、14岁和16岁)母亲使用药物的数据。父母的研究从广泛的领域收集了数据，包括详细的人口统计、心理和行为特征。更大的组合数据集将允许随着时间的推移建立先进和复杂的物质使用统计模型，并允许我们测试几个按种族和性别分层的关于产妇年龄、物质使用和儿童健康的新问题。我们的具体目标是(1)确定母亲使用物质的轨迹；(2)确定第一次出生的孕妇年龄是否预测轨迹成员；(3)检查物质使用和生殖风险的种族差异；(4)调查不同种族的青少年后代中母亲使用物质的轨迹对生殖风险的影响；以及(5)测试母亲的物质使用是否缓和了母亲年龄对不同种族青少年后代生殖风险的影响。这项应用的一个创新特征是，我们正在提出并测试一个新的理论模型，即母亲的年龄和母亲使用的物质对后代早期生殖风险的影响。该模型以脆弱性模型和生命历程理论为基础，将有助于阐明产妇年龄与下一代危险行为和生殖健康之间的联系机制。该模型将为高危家庭的针对性干预策略提供经验支持。这项提议既有时间效益，又有成本效益，因为我们可以获得两个出生队列的16年前瞻性纵向数据。到目前为止，还没有研究审查产妇年龄和长期药物使用模式在育龄妇女中的作用，以确定产妇使用药物如何可能有助于早期儿童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.